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.
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.
Corticosteroids and osteoporosis to reduce the risk of osteoporosis, doses of oral corticosteroids should be as low as possible and treatment courses as short as possible. Risk may be related to cumulative doses so even intermittent courses can increase the risk. The greatest rate of bone loss is in the first 6-12 months so early steps to prevent development of osteoporosis are important. Long-term use of high-dose inhaled corticosteroid may also contribute to corticosteroid-induced osteoporosis.
Patients taking the equivalent of 7.5mg of prednisolone or more daily for 3 months or longer should be assessed and where necessary given prophylactic treatment; those aged >65 years are at increased risk. Any patient taking oral corticosteroids who sustains a low impact fracture should receive treatment for osteoporosis.
ALL PATIENTS ON LONG-TERM OR HIGH DOSE CORTICOSTEROID TREATMENT SHOULD CARRY A STEROID CARD.
