Glucocorticoids for

Due to the side-effect problems seen with high doses of inhaled glucocorticoids resulting from systemic absorption and the use of oral glucocorticoids in severely affected patients, there has been a search for safer glucocorticoids for inhalation and even for oral administration. As discussed above, a major mechanism... 

Osteoporosis Encourage patients to ingest adequate amounts of calcium and vitamin D, encourage smokers to discontinue tobacco use, and consider initiation of medications for osteoporosis (e.g., bisphosphonates, calcitonin, and parathyroid hormone) if the patient is taking glucocorticoids for an extended period of time or if the patient has evidence of low bone mineral density.15,41... 

The use of glucocorticoids for tuberculous meningitis remains controversial. The administration of steroids such as oral prednisone, 60 to 80 mg/ day (1 to 2 mg/kg/day in children), or 0.2 mg/kg/day of IV dexametha-sone, tapered over 4 to 8 weeks, improves neurologic sequelae and survival in adults and decrease mortality, long-term neurologic complications, and permanent sequelae in children. 

Glucocorticoids for aerosol use See Chapter 20. Glucocorticoids for dermatologic use See Chapter 61. Glucocorticoids for gastrointestinal use See Chapter 62. 

The eye can be involved in generalized adverse reactions to systemically administered glucocorticoids. For example, conjunctivitis can occur as part of an allergic reaction and infections of the eye can be masked as a result of antiinflammatory and analgesic effects. Ophthalmoplegia can occur as one of the consequences of glucocorticoid myopathy (SEDA-16, 450). Two complications that require special discussion are cataract and glaucoma. 

Glaucoma and ocular hypertension have been reported after dermal application of glucocorticoids for facial atopic eczema (SEDA-19,376) (64), and after treatment with beclomethasone by nasal spray and inhalation (SEDA-20, 373 65). 

Glucocorticoids can even cause osteoporosis when they are used for long-term replacement therapy in the Addison s disease, as has been shown by a study of 91 patients who had taken glucocorticoids for a mean of 10.6 years, in whom bone mineral density was reduced by 32% compared with age-matched controls (SEDA-19, 377 198). However, these results contrasted with the results of a Spanish study in patients with Addison s disease, in which no direct relation was found between replacement therapy and either bone density or biochemical markers of bone turnover of calcium metabolism (alkaline phosphatase, osteocalcin, procollagen I type, parathormone, and 1,25-dihydroxycolecalciferol) (SEDA-19, 377 199). 

The myopathy usually develops gradually, without pain, and symmetrically. However, a single epidural injection of a glucocorticoid for lumbar radicular pain has caused Cushing s syndrome and myopathy (SEDA-20, 370 97). 

In the previous literature this adverse reaction was described in patients taking glucocorticoids for from 4 months to several years. 

Hyperadrenalism has never otherwise been reported after the sequential use of glucocorticoids for fetal lung maturation. 

Topical administration to the nose The safety of nasal glucocorticoids in the treatment of allergic rhinitis has been reviewed (434,435). The local application of glucocorticoids for seasonal or perennial rhinitis often results in systemic adverse effects. The use of nasal sprays containing a glucocorticoid that has specific topical activity (such as beclomethasone dipropionate or flunisolide) seems to reduce the systemic adverse effects, but they can nevertheless occur, even to the extent of suppression of basal adrenal function in children (436). Local adverse effects include Candida infection, nasal stinging, epistaxis, throat irritation (437), and, exceptionally, anosmia (438). 

An acute adrenal crisis occurred in a woman who received an intra-articular glucocorticoid for pseudogout of the knee (464). 

Ventura MT, Calogiuri GF, Matino MG, Dagnello M, Buquicchio R, Foti C, Di Corato R. Alternative glucocorticoids for use in cases of adverse reaction to systemic glucocorticoids a study on 10 patients. Br J Dematol 2003 148 139-41. 

Karadimas P, Kapetanios A, Bouzas EA. Central serous chorioretinopathy after local application of glucocorticoids for skin disorders. Arch Ophthalmol 2004 122 784-6. 

In 3677 patients undergoing cataract extraction over 2 years compared with a matched control group of 21 868 people, the patients were more likely to undergo cataract extraction if they had used inhaled glucocorticoids for more than 3 years (OR = 3.06 Cl = 1.53, 6.13). This risk was not significant in patients who used low to medium doses (1000 micrograms/day or less) when the OR was 1.63 (Cl = 0.85, 3.13) after 2 years. The OR was higher in... 

A 67-year-old man using glucocorticoids for asthma, ranitidine 300 mg/day, and enalapril 5 mg/day developed a low blood glucose (1.2 mmol/ 1) within 48 hours of starting to take glibenclamide 5-10 mg/day. 

In patients taking glucocorticoids for Addison s disease, rifampicin may necessitate an increase in glucocorticoid dosage. Thus, incipient adrenal insufficiency can be unmasked by rifampicin (SEDA-13, 261). The phenomenon is due to liver enzyme induction (1008). 

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