To see all protocols that comply with the WHO Essential Medicine List 

This document is an evidence-based summary to complement treatment protocols and includes background and rationale for specific point of care actions. It is not intended to be a comprehensive literature review of all available evidence.

Corticosteroids regulate gene expression and are used for a number of medical conditions including autoimmune diseases, allergic reactions, anti-inflammatory conditions, nausea and vomiting and immunosuppression for malignancy.r Prednisolone, dexamethasone or methylprednisolone are the most common systemic corticosteroids. When administered continuously for longer periods of time or for short, high-dose treatment courses that are repeated regularly (e.g. dexamethasone 40 mg daily for 4 days, or prednisone 100 mg daily for 5 days) may be associated with adverse effects.r

Adverse effects 

Adverse effects include:r

  • insomnia and sleep disturbances
  • gastric irritation
  • hyperglycaemia - increased thirst, frequent urination, high blood glucose and high levels of sugar in the urine
  • mood changes - agitation, emotional lability
  • increased appetite and weight gain
  • osteoporosis
  • sodium and fluid retention
  • adrenal suppression
  • increased risk of infection
  • hypertension
  • delayed wound healing.

Adrenal Suppression

Long term use and high dose treatment can cause adrenal suppression with abrupt withdrawal leading to adrenal crisis. To prevent adrenal crisis gradual withdrawal of treatment is recommended. Doses less than 7.5 mg daily of prednisolone (approx equiv. to less than 1 mg dexamethasone) or treatment for less than 3 weeks are unlikely to cause adrenal suppression therefore dose tapering is not usually required.r

Recommendations

To minimise adverse effects it is recommended to:r

  • take steroid medication in the morning after breakfast, this will minimise sleep disturbances and adrenal suppression.
  • take steroid medication immediately after food to minimise gastric irritation and consider the use of a H2 antagonist or proton pump inhibitor if appropriate. 
  • diabetic patients should have increased monitoring of blood sugar levels and their diabetic medications adjusted as appropriate.
  • advise the patient to monitor for signs of fluid problems such as shortness of breath or difficulty breathing, swelling of feet or lower legs, or rapid weight gain.
  • monitor for signs of infection and notify doctors immediately.

While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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04 Mar 2024