Steroids also can be given into a vein (intravenously) instead of being taken by mouth. IV steroids are usually given in an infusion unit or a hospital, and medicines can be used to briefly numb the skin on your child’s hand or arm before the needle is placed in the vein. The steroid is given over a few minutes. Common side effects of steroids include • heartburn (reflux) • increase in appetite or weight gain • mood changes • puffiness in the face or behind the neck • problems with sleep • acne.
Most of the common side effects of steroids will get better when the medication is stopped. Children who take steroids for weeks or months may have other side effects, including elevated blood pressure, increased sugar in the blood or urine, risk of infection, thinning of the skin, problems with growth, or calcium loss from the bones. Because of these risks, steroids are usually given only for a few weeks or months at a time. Contact your healthcare provider immediately if your child • is exposed to chickenpox and has not yet had chickenpox or received the vaccine • is drinking more or has an increase in the amount of urine • has black, tar-like stools.
Thrombopoietic Agents Thrombopoietic agents are human-made proteins that increase the number of platelets made in the bone marrow. They are typically used only for patients who have chronic ITP or who have ITP that has not responded to medications that decrease platelet destruction such as IVIG or steroids. Romiplostim (Nplate®) and eltrombopag (Promacta®) are two thrombopoietic medications that are used to treat ITP. Romiplostim is given by subcutaneous injection (under the skin) once a week. The amount given is based on the platelet count. Romiplostim must be given in a doctor’s office or by a caregiver who
has been taught how to administer the medication to the child at home. It is important not to miss an injection. The platelet count may drop very low if the medication is not given on a regular basis. Common side effects of romiplostim include
• headache • dizziness • trouble sleeping (insomnia) • abdominal pain • joint or muscle pain • rebound thrombocytopenia • antibody formation.
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