Tapering systemic steroids

Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.

Fludrocortisone is rapidly and completely absorbed after oral administration. Man, dog, rat, monkey and guinea-pig were studied after . and intraduodenal administration. Depending on species, 50% or more of the steroid remained unchanged 30 minutes after administration. Fludrocortisone is hydrolysed to produce the non-esterified alcohol; after administration of the acetate, only the non-esterified alcohol is detectable in blood. The blood level reaches a peak between 4 and 8 hours. The highest blood level after . administration to human volunteers was hours.

The degree and extent of bone loss is most closely related to cumulative corticosteroid dose. The most rapid rate of bone loss is during the first 3 to 6 months of therapy. All patients starting gluocorticoids at any dose with an anticipated duration of at least 3 months or longer should start calcium 1200-1500mg/day and vitamin D 800-1000 international units/day supplementation. These patients should also be counseled on smoking cessation and weight-bearing activities. Additionally, they should be assessed for fall risk, baseline height, and history of fragility fractures.

The following observations relevant to systemic absorption were made in clinical studies. In one uncontrolled study a statistically significant decrease in responsiveness to metyrapone was noted in 15 adult steroid-independent patients treated with mg of flunisolide per day (the maximum recommended dose) for 3 months. A small but statistically significant drop in eosinophils from % to % of total circulating leucocytes was noted in another study in children who were not taking oral corticosteroids simultaneously. A 5% incidence of menstrual disturbances was reported during open studies, in which there were no control groups for comparison.

Tapering systemic steroids

tapering systemic steroids

The following observations relevant to systemic absorption were made in clinical studies. In one uncontrolled study a statistically significant decrease in responsiveness to metyrapone was noted in 15 adult steroid-independent patients treated with mg of flunisolide per day (the maximum recommended dose) for 3 months. A small but statistically significant drop in eosinophils from % to % of total circulating leucocytes was noted in another study in children who were not taking oral corticosteroids simultaneously. A 5% incidence of menstrual disturbances was reported during open studies, in which there were no control groups for comparison.

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