Key messages (steroid treatment)

• steroid treatment should be given for the shortest length of time at the lowest dose that is clinically necessary
• suppression of the hypothalamo-pituitary-adrenal axis may be reduced by taking corticosteroid tablets in the morning. Alternate day therapy should be considered if disease control will allow
• if a patient has received corticosteroid therapy for more than 3 weeks then withdrawal should not be abrupt.
• it is appropriate for abrupt withdrawal in some patients treated for up to 3 weeks
• patients who encounter stresses such as surgery, trauma or infection and who are at risk of adrenal insufficiency should receive systemic corticosteroid cover over these periods
• the risk of corticosteroid induced osteoporosis should be considered, particularly in adults receiving the equivalent of 7.5mg prednisolone daily for more than 6 months

Note that these treatment recommendations should only be used as a guide due to considerable variability between individuals.

Reference:

• Current Problems in Pharmacovigilance (1998), 24, 7.