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Rational Use of Steroids: Understanding Classifications and Clinical Applications

This presentation by Dr. Sachin Kuchya provides an overview of the rational use of steroids, explaining the three classes of steroids—glucocorticoids, mineralocorticoids, and sex steroids. It highlights the common irrational use of glucocorticoids, the risks of inadequate immunosuppression, and HPA axis suppression. The presentation includes examples of dosing regimens for conditions such as asthma exacerbation and gouty arthritis, emphasizing the importance of rational dosing for effective treatment and patient safety. Insights into the benefits of rational use are also discussed.

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Rational Use of Steroids: Understanding Classifications and Clinical Applications

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  1. Rational use of Steroids Sachin Kuchya, MD DNB

  2. Steroids - Introduction Three classes, • Glucocorticoids – The daily secretion of cortisol is about 20 mg/ day with diurnal variation, peaks during early morning hrs, lowest during late evening hrs. Also exert feedback inhibition on HPA axis, maximal inhibition during late evening hours • Mineralocorticoids – for salt & water balance • Sex steroids – for reproductive function

  3. IRRATIONAL USE ? • Glucocorticoids – most common.

  4. Example 1 • Methylprednisolone 4 mg / Prednisolone 4 mg / Dexamethasone 0.5 –1.0 – 2 mg three times daily for treating an episode of Asthma exacerbation / attack of Gouty arthritis. Why Irrational – Inadequate Immunosupression & risk of HPA axis suppression

  5. Example 2 • IV Hydrocortisone 100 – 200 mg every 6 hourly / IV Methyl prednisolone 40 – 125 mg every 8 hourly for status asthmaticus (even included in some guidelines) Why Irrational –Risk of salt & water retention ( greater with hydrocortisone) & risk of HPA axis suppression

  6. Steroids – Classification(on the basis of biological half lives)

  7. Steroids – Classification

  8. Glucocorticoids - Indications • As hormone replacement therapy – in deficiency syndromes like Addisonian states ( physiological replacement doses) • For HPA axis suppression, in Congenital Adrenal Hyperplasia (physiological doses are sufficient) • Anti Inflammatory activity / Immunosuppressive action (5- 20 times of physiological doses)

  9. Glucocorticoid - Doses

  10. Glucocorticoid – Preferred ones

  11. Glucocorticoids – Dosing regimen

  12. Rational use…. Example 1 Methylprednisolone 4 mg / Prednisolone 4 mg / Dexamethasone 0.5 – 2 mg three times daily for treating an episode of Asthma exacerbation / attack of Gouty arthritis. The rational regimen for treating an episode of Asthma exacerbation / attack of Gouty arthritis - Methylprednisolone 16 - 32 mg / Prednisolone 20 - 60 mg once daily / on alternate days, repeated at 8 AM in the morning.

  13. Rational use….. Example 2 IV Hydrocortisone 100 – 200 mg every 6 hourly / IV Methyl prednisolone 40 – 125 mg every 8 hourly for status asthmaticus (even included in some guidelines) The rational regimen for status asthmaticus–IV Methylprednisolone 125 – 1000mg stat followed by oral regimen stated above (example 1), once the condition settles down.

  14. Benefit of RUD - Glucocorticoids Better immunosupression in patients with Br Asthma / RA / without any HPA axis inhibition Adequate inhibition of HPA axis in patients with Congenital Adrenal Hyperplasia, without salt & water overloading.

  15. Thank you, wish to have your views & comments. Based on Goodman & Lawrence.

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