Therapeutic issues in oral glucocorticoid use

The therapeutic use of glucocorticoids are extensive despite numerous adverse effects related to their use. The fear of hypothalamic-pituitary-adrenal (HPA) axis suppression and adrenal crisis often prolongs glucocorticoid therapy unnecessarily. Glucocorticoids are the most common cause of drug-induced osteoporosis and cataract formation. Other effects of concern to the primary care provider include increased blood pressure, blood glucose, and cholesterol. Glucocorticoid therapy also may lead to avascular necrosis, growth retardation, and myopathy. Practical dosing strategies such as alternate-day therapy reduce the risk of developing most adverse effects. Several tapering regimens exist that lessen the potential for steroid withdrawal syndrome. Identifying common glucocorticoid drug interactions averts drug toxicity. By appropriately monitoring patients on long-term glucocorticoid therapy, adverse outcomes are minimized.