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Ivim divided q4-6hr not to exceed 16 mgday plasma cortisol level then determined at 800 am on following morning level will be decreased in normal individuals but at baseline level in cushing syndrome cardiovascular bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis dermatologic acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria endocrine decreased carbohydrate and glucose tolerance, development of cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients fluid and electrolyte disturbances congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention, tumor lysis syndrome gastrointestinal abdominal distention, elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis metabolic negative nitrogen balance due to protein catabolismmusculoskeletal aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures neurologicalpsychiatric convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo ophthalmic exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, vision blurred other abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, malaise, moon face, weight gain administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids use with caution in cirrhosis, diverticulitis, myasthenia gravis, peptic ulcer disease, ulcerative colitis, renal insufficiency, pregnancy average and large doses of corticosteroids can cause elevation of blood pressure, sodium and water retention, and increased excretion of potassium these effects are less likely to occur with synthetic derivatives except when used in large doses dietary salt restriction and potassium supplementation may be necessary all corticosteroids increase calcium excretion literature reports suggest apparent association between use of corticosteroids and left ventricular free wall rupture after recent myocardial infarction therapy with corticosteroids should be used with great caution in these patients corticosteroids can produce reversible hypothalamic-pituitary adrenal (hpa) axis suppression with potential for glucocorticosteroid insufficiency after withdrawal of treatment adrenocortical insufficiency may result from too rapid withdrawal may be minimized by gradual reduction of dosage relative insufficiency may persist for months after discontinuation of therapy therefore, in any situation of stress occurring during that period, reinstitute hormone therapy if patient is receiving steroids already, may increase dosage metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients changes in thyroid status of patient may necessitate adjustment in dosage corticosteroids may exacerbate systemic fungal infections not for use in presence of such infections unless needed to control life-threatening drug reactions concomitant use of amphotericin b and hydrocortisone followed by cardiac enlargement and congestive heart failure reported latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by amoeba, candida, cryptococcus, mycobacterium, nocardia, pneumocystis, toxoplasma rule out latent amebiasis or active amebiasis before initiating corticosteroid therapy in any patient who has spent time in the tropics or any patient with unexplained diarrhea corticosteroids should be used with great care in patients with known or suspected strongyloides (threadworm) infestation corticosteroid-induced immunosuppression may lead to strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia not for use in cerebral malaria close observation necessary if corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity reactivation of the disease may occur during prolonged corticosteroid therapy, these patients should receive chemoprophylaxis use of oral corticosteroids not recommended in treatment of optic neuritis and may lead to increase in risk of new episodes corticosteroids should not be used in active ocular herpes simplex use lowest possible dose to control condition under treatment riskbenefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used may lead to inhibition of bone growth in pediatric patients and development of osteoporosis at any age special consideration should be given to patients at increased risk of osteoporosis (e...

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