Oral corticosteroids for addison's disease

Most clinicians in private practice are regularly faced with challenging dermatologic cases, and a common question arises: How much prednisone is too much? No one can definitively answer this question, as different dogs respond in different ways. Some patients are unaffected by long-term prednisone administration, while others immediately demonstrate polyphagia, polydipsia and polyuria, or incontinence. Still others show signs of iatrogenic Cushing's disease—muscle wasting, a pot-bellied appearance, and muscle weakness—early on in therapy. The best approach is to try the safest treatment first, monitor the patient's response carefully, and adjust the therapeutic protocol if side effects become problematic or the condition does not respond.

Oral and injectable systemic corticosterois are steroid hormones prescribed to decrease inflammation in diseases and conditions such as arthritis (rheumatoid arthritis, for example), ulcerative colitis, Crohn's disease, asthma, bronchitis, some skin rashes, and allergic or inflammatory conditions that involve the nose and eyes. Examples of systemic corticosteroids include hydrocortisone (Cortef), cortisone, prednisone (Prednisone Intensol), prednisolone (Orapred, Prelone), and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol). Some of the side effects of systemic corticosteroids are swelling of the legs, hypertension, headache, easy bruising, facial hair growth, diabetes, cataracts, and puffiness of the face.

If you require short bursts of oral corticosteroids, you can be taken off of them by quickly decreasing the dose or at times even abruptly stopping the medications. In contrast, long term use of corticosteroids require slow, careful reduction in dosing. You may experience unpleasant side effects upon discontinuing short or long term oral corticosteroid administration. This is known as "steroid withdrawal." These adverse effects may include muscle aches, joint pains, fatigue, poor appetite, and even fever. When coming off corticosteroids, you may even be at risk for symptoms that were suppressed while on corticosteroids such as skin problems, hayfever, sinus symptoms, and arthritis-like symptoms. If you are at risk for "steroid withdrawal" symptoms, a slow taper over a long period of time may be necessary in addition to supplemental aspirin-like medication to relieve musculo-skeletal discomfort.
 

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  • Citation tools Download this article to citation manager Waljee Akbar K , Rogers Mary A M , Lin Paul , Singal Amit G , Stein Joshua D , Marks Rory M et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study BMJ 2017; 357 :j1415
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    Oral corticosteroids for addison's disease

    oral corticosteroids for addison's disease

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  • Citation tools Download this article to citation manager Waljee Akbar K , Rogers Mary A M , Lin Paul , Singal Amit G , Stein Joshua D , Marks Rory M et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study BMJ 2017; 357 :j1415
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