6.3.2 Glucocorticoid therapy

ChoiceDrugDosage
Formulary choicesPrednisolone tablets 1mg, 5mg;
Note: Soluble tablets are high cost

Dose:
Dependent on condition being treated (refer to BNF). Preferably taken in the morning after breakfast

Or
Dexamethasone tablets 500micrograms, 2mg; injection 3.8mg/mL, 3.3mg/mL

Dose:
Dependent on condition being treated (refer to BNF)

Or
Hydrocortisone injection (Solu-Cortef®) hydrocortisone (as sodium succinate) 100mg vial with 2mL amp water for injectionsDose:
Dependent on condition treated (refer to BNF)
Or

Methylprednisolone tablets 2mg, 4mg, 16mg, 100mg;
Methylprednisolone sodium succinate (Solu-Medrone®) vials 40mg, 125mg, 500mg, 1g, 2g;
Intramuscular depot: Methylprednisolone acetate (Depo-Medrone®) vials 40mg/mL, 80mg/2mL, 120mg/3mL

Dose:
Dependent on condition treated (refer to BNF)

Prescribing Notes

  • Corticosteroids are used in the treatment of a wide range of conditions. Doses of corticosteroids used vary widely in different diseases and in different patients. Refer to relevant section of BNF.
  • Steroid cards should be given when appropriate. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net.
  • Patients receiving 7.5mg or more of prednisolone daily (or equivalent, see BNF chapter 6) for longer than 3 months should receive osteoporosis prophylaxis. No osteoporosis prophylaxis is indicated when corticosteroids are used as replacement therapy. See BNF chapter 6.
  • Care should be taken in reducing pharmacological doses of glucocorticoids if the patient has been treated for longer than 3 weeks, to avoid cortisol insufficiency due to prolonged suppression of the hypothalamic-pituitary-adrenal (HPA) axis.
  • In terms of their anti-inflammatory properties, approximately 20mg hydrocortisone is equivalent to 5mg prednisolone or 750 micrograms dexamethasone. See BNF chapter 6.
  • The table below shows the equivalent anti-inflammatory doses.

 

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