6.2 Corticosteroid responsive conditions

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6.2 Corticosteroid responsive conditions

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only

Corticosteroids

Glucocorticoid therapy

Following concern about severe chickenpox associated with systemic corticosteroids, the CSM has issued notice that every patient prescribed a systemic corticosteroid should receive the patient information leaflet supplied by the manufacturer.

Corticosteriods (Systemic)

Prednisolone

Tablets 1mg, 5mg, 25mg
Oral solution 5mg in 5ml unit-dose container (only when plain tablets cannot be used)
Enteric coated tablets 2.5mg, 5mg

Note:

The link between peptic ulceration and standard formulation prednisolone tablets is weak.
The enteric coated tablets have no proven additional benefit and are 9 times more expensive.

Dexamethasone

Tablets 500micrograms, 2mg
Injection (as sodium phosphate) 3.8mg in 1mL
Tablets, soluble 2mg, 4mg, 8mg
Oral solution Sugar free 2mg in 5mL
Elixir 500micrograms in 5mL U

Hydrocortisone

Tablets 10mg, 20mg
Injection (as sodium succinate) 100mg vial

Fludrocortisone acetate

Tablets 100 micrograms

Notes:

Fludrocortisone may be given as a mineralocorticoid in combination with hydrocortisone in adrenocortical insufficiency.
Use can be made of the mineralocorticoid activity of fludrocortisone in the treatment of neuropathic postural hypotension. (Unlicensed indication - See BNF section 6.1.5)

Methylprednisolone

Depo-Medrone® Injection (aqueous suspension), methylprednisolone acetate 40mg in 1mL, 80mg in 2mL, 120mg in 3mL vial
Solu-Medrone® Injection, powder for reconstitution, methylprednisolone (as sodium succinate) (all with solvent); 40mg, 125mg, 500mg, 1g, 2g vial

Methylprednisolone (Amber 2)

Medrone® Tablets 100mg

Note:

Unlicensed use for relapse in Multiple Sclerosis
Dose - Medrone tablets, 5 x 100mg (500mg) once daily for 5 days
Consultant Neurologist recommendation only.
See Fax sheet to ask GP to prescribe High Dose Oral Methylprednisolone in MS relapse.

Notes:

Equivalent doses of glucocorticoid activity:5mg Prednisolone = Dexamethasone 750micrograms, Hydrocortisone 20mg, Methylprednisolone 4mg
Different preparations of dexamethasone contain different salts. Therefore, care is needed to ensure that patients receive equivalent doses when transferring from tablets to injections.
The equivalent doses are:1mg dexamethasone = 1.2mg dexamethasone phosphate = 1.3mg dexamethasone sodium phosphate

Betamethasone (Amber 2)

Soluble tablets (as sodium phosphate) 500 micrograms
Injection 4mg in 1mL - (Hospital only)

Triamcinolone acetonide

Injection (as acetonide) 40mg in 1mL

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only