6.3.2 Glucocorticoid therapy

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: