Table 10 General strategies for the prevention of GC-induced AEs

• Treat pre-existing comorbid conditions that may increase risk of GC-associated AEs

• Prescribe lowest effective GC dose for minimum period of time required to achieve treatment goals

• Administer as single daily dose (given in the morning), if possible

• Consider intermittent or alternate-day dosing, if possible

• Use GC-sparing agents whenever possible (e.g., omalizumab in severe asthma, azathioprine/cyclophosphamide in vasculitis, methotrexate in rheumatoid arthritis)

• Advise patients to:

 ▪ Carry a steroid treatment card

 ▪ Seek medical attention if they experience mood or behavioural changes

 ▪ Avoid contact with persons that have infections, such as shingles, chickenpox, or measles (unless they are immune)

 ▪ Not discontinue GC therapy abruptly unless advised to do so by their physician

 ▪ Adopt lifestyle recommendations to minimize the risk of weight gain or other AEs:

  ▫ Eat a healthy balanced diet, including adequate calcium intake

  ▫ Smoking cessation

  ▫ Reduction in alcohol consumption

  ▫ Regular physical activity

• Regularly monitor for signs/symptoms of AEs