Adverse reactions associated with prolonged systemic glucocorticoid therapy are unlikely when high doses are administered over a short period of time.
Nevertheless, gastric and duodenal ulceration with possible perforation and hemorrhage, may occasionally occur. Hypersensitivity reactions may occasionally occur. A transient burning or tingling sensation, mainly in the perineal area, may occur following IV injection of large doses of corticosteroid phosphates. The following adverse reactions have been associated with prolonged systemic glucocorticoid therapy: Endocrine and Metabolic Disturbances: Cushing-like syndrome, hirsutism, menstrual irregularities, premature epiphyseal closure, secondary adrenocortical and pituitary unresponsiveness, decreased glucose tolerance, negative nitrogen and calcium balance.
Fluid and Electrolyte Disturbances: Sodium and fluid retention, hypertension, potassium loss, hypokalemic alkalosis.
Musculoskeletal Effects: Myopathy, abdominal dystention, osteoporosis, aseptic necrosis of femoral and humeral heads.
Gastrointestinal Effects: Gastric and duodenal ulceration, perforation and hemorrhage.
Dermatologic Effects: Impaired wound healing, skin atrophy, striae, petechiae and ecchymoses, bruising, facial erythema, increased sweating, acne.
CNS Effects: Psychic disturbances ranging from euphoria to frank psychotic manifestations, convulsions; in children, pseudotumor cerebri (benign intracranial hypertension) with vomiting and papilloedema.
Ophthalmic Effects: Glaucoma, intraocular pressure, posterior subcapsular cataracts.
Immunosuppressive Effects: Increased susceptibility to infections, decreased responsiveness to vaccination and skin tests.
Local adverse reactions include post-injection flare and a painless destruction of the joint reminiscent of Charcot's arthropathy, especially with repeated intra-articular injections.