Prescribing oral corticosteroids
- Adverse effects are uncommon with infrequent, short courses of oral corticosteroids.
- Table 1 below shows the dose of oral prednisolone recommended in an acute exacerbation of asthma:
- In adults, oral corticosteroids should be continued for at least 5 days, until recovery.
- In children, oral corticosteroids should be continued for at least 3 days, until recovery.
- Prescribe soluble prednisolone tablets for children who cannot swallow tablets.
- Repeat the dose of prednisolone in children who vomit.
- After recovery from the acute exacerbation, therapy with prednisolone can be stopped abruptly, without tapering the dose, unless the course was longer than 3 weeks or the person was previously receiving maintenance oral corticosteroid treatment.
Table 1. Dose of oral prednisolone used in acute severe exacerbation of asthma.
|Dose of oral prednisolone (once daily)||< 2 years old||2–5 years old||6–12 years old||> 12 years old|
|People not taking regular oral corticosteroid||10 mg||20 mg||30–40 mg||40–50 mg*|
|People taking regular oral corticosteroid||2 mg/kg (maximum 40 mg)||2 mg/kg
(maximum 60 mg)
(maximum 60 mg)
(maximum 60 mg)
|* In practice, many healthcare professionals prescribe 30 mg/day.
Data from: [BNF 53, 2007; BNF for Children, 2007; SIGN and BTS, 2011]
What are the adverse effects of continuous or frequent use of oral corticosteroids and how can they be managed?
- The risk and severity of adverse effects with oral corticosteroids increase with the dose and the duration of treatment. People receiving long-term oral corticosteroids (more than 3 months) or those needing frequent courses of an oral corticosteroid (three to four per year) are at risk of systemic adverse effects.
- Systemic adverse effects include osteoporosis, hypertension, diabetes, hypothalamic–pituitary–adrenal axis suppression, weight gain, cataracts, glaucoma, skin-thinning, easy bruising, and muscle weakness.
- Aim to prevent, minimize, or quickly detect adverse effects of long-term corticosteroids. General and lifestyle recommendations to minimize adverse effects include the following:
- Encourage adequate dietary calcium intake and good nutrition.
- Maintain normal body weight where possible.
- Advise on smoking cessation.
- Advise on moderate alcohol consumption.
- Encourage physical exercise within the limits imposed by the underlying disease.
- Perform a falls risk assessment, where appropriate, and advise those at increased risk of fractures from falling.
- Monitor, prevent, and treat the systemic adverse effects of continuous or frequent courses of oral corticosteroids:
- Blood pressure: monitor regularly and treat if necessary.
- Diabetes mellitus: screen regularly and treat if necessary.
- Osteoporosis: see the Prodigy topic on Osteoporosis – prevention of fragility fractures for details on when to prescribe prophylactic bisphosphonate therapy.
- Growth suppression: record height of children regularly and accurately.
- Cataracts: screen children periodically through community optometric services.
- Children who frequently use courses of oral corticosteroids should have regular checks for signs of adrenal suppression. Refer to a paediatrician who can arrange Synacthen® testing, where appropriate.
- Document the person’s history of chickenpox (fatal disseminated chickenpox may occur in non-immune people). Advise all people without a history of chickenpox who are taking systemic prednisolone to avoid close contact with people who have chickenpox or shingles, and to seek urgent medical advice if they are exposed.