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Medicines Monitoring

Corticosteroids monitoring

Published Last updated
Topics: BetamethasoneDexamethasoneFludrocortisone · HydrocortisoneMonitoringPrednisolone ·
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents

  1. Before starting
    1. Required
  3. Ongoing once stable
    1. Required
    2. Children and adolescents
  5. Bibliography
  6. Update history

Before starting

Required

  • Baseline
    • Blood pressure
    • Weight
    • Body mass index
    • Bone mineral densityin adults expected to be on prednisolone at a dose equal or greater than 5mg a day, or equivalent, for over 3 months
    • HbA1c
    • Heightin children and adolescents
    • Eye examinationfor glaucoma or cataract
    • Risk factor assessmentcheck for pre-existing conditions potentially exacerbated by steroids
    • Serum potassium
    • Triglycerides

Risk factor assessment

Prior to starting treatment, assess for risk factors or pre-existing conditions that may potentially be exacerbated by steroid therapy, such as:

  • diabetes
  • dyslipidemia
  • cardiovascular disease
  • gastrointestinal disorders
  • glaucoma
  • mood or psychiatric disorders
  • osteoporosis

Patients taking oral corticosteroids should be considered for a fracture-risk assessment.

For further information on cautions and pre-existing conditions that may be exacerbated by steroid therapy see NICE CKS monitoring of long-term oral corticosteroids.

Ongoing once stable

Required

  • Every 3 months
    • HbA1cmonitor people with confirmed diabetes mellitus more closely, depending on clinical judgement
  • Every 6 - 12 months
    • Eye examinationearlier for those with symptoms of cataracts
    • Serum potassium
    • Triglycerides
  • At 12 months; then annually or every 2-3 years depending on risk
    • Bone mineral density
  • Periodically at appointments
    • Blood pressure
    • Falls risk assessmentwhere appropriate
    • Signs of adrenal suppressionfollow NICE CKS adrenal insufficiency advice if long-term or regular oral corticosteroids
    • Weight
    • Heightin children and adults

Determining BMD monitoring frequency

  • If BMD is stable at 12 months and fracture risk low, monitor again every 2 to 3 years.
  • If BMD decreased at 12 months, monitor BMD and fracture risk annually, consider referral.

Consider referral following eye examination

Consider referral for intraocular pressure assessment if personal or family history of:

  • open angle glaucoma
  • diabetes
  • high myopia
  • connective tissue disease (particularly rheumatoid arthritis)

Children and adolescents

  • Every 6 months
    • Heightplot on a growth chart; refer to a paediatrician if growth suppression suspected.

Follow NICE CKS monitoring of long term oral corticosteroids for children and adolescents receiving long-term or regular oral corticosteroid treatment.

Bibliography

Update history

  1. Full review and update. Minor changes to wording, no significant changes made.
  1. Republished
  1. Published