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Consultations & Comments

Preventing the Adverse Effects of Glucocorticoids: A Reminder

Shweta Kumar, MD; Balaji Yegneswaran, MD; and Capecomorin S. Pitchumoni, MD 

Volume 57 - Issue 12 - December 2017

Authors:
Shweta Kumar, MD; Balaji Yegneswaran, MD; and Capecomorin S. Pitchumoni, MD

Citation:
Kumar S, Yegneswaran B, Pitchumoni CS. Preventing the adverse effects of glucocorticoids: a reminder. Consultant. 2017;57(12):726,728.

 

Corticosteroids have become one of the most widely used treatments for numerous inflammatory and autoimmune disorders. Long-term glucocorticoid use is common in patients who have rheumatoid arthritis, chronic obstructive pulmonary disease, systemic lupus erythematosus, inflammatory bowel disease, and asthma.

A number of definitions and concepts are essential for understanding the therapeutic effects—and possible undesirable adverse effects (AEs)—of glucocorticoids such as methylprednisolone, dexamethasone, and hydrocortisone. Among them, for example, are the duration of treatment, whether short-term (< 10 d), intermediate-term (10-30 d), or long-term (> 30 d), and the therapeutic doses of prednisone, whether low (< 5 mg/d), medium (5-20 mg/d), high (> 20 mg/d), or very high (> 50 mg/d). It is important to remember that various glucocorticoid formulations (oral tablets, oral solution, injection, topical preparations) are used depending on the clinical condition of the patient being treated. In general, 5 mg of prednisone is equal to 4 mg of methylprednisolone, to 0.75 mg of dexamethasone, and to 20 mg of hydrocortisone.

No guidelines are currently available that recommend comprehensive screening of patients before starting corticosteroid therapy, despite that the multisystem AEs of glucocorticoid use are potentially serious. Many of these AEs can be minimized through careful patient monitoring and implementation of preventive measures (Table). Nevertheless, certain areas require further research, such as the dose and duration of corticosteroid therapy, which should prompt concern for AEs, and the drafting of guidelines for pretreatment screening, ongoing monitoring, and counseling recommendations. 

Glucocorticoids

Shweta Kumar, MD, is a resident physician at Saint Peter’s University Hospital in New Brunswick, New Jersey.

Balaji Yegneswaran, MD, is the associate program director of the Internal Medicine Residency Program at Saint Peter’s University Hospital in New Brunswick, New Jersey.

Capecomorin S. Pitchumoni, MD, is chief of the Division of Gastroenterology, Hepatology, and Clinical Nutrition at Saint Peter’s University Hospital in New Brunswick, New Jersey.

References:

  1. Moghadam-Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010;49(3):239-248.
  2. Sepkowitz KA. Pneumocystis carinii pneumonia without acquired immunodeficiency syndrome: who should receive prophylaxis? Mayo Clin Proc. 1996;71(1):102-103.
  3. Zeehaida M, Zairi NZ, Rahmah N, Maimunah A, Madihah B. Strongyloides stercoralis in common vegetables and herbs in Kota Bharu, Kelantan, Malaysia. Trop Biomed. 2011;28(1):188-193.
  4. López-Serrano P, de la Fuente Briongos E, Carrera Alonso E, Pérez-Calle JL, Fernández Rodríguez C. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: when and how to apply prophylaxis, with a special focus on corticosteroid therapy. World J Hepatol. 2015;7(3):539-547.
  5. Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 2006;55(1):​19-26.
  6. Vonkeman HE, Fernandes RW, van der Palen J, van Roon EN, van de Laar MAFJ. Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs: a nested case-control study. Arthritis Res Ther. 2007;​9(3):R52.
  7. Greenstone MA, Shaw AB. Alternate day corticosteroid causes alternate day hyperglycemia. Postgrad Med J. 1987;63(743):761-764.
  8. Ismail M, Lyster G. Treatment of psychotic depression associated with steroid therapy in Churg-Strauss syndrome. Ir Med J. 2002;95(1):18-19.
  9. Renfro L, Snow JS. Ocular effects of topical and systemic steroids. Dermatol Clin. 1992;10(3):505-512.
  10. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.