Corticosteroid therapies

There are several forms of corticosteroid therapies defined according to their route of administration, the duration of the prescription and the dosage recommended.

 

Note

The main routes of administration of corticosteroids are :

  • - Oral (by ingestion through the mouth) e.g., prednisone, prednisolone, methylprednisolone, betamethasone, hydrocortisone, dexamethasone
  • - Parenteral (intravenous or intramuscular) e.g., methylprednisolone, triamcinolone, dexamethasone
  • - Inhalation (e.g. aerosol in asthma) e.g., beclometasone, budesonide, flunisolide, fluticasone
  • - Topically (e.g. application to skin) e.g., beclometasone, betamethasone, clobetasol
  • - In addition, corticosteroids may also be administered by intra-articular, ocular, nasal, rectal (enema), in ear or spinal methods.

How cortisone is administered depends largely on the patient's illness and the subsequent decision by the doctor. For certain diseases, two modes of administration are combined (e.g. orally and intra-articular injection for rheumatoid arthritis) or alternated (e.g. orally and by inhalation for asthma). In the USA and in France, prednisone is mainly prescribed when a systemic therapy is needed. In the UK, prednisolone is favoured.

When possible, your doctor will focus on "local" routes of administration (e.g. inhalation or intra-articular injection). These pathways usually result in fewer side effects. However, it should be taken into account that these local routes of administration may also induce systemic side effects, especially during repeated exposure.

Short and long-term corticosteroid therapies have one significant difference: prolonged therapy with cortisone results in a set of unique side effects. Long term corticosteroid therapy is defined as treatment over a period lasting at least three months. Please keep in mind, this is an arbitrary timeframe. Medical professionals are always looking to prescribe the appropriate amount of cortisone over the shortest time possible.

Another useful reference point is the daily dosage of cortisone administred. If the daily dosage is less than 7.5 mg prednisone/prednisolone (or equivalent) it is considered a low dose. Between 7.5 mg and 30 mg of prednisone is considered a moderate dose. Over 30 mg of cortisone administered per day is considered a high dosage. Please note: these definitions are somewhat arbitrary. They are meant to give you an idea of how steroids are prescribed by most medical professionals.

These medications vary in their anti-inflammatory activity. The table below lists each drug with a number that corresponds with its degree of anti-inflammatory activity (in comparison to that of natural cortisol which is 1). These figures are commonly accepted in the medical world but remain somewhat theoretical nonetheless.

 Anti - inflammatory activity
Natural cortisol (or hydrocortisone) 1
Prednisone / prednisolone 4
Methylprednisolone 5 - 7
Triamcinolone 5
Betamethasone 25 - 30
Dexamethasone 25 - 80
GOOD TO KNOW
  • When beclometasone (e.g. Becotide®, Clenil®, Qvar®) is inhaled by two puffs, four times a day the daily dosage is closed to an equivalent of 3 mg of prednisone taken orally.
Useful references
  • Huscher D et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009
  • Walsh LJ et al. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ. 1996

lastest update : May 08 2015