Concurrent disease: Caution should be exercised in administering large doses of hydrocortisone to patients with known cardiac failure, hypertension, peptic ulceration, glaucoma, epilepsy, diabetes mellitus, chronic psychosis, and a past history of tuberculosis. The effects are enhanced in hepatic disease and hypothyroidism.
Adrenal Suppression: During prolonged therapy adrenal atrophy may develop and persist for years after stopping. Abrupt withdrawal after a prolonged period may lead to adrenal insufficiency, hypotension or death; however in most asthma patients (who continue to receive other appropriate treatment), abrupt withdrawal after courses of up to 3 weeks has not resulted in adverse effects. Withdrawal may also be associated with fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss.
Any significant intercurrent illness, trauma, or surgical procedure requires a temporary increase in dosage, or if already stopped, temporary re-introduction of corticosteroid.
Patients should carry a Steroid Treatment Card giving clear guidance on precautions to minimise risk and providing details or prescriber, drug, dosage and duration of treatment.
High Risk Groups: Fertility: Corticosteroids have been reported to increase or decrease the number or motility of spermatozoa but it is not known whether reproductive capacity in humans is adversely affected.
Use in Pregnancy: Corticosteroids cross the placenta. Although adequate studies have not been done in humans, there is some evidence that pharmacologic doses of corticosteroids may increase the risk of placental insufficiency, decreased birth weight, or stillbirth. However, teratogenic effects in humans have not been confirmed. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism and replacement therapy administered if required.
Use in Lactation: Problems in humans have not been documented. Breast-feeding is not recommended because it is excreted in breast milk and may cause unwanted effects, such as growth suppression and inhibition of endogenous steroid production, in the infant.
Use in Children: Chronic use of corticosteroids may suppress growth and development of the paediatric or adolescent and should be undertaken with caution. Also, paediatric patients may be at increased risk of developing osteoporosis, avascular necrosis of the femoral heads, glaucoma, or cataracts during prolonged therapy. Children and adolescents receiving prolonged therapy should be closely monitored. Large doses or corticosteroids may be associated with intra-cranial hypertension in children.
Use in Elderly: Geriatric patients may be more likely to develop hypertension during corticosteroid therapy. Geriatric patients, especially postmenopausal women, may also be more likely to develop glucocorticoid-induced osteoporosis.