Corticosteroids also
known as steroids are used for the treatment of inflammatory, autoimmune, and
endocrine disorders, and nausea and vomiting symptom control in cancer
patients.
Which corticosteroid
should be used for a given indication?
Hydrocortisone is chosen
only when sodium and water retention are desired (for its mineralocorticoid
action) Intermediate-acting agents (prednisone, prednisolone,
methylprednisolone) given once daily may minimize Hypothalamic Pituitary Adrenal (HPA-axis) suppression.
Dexamethasone is used for certain indications such as in brain tumours and
nausea and vomiting. Oral liquid prednisolone formulations are often used in
children.
Does the corticosteroid
require tapering?
If you are on prolonged
high dose of corticosteroids, you should not stop taking it suddenly as it may
lead to a condition called adrenal insufficiency or lead to a flare up of your
disease.
Your doctor should
instead taper the dose ( reducing the dose gradually before taken off the
drug)
General management
include:
(1) taper by 5% to 20%
every 1 to 2 weeks, depending in underlying illness;
(2) increase dose and
slow taper if patient complains of flulike symptoms or disease flare;
(3) consider switching
to a shorter-acting agent (prednisone), consolidating multiple daily doses to a
single morning dose, and converting to alternate day dosing,
(4) consider use of ACTH
test to confirm adrenal recovery,
(5) consider increased
dose or supplemental hydrocortisone in times of stress
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Common
corticosteroid indications and preferred corticosteroid
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Adrenal Insufficiency
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Hydrocortisone and flurocortisone.
Hydrocortisone provides both mineralocorticoid and glucocorticoid activity.
Flurocortisone provides additional mineralocorticoid if needed
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Asthma
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Prednisolone. Prednisolone provides
more glucocorticoid and less mineralocorticoid activity than hydrocortisone
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Brain tumours
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Dexamethasone
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Chronic obstructive pulmonary
disease (COPD)
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Prednisone or Predinisolone or
methylprednisolone
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Connective tissue and rheumatic
disorders (e.g., lupus, rheumatoid arthritis)
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Prednisolone, methylprednisolone
or Prednisone
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Nausea and vomiting (radiation,
chemotherapy, postoperative, pregnancy)
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Dexamethasone
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Corticosteroid
Tapering to Prevent Disease Flare and/or Adrenal Insufficiency
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Consider Tapering If…
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Patient frail or very ill (e.g.,
severe hematologic, inflammatory, or immune disease); Treating disease flare
in patient taking systemic steroids prior to flare; Patient has cushingoid
symptoms (e.g., moon face, buffalo hump)
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Consider Not Tapering If…
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Course lasts less than 2 to 3
weeks (and no reason for taper such as those described in column to left);
Treating asthma or COPD flare for 1 to 2 weeks (patient not on systemic
steroids prior to flare); Patient being treated for allergic reaction which
has resolved
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