A review on challenges & clinical management of adverse drug reactions associated with corticosteroids treatment by clinical pharmacist perspective
Abstract
Corticosteroids are used extensively in clinical practice because of their strong anti-inflammatory and immunosuppressive actions, rendering them useful in the management of various conditions such as autoimmune diseases, allergic diseases, and chronic inflammatory conditions. Despite their beneficial use, the prolonged use of corticosteroids has been related to a vast number of adverse drug reactions (ADRs) that can strongly influence patient health and treatment outcomes. These ADRs are associated with metabolic abnormalities like hyperglycaemia, hypertension, osteoporosis and susceptibility to infections caused by profound immunosuppression. Corticosteroid use can also cause mood alterations, weight gain, Cushing's syndrome, and gastrointestinal adverse effects. Healthcare practitioners must use careful monitoring and efficient management due to the serious consequences of corticosteroid-induced adverse drug reactions. Reword this statement. This involves performing routine supervising to detect ADRs in a timely manner, employing the smallest required corticosteroid dose for the minimum duration, and using alternative therapy where possible. Reporting and monitoring of ADRs are important practices in enhancing patient safety and for making clinical recommendations. Patient-orientated strategies involving education about early detection of ADR symptoms and compliance with management strategies are critical in preventing risks. This review highlights the need for thorough risk assessment and tailored therapy to maximize therapeutic effectiveness and reduce corticosteroid-related adverse effects.
Keywords:
Corticosteroids, drug adverse reactions (ADRs), immunosuppression, metabolic disturbances, clinical management, patient-focused care
References
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31. Farzan N, Vijverberg SJH, Arets HG, et al. Pharmacogenomics of inhaled corticosteroids and leukotriene modifiers: a systematic review. Clin Exp Allergy 2017; 47:271–93. https://doi.org/10.1111/cea.12844.
2. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). 1932. Obes Res 1994;2:486–508. https://doi.org/10.1002/j.1550-8528.1994.tb00097.x.
3. Sambrook P, Lane NE. Corticosteroid osteoporosis. Best Pract Res Clin Rheumatol 2001; 15:401–13. https://doi.org/10.1053/berh.2001.0157.
4. Bektaş O. Coronary Slow Flow Accompanying Exertional Blurred Vision and Effects of Corticosteroids. Am J Case Rep 2015; 16:315–8. https://doi.org/10.12659/AJCR.893461.
5. Porta S, Danza A, Arias Saavedra M, et al. Glucocorticoids in Systemic Lupus Erythematosus. Ten Questions and Some Issues. J Clin Med 2020; 9:2709. https://doi.org/10.3390/jcm9092709.
6. Curtis JR, Westfall AO, Allison J, et al. Population‐based assessment of adverse events associated with long‐term glucocorticoid use. Arthritis & Rheumatism 2006; 55:420–6. https://doi.org/10.1002/art.21984.
7. Manson SC, Brown RE, Cerulli A, Vidaurre CF. The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med. 2009 Jul;103(7):975-94. doi: 10.1016/j.rmed.2009.01.003. Epub 2009 Apr 15. PMID: 19372037.
8. Fardet L, Petersen I, Nazareth I. Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing’s syndrome: cohort study. BMJ 2012;345: e4928. https://doi.org/10.1136/bmj.e4928.
9. Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and post discharge call-backs (IPITCH Study). J Hosp Med 2016; 11:39–44. https://doi.org/10.1002/jhm.2493.
10. Burle, G. S., Kakullamarri, P. R., Kothamasu, S. B., Kallam, S. D. M., & Bodapati, A. (2024). Case Study on Regulatory Approaches for New Degradation Impurity Exceeding ICH Thresholds in Solubilized Ibuprofen Capsules During Stability Testing. Journal of International Research in Medical and Pharmaceutical Sciences, 19(3), 70–82. https://doi.org/10.56557/jirmeps/2024/v19i38936
11. Yasir M, Goyal A, Sonthalia S. Corticosteroid Adverse Effects. StatPearls, Treasure Island (FL): StatPearls Publishing; 2025.] [Manson SC, Brown RE, Cerulli A, Vidaurre CF. The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med. 2009 Jul;103(7):975-94. doi: 10.1016/j.rmed.2009.01.003. Epub 2009 Apr 15. PMID: 19372037.
12. Simons FER, Ardusso LRF, Bilò MB, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J 2011; 4:13–37. https://doi.org/10.1097/WOX.0b013e318211496c.]
13. Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270–7. https://doi.org/10.1016/j.jaci.2014.02.036.
14. Divya Kumar Vemuri, Rambabu Gundla, Jayaprakash Kanijam Raghupathi, Nagalakshmi Jeedimalla, Gowri Sankararao Burle, Naresh Kumar Katari, Sreekantha Babu Jonnalagadda, Development of LC/LCMS method for estimation of impurities in anti-HIV drug (Bictegravir) using Analytical Quality by Design (AQbD) approach., Chinese Journal of Analytical Chemistry, 2024, 100469, ISSN 1872-2040,
https://doi.org/10.1016/j.cjac.2024.100469.
15. Abubakar AR, Simbak NB, Haque M. Adverse Drug Reactions: Predisposing Factors, Modern Classifications and Causality Assessment. Research Journal of Pharmacy and Technology 2014; 7:1091–8.
16. Vatti RR, Ali F, Teuber S, et al. Hypersensitivity reactions to corticosteroids. Clin Rev Allergy Immunol 2014; 47:26–37. https://doi.org/10.1007/s12016-013-8365-z.
17. Föger-Samwald U, Dovjak P, Azizi-Semrad U, et al. Osteoporosis: Pathophysiology and therapeutic options. EXCLI J 2020; 19:1017–37. https://doi.org/10.17179/excli2020-2591.
18. Tavares LCP, Caetano L de VN, Ianhez M. Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know. An Bras Dermatol 2024; 99:259–68. https://doi.org/10.1016/j.abd.2023.05.005.
19. Halliday HL, Ehrenkranz RA, Doyle LW. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2009:CD001146. https://doi.org/10.1002/14651858.cd001146.pub2.
20. Gulliford MC, Charlton J, Latinovic R. Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care. 2006 Dec;29(12):2728-9. doi: 10.2337/dc06-1499. PMID: 17130214.
21. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma & Clinical Immunology 2013;9:30. https://doi.org/10.1186/1710-1492-9-30.
22. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 2002; 96:23–43. https://doi.org/10.1016/s0163-7258(02)00297-8.
23. Ciriaco M, Ventrice P, Russo G, et al. Corticosteroid-related central nervous system side effects. J Pharmacol Pharmacother 2013;4: S94–8. https://doi.org/10.4103/0976-500X.120975.
24. Maghimaa M, Suresh Sagadevan, Punna Rao Suryadevara, Hari Hara Sudhan, Gowri Sankara Rao Burle, Janne Ruokolainen, Vinod Kumar Nelson, Kavindra Kumar Kesari, Cytotoxicity and targeted drug delivery of green synthesized metallic nanoparticles against oral Cancer: A review, Inorganic Chemistry Communications, Volume 173, 2025, 113806, ISSN 1387-7003, https://doi.org/10.1016/j.inoche.2024.113806.
25. Waljee AK, Rogers MAM, Lin P, et al. short-term use of oral corticosteroids and related harms among adults in the United States: population-based cohort study. BMJ 2017;357: j1415. https://doi.org/10.1136/bmj.j1415.
26. 5. Godela, R., Nelson, V.K., Nuli, M.V. et al. A new RP-HPLC approach for estimation of potential impurities of Fosamprenavir - method development and validation. BMC Pharmacol Toxicol 26, 60 (2025). https://doi.org/10.1186/s40360-025-00892
27. Arulmani R, Rajendran SD, Suresh B. Adverse drug reaction monitoring in a secondary care hospital in South India. Brit J Clinical Pharma 2008; 65:210–6. https://doi.org/10.1111/j.1365-2125.2007.02993.x.
28. Nelson, V., Krishnan, S., Dera, A., Ali, S., Begum, M., Burle, G., Suryadevara, P. and Birudala, G. (2025), Investigating the Cytoprotective Effect of Syzygium aromaticum and Elettaria cardamomum in Arsenic-Induced Toxicity in the HCT-116 Cell Model: A Luminesce-Based Study. Luminescence, 40: e70119. https://doi.org/10.1002/bio.70119
29. Kavanaugh A, Wells AF. Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis. Rheumatology (Oxford) 2014;53:1742–.
30. Cullen DJ, Sweitzer BJ, Bates DW, et al. Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med 1997; 25:1289–97. https://doi.org/10.1097/00003246-199708000-00014.
31. Farzan N, Vijverberg SJH, Arets HG, et al. Pharmacogenomics of inhaled corticosteroids and leukotriene modifiers: a systematic review. Clin Exp Allergy 2017; 47:271–93. https://doi.org/10.1111/cea.12844.
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M, H. B., D, G. R., B, D., B, S. V., M, A., & N, B. K. R. (2024). A review on challenges & clinical management of adverse drug reactions associated with corticosteroids treatment by clinical pharmacist perspective. Journal of Integral Sciences, 7(4), 16-22. https://doi.org/10.37022/jis.v7i4.99
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