Steroids and therapy

Finding the most adequate dose in steroid therapy is difficult and is very patient specific. Chronic corticosteroid therapy increases the risk of the following adverse effects:

  • Changes in body fat distribution: moon face and buffalo hump
  • Increased mineralocorticoids: fluid retention and increased blood pressure
  • Suppression of the HPA-axis: decreased ability to respond to physiological insults

 

 

Here is a guide for long-term dosing of corticosteroids:

  • Flare-ups: the best effects are achieved with a high dose for a short time. A major flare-up is treated with either 1000 mg methylprednisolone iv for 1-3 days or a mini pulse with 100-200 mg prednisone po for 2 to 5 days.
  • Maintenance: the high-dose short term oral treatment of about 1 mg/kg should be tapered down to >10 mg prednisone on alternate days.
  • Tapering: there is no agreement, but some suggest a decrease of 2,5 mg every 1-2 weeks when on daily therapy and a decrease of 5 mg every 1-2 weeks when on alternate day therapy. When the dosing level reaches the physiologic equivalent, which is about 5-7 mg of prednisone, further tapering is achieved by switching to 20 mg hydrocortisone, which can be lowered weekly by 2,5 mg.

 

 

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Glucocorticosteroids have the following effects, except 

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