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In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated. Drug-induced secondary adrenocortical insufficiency may result from too rapid withdrawal of corticosteroids. Corticosteroids may mask some signs of infection, and new infections may appear during their use. Corticosteroids may affect the nitro blue tetrazolium test for bacterial infection and produce false negative results.
Administration of live virus vaccines is contraindicated in individuals receiving immunosuppressive doses of corticosteroids. If inactivated viral or bacterial vaccines are administered to individuals receiving immunosuppressive doses of corticosteroids, the expected serum antibody response may not be obtained.
Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of corticosteroid withdrawal syndrome including fever, myalgia, arthralgia and malaise. There is an enhanced effect of corticosteroid in patients with hypothyroidism and in those with cirrhosis. Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation.
Psychotic derangement may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes and severe depression. Steroids should be used with caution in nonspecific ulcerative colitis. The use of triamcinolone in active tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculous regimen. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, dose observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.
Use in Children: Chronic use of corticosteroids should be undertaken with caution since prolonged use may suppress growth and development.
