Glucocorticoid therapy: minimizing side effects.
OBJECTIVE
To describe the main undesirable side effects of glucocorticoid therapy, mechanisms of action and the necessary measures to minimize side effects.


METHODS
Author's experience, supplemented with papers published in MEDLINE.


RESULTS
The principles for minimizing undesirable side effects of glucocorticoid therapy include: a) only use glucocorticoids if they are essential; b) avoid the use of long-acting glucocorticoids, using short- and intermediate-acting glucocorticoids instead; c) keep treatment as short as possible, since treatment lasting 5 to 7 days shows fewer side effects and quick recovery of the hypothalamic-pituitary axis; d) use glucocorticoids with local activity preferentially, such as inhaled glucocorticoids; e) use in association with other drugs, especially with other more specific anti-inflammatory or immune suppressive drugs, promoting a synergistic effect in order to avoid the use of glucocorticoids or to reduce dosage and duration of glucocorticoid therapy; f) indicate the minimum effective dose, respecting individual sensitivity to glucocorticoids.


CONCLUSIONS
In order to choose the best glucocorticoid schedule it is essential to understand the pharmacological characteristics and the biological action of glucocorticoids, allowing the most adequate indication, glucocorticoid dose, mode of administration and the duration of glucocorticoid therapy.
Longui
Carlos Alberto
CA
Unidade de Endocrinologia Pediátrica, Depto. Pediatria e Puericultura, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil. carloslongui@msn.com
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D007333:Insulin Resistance; D011965:Receptors, Glucocorticoid / Q000502:physiology; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011965:Receptors, Glucocorticoid