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.
  • An additional Steroid Emergency Card for Northern Ireland has been developed in response to the National Patient Safety Alert that was issued in August 2020. 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.
  • 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:
Equivalent anti-inflammatory doses of corticosteroids
This table takes no account of mineralocorticoid effects, nor does it take account of variations in duration of action
Prednisolone 5mg

≡ Betamethasone 750 micrograms

≡ Deflazacort 6mg

≡ Dexamethasone 750 micrograms

≡ Hydrocortisone 20mg

≡ Methylprednisolone 4mg

≡ Prednisone 5mg

≡ Triamcinolone 4mg