Makindo Medical Notes

📌 Related Subjects: | Osteoporosis

⚠️ Avoid exposure to shingles or chickenpox in patients lacking acquired immunity and taking steroids. Always check the BNF link here before prescribing.

💊 Action

• Glucocorticoid effect with anti-inflammatory & immunosuppressive activity.
• Mild mineralocorticoid activity (fluid retention, BP effects).

📋 Indications

• 🦠 Autoimmune & inflammatory: Rheumatoid arthritis, Inflammatory bowel disease.
• 🩸 Vasculitis: Giant cell arteritis (GCA), Polymyalgia rheumatica (PMR).
• 🧪 Renal: Minimal change disease, transplant rejection prevention.
• 🧬 Endocrine: Addison’s disease (replacement therapy).
• 🫁 Respiratory: Asthma, COPD exacerbations, pulmonary fibrosis.

💊 Dose (specify duration!)

• Typical adult dose: 5–60 mg once daily, depending on indication.
• BNF starting point: usually 10–20 mg once daily, taken in the morning after food.
• Giant Cell Arteritis: 1 mg/kg once daily while awaiting diagnostic confirmation.
• Polymyalgia Rheumatica: typically 15 mg once daily.
• Acute severe asthma: 40–60 mg once daily (or divided) for 3–10 days (“burst therapy”).
• 📌 For long courses: co-prescribe Calcium + Vitamin D and a Bisphosphonate for bone protection.

🔻 Tapering Guidance

• 📌 No taper needed if treatment is <3 weeks at standard doses (risk of adrenal suppression is minimal).
• ⚠️ Taper required if:
  • Used for >3 weeks, OR
  • ≥40 mg/day for >1 week, OR
  • Recent repeated courses (esp. within 1 year), OR
  • Evening dosing, OR
  • Features of Cushing’s syndrome (suggesting suppression).
• 🧪 Tapering strategy: Gradually reduce dose to a physiological level (≈5–7.5 mg prednisolone), then wean slowly over weeks to months depending on duration of use and clinical indication.
• 🚨 If patient becomes acutely unwell during taper (e.g. infection, surgery) → may need to increase dose temporarily (“stress dosing”).

⚖️ Interactions

• See full list in the BNF.
• ⚠️ Important: NSAIDs (↑ ulcer risk), anticoagulants (altered INR), antidiabetics (↑ glucose), live vaccines (risk of infection).

⚠️ Cautions

• ⏳ Withdrawal must be gradual if used >3 weeks (risk of adrenal insufficiency).
• 🩺 Consider adding a PPI for GI protection if combined with NSAIDs or at risk of PUD.
• 📈 Monitor: BP, blood glucose, weight, mood, and bone density.

⛔ Contraindications

• 🚫 Untreated systemic infection (bacterial, viral, fungal, parasitic).
• 🚫 Recent live vaccine administration.

⚠️ Side Effects

• 🧬 Endocrine: Cushingoid features, adrenal suppression, steroid-induced diabetes.
• ❤️ Renal/CV: Hypertension, hypokalaemic alkalosis, oedema.
• 🧠 Neuropsychiatric: Insomnia, mood swings, psychosis.
• 🍽️ GI: Dyspepsia, gastritis, peptic ulcer disease → PPI often indicated.
• 🦴 MSK: Osteoporosis, osteopenia, avascular necrosis, proximal myopathy.
• 👁️ Eye: Cataracts, glaucoma.
• 🩹 Skin: Thinning, striae, easy bruising, moon face, buffalo hump.
• 🦠 Immunosuppression: Increased infection risk (esp. opportunistic infections, sepsis).