BNF for Children 2011-2012

BNFC 2011–2012 6.3.2 Glucocorticoid therapy 373Hepatic impairmentWhen corticosteroids are administered orally or parenterally,the plasma-drug concentration may be increasedin children with hepatic impairment. Corticosteroidsshould be used with caution in hepatic impairmentand the child should be monitored closely.Renal impairmentOral and parenteral preparations of corticosteroidsshould be used with caution in children with renalimpairment.•••••Pregnancy and breast-feedingThe benefit of treatment with corticosteroids duringpregnancy and breast-feeding outweighs the risk; pregnantwomen with fluid retention should be monitoredclosely. Corticosteroid cover will be required duringlabour.Following a review of the data on the safety of systemiccorticosteroids used in pregnancy and breast-feedingthe CSM (May 1998) concluded:. corticosteroids vary in their ability to cross theplacenta; betamethasone and dexamethasonecross the placenta readily while 88% of prednisoloneis inactivated as it crosses the placenta;. there is no convincing evidence that systemic corticosteroidsincrease the incidence of congenitalabnormalities such as cleft palate or lip;. when administration is prolonged or repeated duringpregnancy, systemic corticosteroids increasethe risk of intra-uterine growth restriction; there isno evidence of intra-uterine growth restriction followingshort-term treatment (e.g. prophylactictreatment for neonatal respiratory distresssyndrome);. any adrenal suppression in the neonate followingprenatal exposure usually resolves spontaneouslyafter birth and is rarely clinically important;. prednisolone appears in small amounts in breastmilk but maternal doses of up to 40 mg daily areunlikely to cause systemic effects in the infant;infants should be monitored for adrenal suppressionif the mothers are taking a higher dose.6 Endocrine systemtuberculosis (or X-ray changes), hypertension, congestiveheart failure, diabetes mellitus including familyhistory, osteoporosis, susceptibility to angle-closureglaucoma (including family history), ocular herpes simplex—riskof corneal perforation, severe affective disorders(particularly if history of steroid-induced psychosis—seealso Psychiatric Reactions above), epilepsy,peptic ulcer, hypothyroidism, history of steroid myopathy,ulcerative colitis, diverticulitis, recent intestinalanastomoses, thromboembolic disorders, myastheniagravis; interactions: Appendix 1 (corticosteroids)Other contra-indications include: systemic infection(unless specific therapy given); avoid live virus vaccinesin those receiving immunosuppressive doses (serumantibody response diminished)Side-effects of corticosteroidsOverdosage or prolonged use can exaggerate some ofthe normal physiological actions of corticosteroids leadingto mineralocorticoid and glucocorticoid side-effects.Corticosteroids suppress growth and can affect thedevelopment of puberty. It is important to use the lowesteffective dose; alternate-day regimens may be appropriateand limit growth reduction. For the effect ofcorticosteroids given in pregnancy, see Pregnancy andBreast-feeding, above.Mineralocorticoid side-effects include hypertension,sodium and water retention, and potassium, and calciumloss. They are most marked with fludrocortisone,but are significant with cortisone, hydrocortisone, corticotropin,and tetracosactide (tetracosactrin). Mineralocorticoidactions are negligible with the high potencyglucocorticoids, betamethasone and dexamethasone,and occur only slightly with methylprednisolone, prednisolone,and triamcinolone.