Oral Steroids

Potency: Low; also used for its mineralocorticoid effect.
Pharmacokinetics: Rapidly absorbed with an oral bioavailability of about 80-90%. The plasma half-life is about 1.5 hours, but the biological effect lasts for 8-12 hours. It is metabolized in the liver.
Oral Dosing: 20-240 mg daily in divided doses, depending on the condition.
IV Dosing: 100-500 mg, can be higher in stress doses.

Potency: Intermediate.
Pharmacokinetics: It is not commonly used orally for systemic treatment. When injected, it has a prolonged duration of action due to its slow release from the injection site.
Oral Dosing: Not commonly used orally for systemic treatment.
IV Dosing: Typically administered as an intra-articular or intramuscular injection rather than IV.

Potency: Considered intermediate.
Pharmacokinetics: Prednisone is converted to the active form, prednisolone, in the liver. It has a half-life of about 2-3 hours, but the biological half-life is 18-36 hours.
Oral Dosing: Varies widely based on condition; can range from 5 mg to 60 mg daily.
IV Dosing: Methylprednisolone (IV form) is used, typically at a dose equivalent to the oral form.

Potency: Slightly higher than prednisone.
Pharmacokinetics: Good oral absorption and a biological half-life of 18-36 hours. It is extensively metabolized in the liver.
Oral Dosing: 4-48 mg daily in divided doses.
IV Dosing: 10-500 mg, depending on the indication.

Potency: Very high (about 6-8 times more potent than prednisone).
Pharmacokinetics: Well absorbed orally, with a bioavailability close to 100%. The half-life is about 36-54 hours, and it is extensively metabolized in the liver.
Oral Dosing: 0.75 to 9 mg daily in divided doses.
IV Dosing: Same as oral dosing, but given intravenously.

Potency: Very high (similar to dexamethasone).
Oral Dosing: Less commonly used orally for systemic treatment.
Pharmacokinetics: Betamethasone is less frequently used systemically, but when used, it has a long half-life and is metabolized in the liver.
IV Dosing: Mainly used in prenatal care, not typically for systemic illnesses.

Anti-inflammatory: For conditions like rheumatoid arthritis, lupus, vasculitis, and inflammatory bowel disease.
Immunosuppression: In autoimmune conditions and post-organ transplantation.
Allergic Reactions: Severe allergic reactions and asthma exacerbations.
Adrenal Insufficiency: As replacement therapy.
Certain Cancers: Part of chemotherapy regimens.
Other Specific Indications: Like preterm labor (for fetal lung maturity), certain eye conditions, etc.

Hyperglycemia: Steroids can cause an increase in blood glucose levels, leading to steroid-induced diabetes or worsening control in existing diabetes.
Hypertension: Due to fluid retention and increased vascular sensitivity to catecholamines.
Mood and Cognitive Changes: Including euphoria, insomnia, mood swings, increased anxiety, and in some cases, psychosis.
Increased Susceptibility to Infection: Due to immunosuppressive effects.
Gastrointestinal Disturbances: Including gastritis and a higher risk of peptic ulcer disease, particularly when combined with NSAIDs.
Electrolyte Imbalance: Particularly hypokalemia and fluid retention.
Osteonecrosis: Especially of the femoral and humeral heads.
Acute Pancreatitis: Although rare, this is a recognized complication.

Adrenal Suppression: Prolonged use can lead to suppression of the hypothalamic-pituitary-adrenal (HPA) axis, making patients vulnerable to adrenal insufficiency during stress.
Iatrogenic Cushing’s Syndrome: Characterized by central obesity, facial rounding, striae, easy bruising, and muscle weakness.
Osteoporosis and Fractures: Steroids decrease bone formation and increase bone resorption.
Muscle Atrophy and Myopathy: Particularly proximal muscle weakness.
Growth Suppression: In pediatric populations, long-term steroid use can inhibit linear growth.
Ocular Complications: Including cataracts and glaucoma.
Cardiovascular Risks: Increased risk of atherosclerosis, myocardial infarction, and stroke.
Skin Changes: Thinning of the skin, delayed wound healing, and acneiform eruptions.
Psychiatric Disturbances: Including depression and potential exacerbation of pre-existing psychiatric conditions.
Immunosuppression: Increased risk of opportunistic infections and attenuation of the response to vaccines.

Monitoring of patients taking long-term corticosteroids
Baseline monitoring	Weight Height Body mass index Blood pressure	Complete blood count Glucose Lipids Bone mineral density (BMD)
Subsequent monitoring	Bone health	Annual height assessment for fragility fractures BMD four months post–steroid initiation If stable: to assess every 2–3 years If decreased: assess annually Fracture Risk Assessment Tool (FRAX) to estimate fracture risk
	Dyslipidaemia and cardiovascular risks	Assess lipids one month after steroid initiation Reassess every 6–12 months Australian absolute cardiovascular risk calculator to assess five-year cardiovascular risk
	Hyperglycaemia/diabetes	Screen opportunistically for symptoms of diabetes Monitor glucose parameters 48 hours after steroid initiationThen 3–6 months for the first year, annually thereafter
	Ophthalmological examination	Referral for annual eye examination Consider risk factors for glaucoma (family history, high myopia) and refer early if at high risk
	Falls risk	Assess people aged >65 years every 12 months. If previous falls or high risk of falls then every six months.