Steroids ð
Comprehensive guide to corticosteroids: types, indications, dosing, side effects, and conversion calculator for NCHDs.
ðĄ Overview
- Corticosteroids are synthetic analogues of cortisol, used for their anti-inflammatory and immunosuppressive effects.
- Common indications: inflammatory conditions (asthma, COPD, IBD, arthritis), autoimmune diseases, allergic reactions, adrenal insufficiency.
- Can be given orally, IV, IM, or topically depending on indication.
- Important to consider duration of treatment, dose tapering, and monitoring for side effects.
- Never stop long-term steroids abruptly - risk of adrenal crisis.
ð Types of Steroids
- See full table below for common corticosteroids and their properties
- Relative potency: compared to prednisolone (reference = 1)
- Duration of action affects dosing frequency - longer acting steroids may be given once daily
- Route of administration: IV for acute/severe conditions, oral for maintenance, topical for local effects
- Budesonide: minimal systemic absorption, useful in IBD and respiratory conditions
â ïļ Important Considerations
- Relative potency compared to prednisolone (e.g., 1mg prednisolone = 0.15mg dexamethasone = 4mg hydrocortisone)
- Duration of action affects dosing frequency - longer acting steroids may be given once daily
- Route of administration: IV for acute/severe conditions, oral for maintenance
- Consider patient factors: diabetes, hypertension, osteoporosis, peptic ulcer disease, infections
ð Common Indications & Dosing
- Asthma/COPD exacerbation: Prednisolone 30-40mg PO daily for 5-7 days (no taper if short course)
- Inflammatory bowel disease: Prednisolone 40-60mg PO daily, taper over 8-12 weeks
- Rheumatoid arthritis: Prednisolone 5-10mg PO daily (low dose) or higher for flares
- Adrenal insufficiency: Hydrocortisone 15-25mg PO daily in divided doses (stress dosing: 50-100mg IV)
- CNS oedema: Dexamethasone 4-16mg IV/PO daily in divided doses
- Allergic reactions: Prednisolone 40-60mg PO daily or hydrocortisone 100-200mg IV
- Immunosuppression: Variable dosing depending on condition and severity
ðĐš Monitoring & Side Effects
- Short-term (<2 weeks): Usually minimal side effects, can stop abruptly if no underlying adrenal suppression
- Long-term (>2 weeks): Requires gradual taper to prevent adrenal crisis
- Common side effects: Hyperglycaemia, hypertension, fluid retention, mood changes, insomnia, weight gain
- Long-term complications: Osteoporosis, cataracts, glaucoma, skin thinning, easy bruising, muscle weakness
- Monitor: Blood glucose, BP, weight, bone density (if long-term), eye exams
- Infection risk: Increased susceptibility, may mask signs of infection (fever, inflammation)
- Gastric protection: Consider PPI if high-dose or long-term steroids, especially with NSAIDs
ð Tapering Regimens
- Short courses (<2 weeks): Usually no taper needed
- Medium courses (2-4 weeks): Taper over 1-2 weeks
- Long courses (>4 weeks): Gradual taper over weeks to months
- Example taper (from 40mg prednisolone): 40mg â 30mg (1 week) â 20mg (1 week) â 15mg (1 week) â 10mg (1 week) â 5mg (1 week) â stop
- Slower taper if: Long duration, high doses, previous adrenal suppression, or patient symptoms
- Monitor for withdrawal symptoms: fatigue, joint pain, nausea, hypotension
ðĻ Adrenal Crisis Prevention
- Patients on long-term steroids (>3 weeks) may have suppressed adrenal function
- Never stop abruptly - risk of life-threatening adrenal crisis
- Stress dosing: Double or triple normal dose during illness, surgery, or trauma
- Sick day rules: If unwell, increase dose and seek medical advice
- Consider steroid card/alert bracelet for patients on long-term steroids
- If missed dose: Take as soon as remembered, but don't double up
ð Related Topics
Corticosteroids Reference Table
Common steroids, routes, potency, and uses
| Steroid | Route | Relative Potency* | Duration of Action | Common Uses |
|---|---|---|---|---|
| Prednisolone | Oral, IV | 1 (reference) | Short-intermediate (12-36h) | Most common oral steroid, inflammatory conditions |
| Prednisone | Oral | 1 (reference) | Short-intermediate (12-36h) | Converted to prednisolone in liver |
| Methylprednisolone | Oral, IV, IM | 1.25x | Short-intermediate (12-36h) | IV pulse therapy, high-dose treatment |
| Dexamethasone | Oral, IV, IM | 6.67x | Long (36-72h) | CNS oedema, antiemetic, suppression tests |
| Hydrocortisone | Oral, IV, IM | 0.25x | Short (8-12h) | Adrenal replacement, stress dosing |
| Betamethasone | Oral, IV, IM | 6.67x | Long (36-72h) | Similar to dexamethasone |
| Budesonide | Oral, Inhalation, Topical | 0.8x | Short-intermediate (12-24h) | IBD (Crohn's, UC), asthma/COPD, minimal systemic absorption |
| Cortisone | Oral | 0.2x | Short (8-12h) | Rarely used, requires hepatic conversion |
Prednisolone
Oral, IVRelative Potency*:1 (reference)
Duration:Short-intermediate (12-36h)
Uses: Most common oral steroid, inflammatory conditions
Prednisone
OralRelative Potency*:1 (reference)
Duration:Short-intermediate (12-36h)
Uses: Converted to prednisolone in liver
Methylprednisolone
Oral, IV, IMRelative Potency*:1.25x
Duration:Short-intermediate (12-36h)
Uses: IV pulse therapy, high-dose treatment
Dexamethasone
Oral, IV, IMRelative Potency*:6.67x
Duration:Long (36-72h)
Uses: CNS oedema, antiemetic, suppression tests
Hydrocortisone
Oral, IV, IMRelative Potency*:0.25x
Duration:Short (8-12h)
Uses: Adrenal replacement, stress dosing
Betamethasone
Oral, IV, IMRelative Potency*:6.67x
Duration:Long (36-72h)
Uses: Similar to dexamethasone
Budesonide
Oral, Inhalation, TopicalRelative Potency*:0.8x
Duration:Short-intermediate (12-24h)
Uses: IBD (Crohn's, UC), asthma/COPD, minimal systemic absorption
Cortisone
OralRelative Potency*:0.2x
Duration:Short (8-12h)
Uses: Rarely used, requires hepatic conversion
*Relative potency compared to prednisolone (e.g., 1mg prednisolone = 0.15mg dexamethasone = 4mg hydrocortisone)
Steroid Conversion Calculator
Convert between different corticosteroid preparations