[Practical aspects of glucocorticosteroid therapy].
Alternate-day corticosteroid regimens have been advocated for maintenance therapy of several disorders. The objectives of this dose-spacing regimen are to decrease the undesired side effects of corticosteroids and at the same time to preserve their therapeutic effect. An analysis of the literature reveals that both the desired and the undesired effects of corticosteroids are decreased in alternate-day regimens as compared to daily regimens; whether dose-spacing improves the ratio of desired to undesired effects has not yet been established. Since for pharmacokinetic reasons the total exposure to prednisolone is lower in alternate-day regimens than in daily regimens, there is no reason to convert the daily prednisone regimen into an alternate-day schedule, instead of simply reducing the daily dose, in a patient with a good response to daily prednisone. Chronic maintenance of supraphysiologic levels of glucocorticoids is associated with the development of osteopenia. One mechanism responsible for osteopenia is an increase in bone resorption rates attributable to increased parathyroid hormone secretion secondary to inhibition of intestinal calcium absorption. There is evidence that administration of 25-hydroxyvitamin D and calcium may abrogate glucocorticosteroid-induced inhibition of intestinal calcium absorption and improve glucocorticoid-induced osteopenia. This evidence is discussed.
D002118:Calcium / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use
D005938:Glucocorticoids; D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium; D011241:Prednisone
Praktische Aspekte der Glucocorticosteroid-Therapie.