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Sarcina si lactatie Anumite studii pe animale au aratat ca glucocorticoizii administrati la mama in doze mari pot determina malformatii fetaleStudii reproductive umane adecvate nu au fost efectuate cu corticoiziDe aceea folosirea corticosteroizilor in sarcinalactatie sau la femei cu potential fertil se recomanda in cazul in care beneficiile terapiei depasesc evident riscul potential pentru mamaembrion sau fatDeoarece evidenta sigurantei in sarcina este inconsistentamedicamentul va fi folosit in sarcina numai in cazuri de absoluta necesitateCorticosteroizii traverseaza placentaNou-nascutii mamelor care au primit doze substantiale de corticoizi in timpul sarcinii trebuie atent monitorizati si evaluati pentru o posibila insuficienta adrenalianaNu se cunosc efectele corticoizilor asupra travaliului si a expulsiei fetaleCorticoizii trec in laptele matern.

Frequency not reportedCushingoid statehirsutismsecondary adrenocortical and pituitary unresponsivenessparticularly in times of stressas in traumasurgeryor illnessmoon faceRef]

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Frequency not reportedHepatomegalyelevation in liver enzymestoxic hepatitisRef]

Masuri de precautie La pacientii sub terapie corticosteroida supusi unui stres neobisnuit se recomanda cresterea dozei de corticoizi cu actiune rapida inaintein timpul si dupa situatiile stresanteCorticoizii pot masca semnele de infectie sau pot aparea noi infectiiIn timpul tratamentului cu corticosteroizi poate scadea capacitatea de rezistenta la infectii si de localizare a infectieiFolosirea prelungita a corticoizilor poate produce cataracta posterioara subcapsularaglaucom cu posibila afectare a nervului opticaparitia unor infectii oculare secundare cu fungi sau virusuriPot aparea si reactii alergicede exangioedemDoze mari de hidrocortizon si cortizon pot determina cresterea presiunii arterialeretentie sodata si lichidiana cu cresterea excretiei de potasiuAceste efecte sunt putin probabile in cazul folosirii derivatilor sinteticicu exceptia dozelor mariDe aceea se recomanda dieta cu restrictii de sodiu si supliment de potasiuToti corticoizii cresc excretia de calciuIn timpul tratamentului cu corticoizi nu se va face vaccinarea impotriva variceleiDe asemenea nu se vor efectua nici alte proceduri de imunizarein special la doze maridatorita posibilelor complicatii neurologice si a lipsei de raspuns cu anticorpiFolosirea Medrol tablete in tuberculoza activa va fi restransa la cazurile fulminante sau diseminatedar numai in combinatie cu terapia antituberculoasa adecvataDaca se recomanda tratamentul cu corticoizi la pacientii cu tuberculoza latenta sau reactivitate la tuberculinaeste necesara monitorizarea atentaexisand posibilitatea reactivarii boliiIn cazul terapiei prelungite cu corticoizi in aceste cazurise va institui chimioprofilaxiaNu exista o explicatie general acceptata daca corticoizii determina ulcer pepticCorticoizii pot masca simptomele de ulcer peptic si astfel poate aparea perforatia sau hemoragia fara durere semnificativaOsteoporoza este o reactie adversa in general recunoscuta ca fiind asociata cu terapia prelungita sau cu doze mariLa copiii cu tratament zilnic pe termen lung poate aparea supresia cresterii si de aceea glucocorticoizii vor fi rezervati numai cazurilor urgenteTerapia alternanta evita sau minimalizeaza efectele adversePacientii sub tratament cu doze mari de corticoizi au imunitatea scazuta si deci o susceptibilitate crescuta la infectii cu fungibacterii sau virusuriInsuficienta adrenocorticala indusa de corticoizi pote fi redusa prin scaderea treptata a dozeiAceasta insuficienta relativa poate persista luni de zile dupa intreruperea tratamentuluiDe aceea la orice stres ce apare in aceasta perioada se recomanda reinstituirea terapiei hormonaleDeoarece secretia mineralocorticoida poate fi afectatase vor administra si sare sau/si mineralocorticoiziEfectul corticoizilor este amplificat la pacientii cu hipotiroidie sau cirozaLa pacientii cu herpes simplex ocular se vor administra cu precautie corticoizi datorita posibilului risc de perforatie corneanaSe va folosi cea mai mica doza care controleaza simptomatologiaiar cand este posibil se va reduce treptat medicamentul pana la interuperea terapieiIn timpul terapiei cu corticoizi pot aparea tulburari psihicecum ar fi euforieinsomniemodificari ale dispozitieitulburari de personalitate si depresii severe cu manifestari franc psihoticeDe asemenea instabilitatea emotionala sau tendintele psihotice preexistente pot fi agravate in cursul tratamentuluiLa pacientii cu hipoprotrombinemietratati cu corticosteroizise vor folosi cu precautie aspirina sau alte antiinflamatoare nesteroidieneCorticoizii se vor folosi cu precautie si in colitele ulcerative nespecificeunde exista pericolul perforariide abces sau alte infectii piogenicein diverticulitaanastomoze intestinaleulcer peptic latent sau activinsuficienta renalahipertensiuneosteoporoza sau miastenia gravisDeoarece complicatiile tratamentului cu glucocorticoizi sunt dependente de marimea dozei si durata terapieise recomanda individualizarea tratamentului pe baza unui raport risc/beneficiu cu specificarea dozeiduratei si daca este cazul folosirii terapiei zilnice sau alternanteCarcinogenitatemutagenitate si fertilitateNu exista evidente asupra efectelor carcinogeneticemutagenice sau de afectare a fertilitatii ale corticoizilor.

Frequency not reportedDepressionemotional instabilityeuphoriainsomniamood swingspersonality changespsychic disordersconfusional statesanxietyabnormal behaviorirritabilityRef]

Reversible transaminase elevationsASTALThave been observed following corticosteroid therapyThese changes have generally been small and not associated with any clinical syndromeToxic hepatitis has been reported with high doses of cyclically pulsed IV therapyonset has been several weeks or longerResolution has been reported with discontinuationhoweverrecurrence has been reported with rechallengeRef]

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