therapeutic guidelines

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Corticosteroids must be used with caution as they have a great propensity for adverse effects. The following guidelines should be followed:

  • dose:
    • use at the recognised dose for the condition - an inadequate dose may prompt premature withdrawal due to early side effects
    • once the disorder is under control, reduce dose gradually - see withdrawal section
    • when changing between steroids, be alert to difference in potency and modify dose accordingly
    • 20-30 mg of hydrocortisone is the standard dose to completely replace physiological adrenal steroid output; a dose above this range for prolonged periods can result in adrenal suppression - the equivalent can be calculated for other steroids from the potency conversion submenu.
  • be alert to absolute or relative contraindications e.g.:
    • previous peptic ulceration
    • osteoporosis
    • diabetes mellitus
    • salt or water retention
    • affective disorders
    • use in children, due to possibility of growth suppression
  • prescribe standard preparations e.g. prednisolone for oral use and hydrocortisone for intravenous use
  • minimize adverse effects by:
    • administering steroids in the morning; giving them at night causes increased adrenal suppression
    • using alternate day regimes; adrenal suppression may be less likely and anti-inflammatory effects have a long half-life
  • advise patients:
    • to carry a steroid card
    • not to withdraw steroids suddenly

Last reviewed 01/2018

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