Drug Safety Update
September 2007: Corticosteroids: early psychiatric side-effects
December 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
August 2017: Corticosteroids: rare risk of central serious chorioretinopathy with local as well as systemic use.
October 2017: Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40mg) do not use in patient's with cows milk allergy
FOR DETAILED INFORMATION ON SAFETY ISSUES WHEN PRESCRIBING CORTICOSTEROIDS, REFER TO THE BNF using the links below.
NICE clinical knowledge summaries (CKS)
Management of patients receiving corticosteroids in primary care (treatment principles also apply in secondary care), revised Nov 2017
Corticosteroids should be prescribed as a single dose in the morning after breakfast to avoid excessive suppression of the pituitary-adrenal function.
Prednisolone plain tablets are the most commonly used corticosteroids. The uncoated tablets achieve quicker and more predictable plasma levels and are the formulation of choice.
Prednisolone EC/gastro-resistant tablets: there is little data to support the idea that enteric-coated prednisolone causes less gastric irritation compared with uncoated tablets. The absorption of the EC tablets can be delayed and the timing of a meal in relation to taking the tablets can cause wide variations is plasma levels. EC tablets should not be prescribed routinely. The EC tablets may be useful for long-term treatment of conditions such as rheumatoid arthritis.
Hydrocortisone is used for adrenal replacement and also for short term use by IV injection for emergency management of a range of conditions.
Methylprednisolone is mainly used IV for specific conditions where short term high dose therapy is needed.