Acute short term effects from corticosteroids

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.