Monday 06, Jul 2009
Ways To Minimize The Side Effects Of Corticosteroids
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Corticosteroid medications naturally have side effects, but there are ways to minimize them. One of the best known side effects of inhaled corticosteroids (ICS) is stunted growth in children. The most important way to try to avoid this adverse effect is to provide children with the lowest effective dose of ICS.
For patients on oral corticosteroids, another serious potential side effect is suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to adrenal insufficiency. Patients at high risk for HPA suppression include those with Cushingoid appearance, those who have received daily doses of more than 20mg of prednisone for more than three weeks, and those who have received an evening dose of prednisone for more than three weeks. One way to prevent this is by creating a prodrug that is converted to an active state in the lung tissue, thereby bypassing the dangers of swallowing a portion of the drug.
From Medpage today:
Physicians should also keep in mind that, while compliance with ICS is generally poor in the long-term, children who conscientiously take their medicine will be at the greatest risk for slowed growth, Dr. Allen said. These children should be vigilantly monitored, he said.
Finally, it is important to persuade parents that managing a child’s asthma, which is a potentially life-threatening disease, is worth the risk of slowed growth. “Parents have an unrealistic fear about what the medicine will do to kid’s growth,” Dr. Allen said. “Reassure them that the lowest dose will be used and that their child will be carefully monitored.”
However, patients in whom HPA suppression is unlikely include those who have been on steroids less than three weeks and those who are taking less than 5mg of prednisone daily. Based on the outlined strategies, side effects of corticosteroids can be avoided through proper dosage, administration and monitoring.
Tags: corticosteroids, ICS, inhaled corticosteroids, Prednisone
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