Systemic Steroid Properties

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Note:
  • MedCalc Steroid Equivalence Calculator
  • Medrol Dosepak (Tapering 6 day course) = 24, 20, 16, 12, 8, 4 mg of methylprednisolone daily = 30, 25, 20, 15, 10, 5 mg of prednisone or prednisolone daily
  • “Immunosuppressive doses” defined as:
    • ≥20 mg prednisone QD [or equivalent] for >14 days (US CDC)
    • ≥40 mg prednisolone QD [or equivalent] for >7 days (UK Green Book)
    • Immunosuppression persists for at least 1 mo after treatment discontinuation


Topical Steroids


Inhaled Steroids



Steroid Adverse Effects

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Topical Steroids (Schneider)

  • Steroid side effects are rare and reversible
    • Reversible: telangiectasia, atrophy, acne, rosacea, increased hair growth
    • Non-reversible: striae
    • Low-mid potency steroids will not cause clinically significant adrenal suppression


Steroid Drug Interactions

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Adrenal Suppression Screening

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Steroid Hypersensitivity

  • IgE-mediated reactions may be due to additives:
    • Triamcinolone – carboxymethylcellulose
    • Hydrocortisone – parabens
    • Methylprednisolone – polyethylene glycol
      • Case report that some concentrations of IV methylprednisolone (Pfizer Solu-medrol) and tablets contain cow's milk protein
    • Triamcinolone, hydrocortisone, methylprednisolone – benzyl alcohol

References