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BNSSG Adult Joint Formulary

6.2 Corticosteroid responsive conditions

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Last edited: 25-02-2025

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Corticosteroids (Systemic)

Glucocorticoid side-effects include diabetes and osteoporosis, which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae (see NICE CKS Osteoporosis - prevention of fragility fractures for recommendations); in addition high doses are associated with avascular necrosis of the femoral head. Muscle wasting (proximal myopathy) can also occur. Corticosteroid therapy is also weakly linked with peptic ulceration and perforation; and this risk is increased with concomitant NSAID (including low dose aspirin) use. There is no conclusive evidence that the use of enteric-coated preparations of prednisolone reduces the risk of peptic ulceration. Patients are also at risk of Psychiatric Reactions, see the BNF.

For further information on corticosteroids and monitoring see the CKS ‘Corticosteroids - oral’

High doses of corticosteroids can cause Cushing's syndrome, with moon face, striae, and acne; it is usually reversible on withdrawal of treatment, but this must always be gradually tapered to avoid symptoms of acute adrenal insufficiency (important: see Adrenal insufficiency (Remedy BNSSG ICB).

For further information on glucocorticoid withdrawal and on the use of the Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults see Managing glucocorticoid withdrawal (Remedy BNSSG ICB)

6.2.1 Steroid Replacement Therapy

Recommended: (TLS Green)

Fludrocortisone (oral)

Mineralocorticoid

Hydrocortisone (oral)

Glucocorticoid

Hydrocortisone (Efmody^®) (TLS Amber Specialist Recommended)

For congenital adrenal hyperplasia in patients who are not adequately controlled or have experienced androgen excess with immediate release hydrocortisone. Only for use in patients who were established on Efmody whilst under the care of paediatric endocrinology to support continuity of care
Long-term use of Efmody^® permitted only if long-term benefit on hormone profile has been demonstrated.

6.2.2 Steroid Responsive Therapy

Recommended: (TLS Green)

Hydrocortisone (parenteral)

Hydrocortisone sodium succinate (Solucortef^®) (parenteral)

Prednisolone 5mg tablets (25mg tablets in specific patients) (oral) (TLS Green)

Plain tablets not enteric-coated

Betamethasone (parenteral) (TLS Green)

Dexamethasone (oral & parenteral) (TLS Blue)

Methylprednisolone (parenteral) (TLS Blue)

Methylprednisolone (oral) (TLS Blue)

For treatment of acute episodes of multiple sclerosis

Budesonide (Targeted-release) (TLS Red)

NICE TA973 Targeted-release budesonide for treating primary IgA nephropathy

6.2.3 Cushing's syndrome and disease

Beta-hydroxylase Inhibitors

Metyrapone (TLS Blue)

Management of Cushing's syndrome

Somatostatin analogues

Pasireotide (TLS Red)

As per NHS England Clinical Commissioning Policy 16052/P Pasireotide diaspartate: an injectable medical therapy for the treatment of Cushing's Disease

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