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Prednisolone, dexamethasone or methylprednisolone 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.

Adverse effects include:

  • 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.

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 sleep disturbances, recommend taking steroid medication in the morning after breakfast.
  • To minimise gastric irritation, recommend taking steroid medication immediately after food. 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.

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25 Jun 2019