REVIEW - Optimum management of steroid-treated patients

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Nat Clin Pract Endocrinol Metab. 2008 Mar 18 [Epub ahead of print]

Optimum management of glucocorticoid-treated patients.

Trikudanathan S, McMahon GT.

S Trikudanathan is a Member of the Faculty in the Department of

Medicine at the Tufts University School of Medicine, and practices

clinical medicine at the St 's Medical Center, Boston.

Glucocorticoids are taken by approximately 2% of the US adult

population at any given time. The powerful anti-inflammatory and

immunosuppressive benefits of these drugs must, however, be weighed

against their multisystem adverse effects. Clinicians should always

prescribe the lowest possible dose for the shortest possible time.

Patients should be informed of the short-term and long-term adverse

effects to expect, particularly if the dose of glucocorticoids is

expected to exceed the equivalent of approximately 7.5 mg prednisone

daily for 2 months or more. At the commencement of glucocorticoid

therapy, a patient's blood pressure, lipid profile, 25-hydroxyvitamin

D(3) level and fasting glucose level should be measured and baseline

bone densitometry performed. Bisphosphonate therapy should be

initiated for postmenopausal women and men with a bone density T-score

below -1 or for those with a history of fracture. Regular ophthalmic

screening for cataracts and glaucoma is warranted, and patients at

high-risk of gastric ulceration (especially patients simultaneously

taking nonsteroidal anti-inflammatory drugs) should receive

proton-pump inhibitors. Prophylaxis against opportunistic infections

is appropriate for high-risk populations, such as organ-transplant

recipients. Trimethoprim plus sulfamethoxazole can be given to

high-risk populations, such as organ transplant recipients. The

duration of weaning from glucocorticoid treatment should be

proportionate to treatment duration. Appropriate preventive therapy

can mitigate many of the adverse effects associated with

glucocorticoid therapy.

PMID: 18349823

http://www.ncbi.nlm.nih.gov/pubmed/18349823

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