Steroids and therapy

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