Insomnia with corticosteroids

JR is a 35-year-old man with an acute exacerbation of his UC having three stools per day. His disease is limited to the rectum and distal colon. On last admission, he received IV methylprednisolone that made him "crazy." In addition, he experienced weeks of insomnia with his oral steroid taper. Which corticosteroid is the most appropriate for his current situation ... 

Short-term use of corticosteroids is not associated with most of the adverse effects of chronic steroid use. The most common adverse effects encountered are gastrointestinal upset, insomnia, and mood swings.28... 

Prednisone -corticosteroid -leukocytosis -nausea and vomiting indigestion -anorexia or increased appetite -CNS effects (depression, anxiety, euphoria, insomnia, psychosis, confusion) -fluid retention -hyperglycemia -osteoporosis -acne -adrenal insufficiency with prolonged use... 

Deltacortil is a proprietary preparation of the corticosteroid prednisolone. As with other corticosteroids, prednisolone may lead to precipitation of osteoporosis, insomnia and candidiasis. 

Theophylline improves long-term control of asthma when taken as the sole maintenance treatment or when added to inhaled corticosteroids. It is inexpensive, and it can be taken orally. Its use, however, also requires occasional measurement of plasma levels it often causes unpleasant minor side effects (especially insomnia) and accidental or intentional overdose can result in severe toxicity or death. For oral therapy with the prompt-release formulation, the typical dose is 3-4 mg/kg of theophylline every 6 hours. Changes in dosage result in a new steady-state concentration of theophylline in 1-2 days, so the dosage may be increased at intervals of 2-3 days until therapeutic plasma concentrations are achieved (10-20 mg/L) or until adverse effects develop. 

Corticosteroids Dexamethasone and methylprednisolone used alone are effective against mildly to moderately emetogenic chemotherapy. Their antiemetic mechanism is not known, but may involve blockade of prostaglandins. These drugs can cause insomnia and hyperglycemia in patients with diabetes mellitus. 

Efavirenz is a non-nucleoside reverse transcriptase inhibitor with excellent inhibitory activity against HTV-l. Its most frequent adverse effects involve the central nervous system and the skin (1). At the start of therapy, dizziness, insomnia, or fatigue is observed in most patients, and headache and even psychotic reactions have also been observed. A maculopapular rash is seen in about 10%. These adverse effects usually vanish within the first 2-4 weeks of therapy (2). About 1-2% of individuals stop taking efavirenz because of neurological or dermatological adverse events. Administration of efavirenz at bedtime reduces the incidence of severe adverse effects, and the rash can be managed by short-term antihistamines or topical corticosteroids (1). Nausea and vomiting are less often observed than in patients treated with zidovudine, lamivudine, or indinavir. 

D Hydrocortisone. Hydrocortisone is the only corticosteroid that is available as suppositories, enemas, and foams for rectal use. It is the best choice for this patient since the rectal route may have the potential to minimize systemic toxicities (i.e., behavioral disturbances, insomnia) that the patient previously experienced with the iV and PO corticosteroids. This patient s exacerbation is mild and his disease is localized to the rectum and distal colon. Therefore, per rectum corticosteroids wiil be able to target these areas successfully. 

Hemolytic anemia, rash, and liver damage may occur even with normal doses. In cases of overdosage, headache, vomiting, insomnia, and tachycardia are possible. Reactions may occur in leprosy with or without therapy. In lepromatous leprosy there is erythema nodosum, fever, and in some cases severe malaise. In tuberculoid leprosy the pain increases. About 50% of the treated patients with lepromatous leprosy show erythema nodosum within the 1st year, lasting for 2 weeks. As a rule, therapy with sulfones in combination with clofazimine may be continued in spite of the erythema nodosum. Analgetics, corticosteroids, and thalidomide are suitable for the treatment of leprosy reactions (Rea and Levan 1975). 

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