Corticosteroids
Examples
Oral:
Prednisolone 5mg is equal to:
- Prednisolone
- Hydrocortisone
- Dexamethasone
Prednisolone 5mg is equal to:
- Dexamethasone 750 micrograms
- Hydrocortisone 20mg
- Methylprednisolone 4mg
Indications
Musculoskeletal system
- Rheumatoid arthritis
- Polymyalgia rheumatic
- Gout
- SLE
- Other rheumatic disease
Contraindications
Cautions
- Pregnancy
- Breast-feeding (inhaled corticosteroid unlikely to be significantly present in breast milk)
Mechanism
Corticosteroids have an anti-inflammatory effect in many tissues. Virtually all cells contain steroid receptors which then bind to DNA to prevent or induce gene expression.
In the context of inflammation, corticosteroids:
Corticosteroids are used to reduce the inflammation in Rheumatoid Arthritis and other inflammatory conditions.
In the context of inflammation, corticosteroids:
- Decrease neutrophil and macrophage recruitment and action
- Decrease fibroblast formation
- Decrease osteoblast and increase osteoclast activity
- Decrease production of prostanoids
- Decrease production of cytokines
- Decrease histamine release
- Decrease IgG production
Corticosteroids are used to reduce the inflammation in Rheumatoid Arthritis and other inflammatory conditions.
Administration
Corticosteroids can be administered by the following routes:
- Oral
- Rectal
- Subcutaneous
- Intravenous
- Topical
- Intra-nasal
- Inhalation
- Intra-articular
Adverse Reactions
There are a wide range of adverse effects, which are associated with systemic absorption. These include:
- Osteoporosis
- Ischaemic necrosis of femoral head
- Cataract
- Acute Glaucoma
- Cushingoid features including weight gain
- Increased susceptibility to infection, particularly TB, varicella and candida
- Hyperglycaemia
- Hypertension
- Fluid retention and worsening of heart failure
- Hypokalaemia
- Mask inflammatory response
- Mental disturbance including psychosis
- Addisonian crisis in abrupt withdrawal
Interactions
Pharmacokinetic interactions can occur between liver enzyme inducers and corticosteroids, reducing the effect of the steroids.
Pharmacodynamic interactions can occur where steroid effects increase or antagonise the effect of other drugs. For example:
Pharmacodynamic interactions can occur where steroid effects increase or antagonise the effect of other drugs. For example:
- Steroids can mask the adverse effects of NSAIDs
- Hypokalaemia can be made worse if steroids are used in combination with other drugs which lower potassium
- Antihypertensive and hypoglycaemic agents are antagonised by corticosteroids
Education
Patients prescribed long term corticosteroids should be provided with a "steroid card" and warned not to stop their medication suddenly. In instances where corticosteroids are used for more than 3 weeks, or in multiple short courses, or at very high doses, patients should be given a reducing regime. They should also be warned about the common adverse effects, particularly immunosuppression, adrenal suppression and psychiatric disturbances.
Oral steroids are best taken in the morning to match the body's normal diurnal variation.
Musculoskeletal system
No additional education is needed.
Oral steroids are best taken in the morning to match the body's normal diurnal variation.
Musculoskeletal system
No additional education is needed.
Pharmacokinetics
There is no dosage adjustment required in hepatic or renal insufficiency.
Other Systems
