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Adverse Effects of Cortisone

Factors Influencing the Adverse Effects of Glucocorticoids

Given the diversity in the mechanism of action of glucocorticoids, they can cause a wide array of adverse effects ranging from mild to severe, some of which are unavoidable.Of all the factors influencing the adverse effects of glucocorticoids, dose and duration of therapy are the most important independent and well-documented risk factors.

Adverse Effects of Cortisone

Factors Influencing the Adverse Effects of Glucocorticoids

Given the diversity in the mechanism of action of glucocorticoids, they can cause a wide array of adverse effects ranging from mild to severe, some of which are unavoidable. Of all the factors influencing the adverse effects of glucocorticoids, dose and duration of therapy are the most important independent and well-documented risk factors. It is usually at “supra-physiologic” doses of corticosteroid administration where multiple and especially severe adverse effects of glucocorticoids occur, ranging from mild suppression of hypothalamic-pituitary axis to severe, life-threatening infections.[3] However, long-term use of low to moderate doses of glucocorticoids can also lead to several serious adverse effects.[4][5] Adverse effects of corticosteroids are both dose and time-dependent.[6] Some adverse effects follow a linear dose-response pattern where the incidence increases with an increase in the dose (ecchymosis, cushingoid features, parchment-like skin, leg edema, and sleep disturbance). Other adverse effects may follow a threshold dose-response pattern with an elevated frequency of events beyond a specific threshold value (weight gain and epistaxis at prednisone dose greater than 5 mg daily, glaucoma, depression, hypertension at prednisone dose greater than 7.5 mg daily, etc.).

Several other factors may influence the adverse effects of glucocorticoids. Older age, comorbid conditions (such as diabetes mellitus), concomitant use of other immunosuppressive agents, severity and nature of the underlying disease, and poor nutritional status can all influence the occurrence and magnitude of side effects.