Strategies To Reduce Corticosteroids Side Effects

Any medications, especially inhaled corticosteroids are known to exhibit some bothersome side effects. Some of the side effects are permanent while most are controllable by other medical interventions. One of the best known side effects of inhaled corticosteroids (ICS) is stunted growth in children. In order to avoid this adverse effect is to administer the lowest effective dose of ICS, and avoid night doses.

The portion of the inhaled drug that does not make it into the lung but is instead swallowed and the ensuing systemic effect interferes with the growth process. Therefore, physicians should choose drug formulations with low oral bioavailability.

From Medpage today:

Physicians should also keep in mind that, while compliance with ICS is generally poor in the long-term, children who conscientiously take their medicine will be at the greatest risk for slowed growth, Dr. Allen said. These children should be vigilantly monitored, he said.

Finally, it is important to persuade parents that managing a child’s asthma, which is a potentially life-threatening disease, is worth the risk of slowed growth. “Parents have an unrealistic fear about what the medicine will do to kid’s growth,” Dr. Allen said. “Reassure them that the lowest dose will be used and that their child will be carefully monitored.”

Another serious potential side effect of oral corticosteroids is suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Patients at high risk for HPA suppression include those who have received daily doses of more than 20mg of prednisone for more than three weeks, and those who have received an evening dose of prednisone for more than three weeks. One way to avoid this is through a prodrug that is converted to an active state in the lung tissue.

All these strategies simply suggest that proper administration, dosage and regular monitoring are the ways to lessen these effects of corticosteroids.