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Therapeutic issues in oral glucocorticoid use
1Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA.
Lippincott'S Primary Care Practice
|March 11, 2000
Summary
Glucocorticoid therapy can be prolonged due to HPA axis suppression fears. Practical dosing and monitoring minimize adverse effects, reducing risks like osteoporosis and adrenal crisis.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Glucocorticoids are widely used therapeutically but associated with significant adverse effects.
- Concerns include hypothalamic-pituitary-adrenal (HPA) axis suppression, adrenal crisis, and drug-induced conditions.
- Common side effects encompass osteoporosis, cataracts, hypertension, hyperglycemia, dyslipidemia, avascular necrosis, growth retardation, and myopathy.
Purpose of the Study:
- To review the adverse effects of glucocorticoid therapy.
- To discuss practical strategies for minimizing these adverse effects.
- To emphasize the importance of appropriate patient monitoring.
Main Methods:
- Literature review of glucocorticoid adverse effects and management strategies.
- Analysis of dosing strategies, tapering regimens, and drug interactions.
- Discussion of monitoring protocols for long-term glucocorticoid use.
Main Results:
- Fear of HPA axis suppression can lead to unnecessarily prolonged glucocorticoid treatment.
- Alternate-day therapy and appropriate tapering regimens can mitigate many adverse effects.
- Identifying and managing drug interactions is crucial for preventing toxicity.
Conclusions:
- Adverse outcomes of long-term glucocorticoid therapy can be minimized through practical dosing, careful tapering, and vigilant monitoring.
- Understanding and addressing potential side effects allows for safer and more effective glucocorticoid use.
- Primary care providers play a key role in managing patients on long-term glucocorticoid therapy.