.received more than 40 mg prednisolone (or equivalent)
daily for more than 1 weekor 2 mg/kg daily for 1 weekor
1 mg/kg daily for 1 month;
.been given repeat doses in the evening;
.received more than 3 weeks’treatment;
.recently received repeated courses (particularly if taken
for longer than 3 weeks);
.taken a short course within 1 year of stopping long-term
therapy;
.other possible causes of adrenal suppression.
Systemic corticosteroids may be stopped abruptly in those
whose disease is unlikely to relapseandwho have received
treatment for 3 weeks or lessandwho are not included in
the patient groups described above.
During corticosteroid withdrawal the dose may be
reduced rapidly down to physiological doses (equivalent to
prednisolone 2 – 2. 5 mg/m^2 daily) and then reduced more
slowly. Assessment of the disease may be needed during
withdrawal to ensure that relapse does not occur.
lPATIENT AND CARER ADVICE
Advice for patientsPatients on long-term corticosteroid
treatment should carry a Steroid Treatment Card which
gives guidance on minimising risk and provides details of
prescriber, drug, dosage and duration of treatment.
A patient information leaflet should be supplied to every
patient when a systemic corticosteroid is prescribed.
Patients should especially be advised of the following:
.ImmunosuppressionProlonged courses of
corticosteroids can increase susceptibility to infection
and serious infections can go unrecognised. Unless
already immune, patients are at risk of severe
chickenpoxand should avoid close contact with people
who have chickenpox or shingles. Similarly, precautions
should also be taken against contractingmeasles;
.Adrenal suppressionIf the corticosteroid is given for
longer than 3 weeks, treatment must not be stopped
abruptly. Adrenal suppression can last for a year or more
after stopping treatment and the patient must mention
the course of corticosteroid when receiving treatment
for any illness or injury;
.Mood and behaviour changesCorticosteroid
treatment, especially with high doses, can alter mood
and behaviour early in treatment—the patient can
become confused, irritable and suffer from delusion and
suicidal thoughts. These effects can also occur when
corticosteroid treatment is being withdrawn. Medical
advice should be sought if worrying psychological
changes occur;
.Other serious effectsSerious gastro-intestinal,
musculoskeletal, and ophthalmic effects which require
medical help can also occur.
Steroid treatment cardsSteroid treatment cards should be
issued where appropriate. Consider giving a‘steroid card’
to support communication of the risks associated with
treatment, and specific written advice to consider
corticosteroid replacement during an episode of stress,
such as severe intercurrent illness or an operation, to
patients using greater than maximum licensed doses of
inhaled corticosteroids. Steroid treatment cards are
available for purchase from the NHS Print online ordering
portalwww.nhsforms.co.uk.
GP practices can obtain supplies through Primary Care
Support England. NHS Trusts can order supplies via the
online ordering portal.
InScotland, steroid treatment cards can be obtained
from APS Group Scotland by emailing
[email protected] or by fax on0131 629
9967.eiiiiF 436Betamethasone 21-Dec-2017
lINDICATIONS AND DOSE
Suppression of inflammatory and allergic disorders|
Congenital adrenal hyperplasia
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child 1–11 months:Initially 1 mg, repeated up to 4 times
in 24 hours according to response
▶Child 1–5 years:Initially 2 mg, repeated up to 4 times in
24 hours according to response
▶Child 6–11 years:Initially 4 mg, repeated up to 4 times in
24 hours according to response
▶Child 12–17 years: 4 – 20 mg, repeated up to 4 times in
24 hours according to responselINTERACTIONS→Appendix 1 : corticosteroids
lSIDE-EFFECTSHiccups.malaise.Stevens-Johnson
syndrome
lPREGNANCYReadily crosses the placenta. Transient effect
on fetal movements and heart rate.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, dilute with Glucose 5 % or Sodium Chloride 0. 9 %.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
CAUTIONARY AND ADVISORY LABELS 10
▶Betamethasone (Non-proprietary)
Betamethasone (as Betamethasone sodium phosphate) 4 mg per
1mlBetamethasone 4 mg/ 1 ml solution for injection ampoules|
5 ampouleP£ 18. 81 DT = £ 17. 25eiiiiF 436Deflazacort 21-Dec-2017
lINDICATIONS AND DOSE
Inflammatory and allergic disorders
▶BY MOUTH
▶Child 1 month–11 years: 0. 25 – 1. 5 mg/kg once daily or on
alternate days; increased if necessary up to 2. 4 mg/kg
daily (max. per dose 120 mg), in emergency situations
▶Child 12–17 years: 3 – 18 mg once daily or on alternate
days; increased if necessary up to 2. 4 mg/kg daily (max.
per dose 120 mg), in emergency situations
Nephrotic syndrome
▶BY MOUTH
▶Child:Initially 1. 5 mg/kg once daily (max. per dose
120 mg), reduced to the lowest effective dose for
maintenancelINTERACTIONS→Appendix 1 : corticosteroids
lSIDE-EFFECTSHypotension
lPATIENT AND CARER ADVICEPatient counselling is advised
for deflazacort tablets (steroid card).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: tablet
Tablet
CAUTIONARY AND ADVISORY LABELS5, 10
▶Calcort(Sanofi)
Deflazacort 6 mgCalcort 6 mg tablets| 60 tabletP£ 15. 82438 Corticosteroid responsive conditions BNFC 2018 – 2019
Endocrine system6