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Treatment
12. Prevention and Management of Adverse Events Related
to Steroid Use
12.3 Monitoring for acute/short-term and long-term adverse effects
• Patients should be routinely asked about adverse effects related to glucocorticoids.
During treatment with glucocorticoids and depending upon individual risk factors
such as dose and duration of glucocorticoid usage, other medications being used, and
comorbidities, particular attention should be given to the following acute/short-term
and long-term adverse effects:
▶ Acute/short-term AEs
» Increased vulnerability to infection
» Insomnia
» Anxiety
» Diabetes or glucose intolerance
» Hypertension
» Cutaneous changes
▶ Long-term AEs
» Bone loss (osteopenia, osteoporosis) and fractures
» Cataracts or glaucoma
» Steroid myopathy
» Relative adrenal insufficiency
» Psychiatric disturbance
» Gastric or duodenal ulcers
• GI prophylaxis with proton pump inhibitor or H2 antagonist is recommended.
• To limit steroid-induced bone loss, patient should receive adequate calcium (dietary
or supplementation), vitamin D, and weight-bearing exercise should be encouraged
when feasible. Bone-modifying agents may be offered to patients on steroids for
>3 months and are recommended for all patients with pre-existing osteoporosis.
Patients with or at risk for osteoporosis who have long-term survival potential, should
undergo bone mineral density testing.
(cont'd)
