Therapeutic guidelines

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