therapeutic guidelines

Last reviewed 01/2018

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