Glucocorticoids are drugs with a wide range of indications. They are used in physiological amounts to treat adrenal insufficiency, and in pharmacological amounts to suppress inflammatory and immune reactions. Glucocorticoids exert their action after binding to a glucocorticoid receptor and interaction with the DNA. The natural glucocorticoid, hydrocortisone, is most suitable to treat primary and secondary adrenal insufficiency. Prednison, prednisolon and betamethason are used for immune suppression. The dosage depends on the disease and its severity.
Check the therapeutic application of glucocorticosteroids in other diseases states: IBD (gastroenterology), transplant (immunology), immunology in general, SLE (immunology), allergic rhinitis (immunology), dermatitis (immunology).
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:
- 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.
Prolonged administration of pharmacological amounts of glucocorticoids induces osteoporosis and hypertension.
Extra info: Osteoporosis can be caused by glucocorticoid effects such as disturbance of the bone matrix, inhibition of osteoblast activity and decreased calcium absorption from the gut. Hypertension can be caused by the mineralocorticoid effects of glucocorticoids.