Prescribing Notes
- There is no consistent evidence for an ideal steroid regimen that is suitable for all patients. Therefore, the approach to treatment must be flexible and tailored to the individual. See NICE CKS Corticosteroids.
- Note: the use of enteric-coated formulations of corticosteroid is not recommended for reducing the risk of gastrointestinal bleeding or dyspepsia.
- Consider osteoporosis prophylaxis for patients receiving 7.5mg or more of prednisolone daily (or equivalent) for longer than 3 months. For further details refer to NOGG guideline.
- A Steroid Emergency Card has been developed in response to a National Patient Safety Alert.The alert highlights the dangers associated with adrenal insufficiency for patients taking corticosteroid medication, and recommends that all eligible patients prescribed (or initiated on) steroids are assessed and where necessary issued with a Steroid Emergency Card. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net. For full information see BNF and HSC letter.
- Long-term steroids should be withdrawn gradually.
- The British Society for Rheumatology (BSR) recommends initiation of low-dose steroid therapy (prednisolone 15mg daily) with gradually tailored tapering in straightforward polymyalgia rheumatica (PMR). Refer to NICE CKS.
- Giant cell arteritis (GCA) is a medical emergency and patients should be urgently referred to a specialist ideally for same day evaluation. Patients in whom GCA is strongly suspected should be immediately treated with high-dose glucocorticoids (40 to 60mg prednisolone per day). If same day specialist evaluation is not available, primary care providers should initiate glucocorticoids alongside an urgent referral. For further information see NICE CKS
- Immediate referral to Ophthalmology is essential if there is visual loss for consideration of IV methylprednisolone.