Wherever possible local treatment with creams, eye drops, etc, should be used instead of systemic treatment.
The dosage of steroids varies widely in different diseases and patients. The lowest dose that will produce an acceptable response should be used.
Patients should be made aware of the potential hazards and should carry a "steroid card" giving details of their therapy and patient information.
When long-term corticosteroid treatment is discontinued, the dose should be gradually reduced over a period of several weeks or months, depending on the dosage and duration of therapy.
Patients receiving oral or parenteral steroids for reasons other than replacement are at risk of severe chickenpox, unless they have already had the disease. The Committee on Safety of Medicines has issued a warning stating that these patients should avoid close personal contact with chickenpox or herpes zoster and seek urgent medical attention if they are exposed to it. Passive immunisation with varicella-zoster immunoglobulin is needed for exposed non-immune patients receiving systemic corticosteroids or for those who have used them within three months. Varicella-zoster immunoglobulin should be given within three days of exposure and no later than ten days (see Immunisation against Infectious Diseases, 1996 - "The Green Book" available on the Department of Health website (www.dh.gov.uk). Normal immunoglobulin may also be given for prophylaxis after exposure to measles in children with compromised immunity and in adults with compromised immunity who have no measles antibodies.
The equivalent anti-inflammatory doses of glucocorticoids are as follows. (This table does not take account of mineralocorticoid effects or duration of action).
Betamethasone 0.75 (750 micrograms)
For use of corticosteroids in the treatment of asthma, see 3.2.
Inhaled corticosteroids prescribing points - click here.
For use of corticosteroids in the treatment of musculoskeletal and joint disorders, see 10.1.2.
For use of corticosteroids in dermatology, see 13.4.
Topical corticosteroids prescribing points - click here.
Corticosteroid eye preparations, see 11.4.