[Minimizing side effects of glucocorticoid therapy].
Glucocorticoids are highly valuable medication available to a physician, yet, their serious side effects have severely limited their use. Thus, the major purpose of our review is to provide a practical approach to increasing efficacy and minimizing side effects, that is increasing the benefit/risk ratio, of glucocorticoid therapy. The most effective way of avoiding their side effects, including infection, osteoporosis, atherosclerosis, is simply to avoid the overuse of glucocorticoids and to restrict their use to the truly indicated disease. Side effects can be reduced in part by the development of drug delivery systems, such as topical administration and targeting therapy. Combinations of calcium, vitamin D and sometimes thiazide or calcitonin, as compensatory therapy, have shown some favorable results for the prevention of osteoporosis. Although glucocorticoid therapy causes an increase of high-density lipoprotein and a decrease of lipoprotein (a) in serum, both are possibly preventive for atherosclerosis, hypertension and diabetes mellitus which are risk factors of atherosclerosis should be controlled. Future trends to remove their side effects will be obtained by more specific therapy based upon their pathogenesis.
Kawai
S
S
Institute of Medical Science, St. Marianna University School of Medicine.
Mizushima
Y
Y
D000309:Adrenal Insufficiency / Q000209:etiology / Q000628:therapy; D001161:Arteriosclerosis / Q000209:etiology / Q000628:therapy; D016503:Drug Delivery Systems; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D009894:Opportunistic Infections / Q000209:etiology* / Q000628:therapy; D010024:Osteoporosis / Q000209:etiology* / Q000628:therapy
D005938:Glucocorticoids