Version June 2024
| System | Reported relationship to prednisone dosing for adults | Possible interventions |
| Metabolic and endocrine | ||
| Hypothalamic-pituitary-adrenal axis suppression¶ | Typically with supraphysiologic doses (>5 mg) Rarely reported with <5 mg/day for <4 weeks | Screen for suppression when tapering if compatible symptoms |
| Hyperglycemia | Reported with <10 mg/day | Intensify screening for type 2 diabetes |
| Dermatologic and appearance | ||
| Cushingoid features | Rare with <5 mg/day | Ask about self-image and/or bullying, especially for pediatric patients |
| Weight gain | Typically with >5 mg/day | Monitor weight at visits Ask about gastrointestinal symptoms leading to increased food intake Increase intake of high-fiber foods and water to increase satiety |
| Skin thinning and ecchymoses | Reported with <5 mg/day | Encourage sun-protective measures |
| Acne, hirsutism, facial erythema | Few data available | |
| Cardiovascular | ||
| Fluid retention | Reported with ≥5 mg/day | Monitor weight at visits |
| Hypertension | Rare with <10 mg/day | Monitor blood pressure at visits |
| Premature atherosclerotic disease and major cardiac events (eg, myocardial infarction, stroke) | Reported with ≥7.5 mg/day | Include glucocorticoid use as an additional risk factor when screening for atherosclerotic cardiovascular disease |
| Arrhythmias | Sudden cardiac death reported in patients receiving pulse dose steroids (methylprednisolone 500 to 1000 mg/day) | Use telemetry for patients with significant cardiac disease who receive pulse dose steroids |
| Venous thromboembolism (VTE) | Reported with <20 mg/day | Include glucocorticoid use as an additional VTE risk factor when deciding to use perioperative VTE prophylaxis |
| Possible hyperlipidemia | Typically with >10 mg/day | Intensify screening for hyperlipidemia |
| Gastrointestinal | ||
| Gastritis, peptic ulcer disease, and upper gastrointestinal bleeding | Reported with <20 mg/day | Administer glucocorticoids with food Evaluate other risk factors for gastroduodenal toxicity, particularly the coadministration of nonsteroidal antiinflammatory drugs (NSAIDs), and potential need for primary prevention Consider pharmacologic prophylaxis for upper gastrointestinal complications in critically ill patients receiving high-dose steroids |
| Drug-induced steatotic liver disease | Rare, few data available | |
| Visceral perforation | Rare, few data available | |
| Bone and muscle effects | ||
| Osteoporosis | Reported with as low as 2.5 mg/day | Screen for osteoporosis in patients with >3 months of treatment and prescribe preventive therapies in those at greater risk |
| Osteonecrosis/avascular necrosis | Rare with <15 to 20 mg/day, associated with peak dose | |
| Myopathy | Typically with >40 mg/day Rare with <10 mg/day | Monitor strength examination at visits for patients on chronic glucocorticoids |
| Neuropsychiatric | ||
| Insomnia | Reported with <5 mg/day | Take in the morning or early afternoon when possible |
| Mood disorders, including anxiety and depression | Typically with >7.5 mg/day | Intensify screening for anxiety and depression, especially in patients over age 65 and/or with history of neuropsychiatric disorders |
| Psychosis | Almost always with >20 mg/day | |
| Memory impairment | Reported with as low as 5 mg/day for 1 year | |
| Ophthalmologic | ||
| Cataracts | Reported with <5 mg Typically with >10 mg/day | Ophthalmology referral for screening in select patients |
| Elevated intraocular pressure/glaucoma | Typically with >7.5 mg/day | Ophthalmology referral for screening in select patients |
| Immune system | ||
| Increased risk of infections | Reported with <5 mg/day | Give indicated vaccinations when anticipating a prolonged course of glucocorticoidsΔ Avoid live vaccinations in select patientsΔ Use Pneumocystis jirovecii pneumonia (PJP) prophylaxis in select patients on higher prolonged dosing |
| Decreased response to vaccinations | Typically with ≥20 mg/day for ≥14 days | Modify glucocorticoid dosing when possible or delay vaccination depending on glucocorticoid doseΔ |
| Other | ||
| Tooth hypersensitivity | Reported with <20 mg/day, typically with pulse dose steroids (methylprednisolone 500 to 1000 mg/day) | |
| Epistaxis | Typically with >5 mg/day | |
| Growth impairment in children | Reported with 3 to 5 mg/m2/day | Monitor growth◊ |
* High-dose inhaled glucocorticoid therapy can rarely cause systemic adverse effects. Refer to UpToDate content for information on local adverse effects of inhaled glucocorticoids.
¶ Signs and symptoms of hypothalamic-pituitary-adrenal axis suppression include fatigue, weakness, hypotension, confusion, anorexia, nausea, vomiting, and abdominal pain. Refer to UpToDate content on clinical manifestations of adrenal insufficiency for additional detail.
Δ Refer to UpToDate content on the effects of glucocorticoids on the immune system and immunizations in autoimmune inflammatory rheumatic disease in adults for more details.
◊ Refer to UpToDate content on causes of short stature.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
