BNF for Children 2011-2012

374 6.3.2 Glucocorticoid therapy BNFC 2011–20126 Endocrine systemGlucocorticoid side-effects include diabetes and osteoporosis(section 6.6); in addition high doses are associatedwith avascular necrosis of the femoral head.Muscle wasting (proximal myopathy) can also occur.Corticosteroid therapy is also weakly linked with pepticulceration; there is no conclusive evidence that the useof enteric-coated preparations of prednisolone reducesthe risk of peptic ulceration. See also Psychiatric Reactions,p. 372.High doses of corticosteroids can cause Cushing’ssyndrome, with moon face, striae, and acne; it is usuallyreversible on withdrawal of treatment, but this mustalways be gradually tapered to avoid symptoms ofacute adrenal insufficiency (important: see also AdrenalSuppression, p. 371).Side-effects can be minimised by using the lowesteffective dose for the minimum period possible.Other side effects include: gastro-intestinal effects: dyspepsia,abdominal distension, acute pancreatitis, oesophagealulceration and candidiasis; musculoskeletaleffects: muscle weakness, vertebral and long bone fractures,tendon rupture; endocrine effects: menstrual irregularitiesand amenorrhoea, hirsutism, weight gain,negative nitrogen and calcium balance, increased appetite;increased susceptibility to and severity of infection,reactivation of dormant tuberculosis; neuropsychiatriceffects: psychological dependence, insomnia, increasedintracranial pressure with papilloedema (usually afterwithdrawal), aggravation of schizophrenia, aggravationof epilepsy; ophthalmic effects: papilloedema, posteriorsubcapsular cataracts, corneal or scleral thinning andexacerbation of ophthalmic viral or fungal disease,increased intra-ocular pressure, exophthalmos, veryrarely angle-closure glaucoma; also impaired healing,petechiae, ecchymoses, facial erythema, suppression ofskin test reactions, urticaria, hyperhidrosis, skin atrophy,bruising, telangiectasia, myocardial rupture followingrecent myocardial infarction, congestive heart failure,leucocytosis, hyperglycaemia, hypersensitivity reactions(including anaphylaxis), thromboembolism,nausea, malaise, hiccups, headache, vertigo.For other references to the side-effects of corticosteroidssee section 1.5 (gastro-intestinal system), section3.2 (asthma), section 11.4 (eye) and section 13.4 (skin).BETAMETHASONECautions see notes aboveContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes above; transient effect on fetalmovements and heart rateBreast-feeding see notes aboveSide-effects see notes aboveLicensed use Betnesol c tablets not licensed for useas mouthwashIndication and doseSuppression of inflammatory and allergic disorders;congenital adrenal hyperplasia; seealso notes above. By slow intravenous injection or by intravenousinfusionChild 1 month–1 year initially 1 mg repeated upto 4 times in 24 hours according to responseChild 1–6 years initially 2 mg repeated up to 4times in 24 hours according to responseChild 6–12 years initially 4 mg repeated up to 4times in 24 hours according to responseChild 12–18 years initially 4–20 mg repeated upto 4 times in 24 hours according to responseEye section 11.4.1Ear section 12.1.1Nose section 12.2.1Mouth section 12.3.1Administration For intravenous infusion, dilute withGlucose 5% or Sodium Chloride 0.9%Betnesol c (UCB Pharma) AInjection, betamethasone 4 mg (as sodium phosphate)/mL. Net price 1-mL amp = £1.17. Label: 10,steroid cardDEFLAZACORTCautions see notes aboveContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveIndication and doseInflammatory and allergic disorders. By mouthChild 1 month–12 years 0.25–1.5 mg/kg oncedaily or on alternate days; up to 2.4 mg/kg (max.120 mg) daily has been used in emergency situationsChild 12–18 years 3–18 mg once daily or onalternate days; up to 2.4 mg/kg (max. 120 mg)daily has been used in emergency situationsNephrotic syndrome. By mouthChild 1 month–18 years initially 1.5 mg/kg oncedaily (max. 120 mg) reduced to lowest effectivedose for maintenanceCalcort c (Sanofi-Aventis) ATablets, deflazacort 6 mg, net price 60-tab pack =£15.82. Label: 5, 10, steroid cardDEXAMETHASONECautions see notes aboveContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also perineal irritationmay follow intravenous administration of the phosphateesterLicensed use consult product literature; not licensedfor use in bacterial meningitis