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Uveitis - Management
Managing the adverse effects of systemic corticosteroids

  • Adverse effects of systemic corticosteroids include:
    • Gastrointestinal toxicity: consider prescribing gastrointestinal protection. Peptic ulceration with perforation and haemorrhage, dyspepsia, abdominal distention, and oesophageal ulceration have been reported.
    • Osteoporosis: see the CKS topic on Osteoporosis - preventing steroid-induced for details on when to prescribe prophylactic bisphosphonate therapy.
    • Blood pressure: monitor annually and treat if necessary. See the CKS topic on Hypertension - not diabetic for more information.
    • Diabetes mellitus: screen every 6–12 months and treat if necessary. See the CKS topic on Diabetes type 2 for more information.
    • Glaucoma: screening is usually conducted within 3 months of starting corticosteroids and annually thereafter.
    • Adrenal insufficiency: gradually taper (reduce) the dose after prolonged systemic corticosteroid treatment to prevent potentially fatal acute adrenal insufficiency.
    • Immunosuppression: document the person's history of chickenpox or measles. Advise those without a history of chickenpox or measles who are taking systemic prednisolone to avoid close contact with people who have chickenpox, shingles, or measles and to seek urgent medical advice if they are exposed.
    • Psychiatric effects (such as mood changes, depression, suicidal thoughts, or feeling high) can occur within a few days or weeks after the start of treatment in up to 5–6% of people. Seek specialist advice if psychiatric adverse effects occur. Most people recover from these reactions after dose reduction or withdrawal, although specific treatment might be necessary.

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