TY - JOUR
T1 - Glucocorticoids for therapeutic immunosuppression
T2 - Clinical pearls for the practicing neurologist
AU - Galati, Alexandra
AU - Brown, E. Sherwood
AU - Bove, Riley
AU - Vaidya, Anand
AU - Gelfand, Jeffrey
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/11/15
Y1 - 2021/11/15
N2 - Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal.
AB - Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal.
KW - Glucocorticoid
KW - Neurology
KW - Risk mitigation
KW - Side effect
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U2 - 10.1016/j.jns.2021.120004
DO - 10.1016/j.jns.2021.120004
M3 - Review article
C2 - 34598056
AN - SCOPUS:85116004064
SN - 0022-510X
VL - 430
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 120004
ER -