drug adverse effects of glucocorticoids

Introduction

also see drug adverse effects of topical glucocorticoids

Adverse effects

• easy bruising
• osteoporosis, osteopenia, fractures*
  • may inhibit osteoblast activity
  • may promote osteoblast apoptosis
  • inhibition of intestinal Ca+2 transport
  • systemic glucocorticoids associated with increased risk of fractures in children with asthma
    • no increase in risk with inhaled glucocorticoids
  • long-term glucocorticoids <= 5 mg/day of prednisone do not seem to adversely affect bone mineral density
• aseptic necrosis (osteonecrosis)
• ocular adverse effects
  • cataracts, glaucoma, cataracts, optic neuritis, retinopathy
• hypertension
• weight gain, fluid retention, edema
• glucose intolerance/diabetes mellitus
• depression
• central nervous system effects
  • insomnia, anxiety, irritability (60%)
  • steroid psychosis
    • bipolar symptoms
    • begins 7-10 days after starting
  • memory impairment, confusion
  • elevated incidence of suicide attempts, depression, mania, & delirium
• acne
• gastrointestinal
  • GI intolerance
  • reduced tone of gastroesophageal sphincter
  • gastroesophageal reflux
  • upper GI bleed
• increased cardiovascular risk
  • accelerated atherogenesis, hypercholesterolemia, insulin resistance, hypertension
• immunosuppression
  • disorder of neutrophil phagocytosis
  • lymphopenia & monocytopenia
  • decreased cell-mediated immunity
  • opportunistic infections
  • prophylaxis for pneumocystis pneumonia may be appropriate with chronic high-dose glucocorticoids
• Cushingoid features:
  • puffed facies
  • buffalo hump
  • abdominal striae
    • glucocorticoids synergistic with pregnancy
  • Cushing's syndrome due to glucocorticoids is associated with increased cardiovascular risk
• impaired wound healing
• steroid myopathy (long-term use)
  • proximal muscle weakness
• seizures
• increased risk of atrial fibrillation
  • odds ratio 3.6 (current use)
  • odds ratio 1.7 (long-term use)
  • no increase risk for former users
• 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
• long-term effects or antenatal exposure may be minimal (see betamethasone)
• short-term use of oral glucocorticoids associated with increased risks for sepsis (RR=1.8), venous thromboembolism (RR=1.9), & fracture (RR=1.5), gastrointestinal bleeding, & heart failure
• short courses of oral glucocorticoids in children pose risks for pneumonia, GI bleed, & sepsis
• erythroderma following use of systemic glucocorticoids

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
• alendronate (or other bisphosphonate) may reduce bone loss & reduce risk of fractures & should be prescribed for vulnerable older adults taking equivalent of 5-7.5 mg of prednisone QD for 4 weeks or longer unless contraindicated

More general terms

• drug adverse effect(s)