Systemic corticosteroid therapy - side effects and their management

The anti-inflammatory effects of corticosteroids cannot be separated from their metabolic effects as all cells use the same glucocorticoid receptor; therefore when corticosteroids are prescribed measures should be taken to minimise their side effects. Clearly, the chance of significant side effects increases with the dose and duration of treatment and so the minimum dose necessary to control the disease should be given. Before embarking on a long term course of corticosteroids the factors summarised in Table 1 should be considered. A full discussion with the patient is necessary in order to explain the benefits and risks of corticosteroid treatment. A patient information leaflet is now provided by the manufacturers of all systemic corticosteroid preparations. As emphasised by the recent publication by the Committee on the Safety of Medicines,33 advice to patients is the key to the safe use of long term systemic corticosteroids and it recommends discussing the following points with the patient; not to stop taking corticosteroids suddenly; to see a doctor if they become unwell; of the increased susceptibility to infections, especially chickenpox; of the serious side effects that may occur; to read and keep the patient information leaflet; to always carry the steroid treatment card and to show it to any health professional involved in their treatment. In addition the following suggestions may help to minimise some side effects; a single morning dose; early dietary modification - low calorie, low sodium, and high potassium; awareness of possible errors of judgment on high doses. Once started on corticosteroids the patient should be regularly reviewed to assess the response to the treatment with adjustments to keep the dose at a minimum.