Drug Adverse Effects Glucocorticoid

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Contents 1 Adverse-effects 2 Management 3 More General Terms 4 References

Adverse-effects

• bruising
• osteoporosis, osteopenia, fractures*

• may inhibit osteoblast activity
• may promote osteoblast apoptosis
• inhibition of intestinal Ca+2 transport [8]

• aseptic necrosis
• ocular adverse effects

• cataracts, glaucoma, cataracts, optic neuritis, retinopathy

• hypertension
• weight gain
• glucose intolerance/ diabetes mellitus
• depression
• central nervous system effects

• insomnia, anxiety, irritability (60%) [10]
• steroid psychosis

• bipolar symptoms
• begins 7-10 days after starting

• memory impairment, confusion

• acne
• gastrointestinal

• GI intolerance
• reduced tone of gastroesophageal sphincter
• gastroesophageal reflux
• upper GI bleed [5]

• accelerated atherogenesis
• immunosuppression

• disorder of neutrophil phagocytosis
• lymphopenia & monocytopenia
• decreased cell-mediated immunity
• opportunistic infections

• Cushingoid features:

• puffed facies
• buffalo hump
• abdominal striae

• glucocorticoids synergistic with pregnancy

• impaired wound healing
• steroid myopathy
• increased risk of atrial fibrillation

• odds ratio 3.6 (current use)
• odds ratio 1.7 (long-term use)
• no increase risk for former users [9]

• mediastinal lipomatosis
• inhaled corticosteroids

• oral candidiasis
• dysphonia ( laryngeal myopathy)

• topical glucocorticoids may cause contact dermatitis (3-5%)
• inhaled glucocorticoids have no significant effect on final height or bone density in children [7]
• long-term effects or antenatal exposure may be minimal (see betamethasone)

Management

• Calcium 1.0-1.5 g QD & vitamin D 400-800 IU QD may be helpful & should be prescribed for vulnerable older adults taking equivalent of 7.5 mg of prednisone QD for 1 month or longer [8]
• alendronate (or other bisphosphonate) may reduce bone loss & reduce risk of fractures [4] & should be prescribed for vulnerable older adults taking equivalent of 7.5 mg of prednisone QD for 3 months or longer [8] unless contraindicated

More General Terms

• drug adverse effect(s)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 792, 799
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
4. Journal Watch 21(6):46, 2001 Arthritis Rheum 44:202, 2001
5. Journal Watch 21(14):118, 2001 Hernandez-Diaz & Rodriguez, Am J Epidemiol 153:1089, 2001
6. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
7. Prescriber's Letter 9(8):48 2002
8. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
9. Christiansen CF et al. Glucocorticoid use and risk of atrial fibrillation or flutter: A population-based, case-control study. Arch Intern Med 2009 Oct 12; 169:1677. PMID: [1]
10. Prescriber's Letter 18(5): 2011 Corticosteroid-Induced Psychiatric Effects Detail-Document#: [2] (subscription needed) [3]

drug adverse effects of glucocorticoids