Steroid Usage: Timing, Dosage, and Long-Term Effects

Q: Steroid Usage: Timing, Dosage, and Long-Term Effects

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Regarding steroids, some physicians recommend taking three pills in the morning and two in the afternoon. <br>However, sometimes when I am busier or wake up later, I take three pills within 30 minutes to 1 h

Steroid Administration Timing and Dosage Instructions

Hello, Doctor.
I have systemic lupus erythematosus (SLE) and I am currently 31 years old.
I was diagnosed with SLE and began treatment about 9 years ago.
Currently, I take the following medications daily: 200 mg of Plaquenil (hydroxychloroquine) once, 5 mg of prednisone five times, 50 mg of Azathioprine half a tablet, and 250 mg of Mycophenolate mofetil six times.
I have a few questions for you.
1.
Regarding the prednisone, the doctor advised taking three tablets in the morning and two in the afternoon.
However, sometimes when I am busy or wake up late, I end up taking three tablets 30 minutes to 1 hour after a meal, and then after another half hour, I eat some fruit and rest for 30 minutes before taking the other two tablets.
I would like to know if taking prednisone this way, with doses so close together, could lead to an excessive dose that might negatively affect my body's mechanisms.
2.
Additionally, I would like to understand if the current dosage of prednisone I am taking daily is considered high.
Given my long-term use of prednisone at my current age, is there a need for bone density testing?
Thank you!

Ann, 30~39 year old female. Ask Date: 2021/09/17

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Regarding steroids, some physicians recommend taking three pills in the morning and two in the afternoon.
However, sometimes when I am busier or wake up later, I take three pills within 30 minutes to 1 hour after a meal, then have a fruit snack after half an hour, and take the other two pills afterward.
I would like to ask if taking steroids this way, with doses close together, could lead to an excessive amount that might negatively impact my body's mechanisms? --> Steroids can be taken in large doses and are well absorbed; taking five pills at once in a day is acceptable.
2.
Additionally, I would like to understand if this daily dosage of steroids is considered high.
Also, given my current age, is there a need for bone density testing with long-term steroid use? --> Whether this dosage is considered high depends on body weight for calibration.
However, we generally categorize steroid dosages into "anti-inflammatory doses" and "immunosuppressive doses." If your weight is around 50 kg, your current steroid dosage is approximately within the anti-inflammatory range.
As body weight increases, the same dosage will have a lesser effect; conversely, as body weight decreases, the same dosage will shift towards immunosuppressive effects, meaning it will be stronger and increase the risk of microbial infections.
The impact of steroids on bone density primarily occurs after the age of 40, when bone density declines rapidly, at which point monitoring is necessary.
Since you are currently only 31 years old, the reference value for bone density testing is relatively low.
Moreover, if you can continue to reduce your steroid dosage in the future, the impact on bone density will be less significant.
Therefore, I believe monitoring is not necessary at this time.
However, please continue to supplement with vitamin D and calcium, along with regular exercise, to mitigate the effects of steroids on bone health.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/09/17

More Info

When it comes to the use of steroids, particularly in the context of managing conditions like systemic lupus erythematosus (SLE), there are several important considerations regarding timing, dosage, and long-term effects. Your current regimen includes a significant amount of corticosteroids, which can have both therapeutic benefits and potential side effects.

1. Timing and Dosage of Steroids
The timing of steroid administration is crucial for maximizing their effectiveness and minimizing side effects. Corticosteroids like prednisolone (康素龍錠) are typically recommended to be taken in the morning. This is because they mimic the natural rhythm of cortisol production in the body, which peaks in the morning. Taking your medication later in the day can disrupt this rhythm and may lead to increased side effects, such as insomnia or mood changes.

From your description, it seems that you sometimes take your doses closer together than recommended. While taking your medication within a short time frame (like 30 minutes to an hour) is generally acceptable, it is essential to maintain a consistent schedule as much as possible. Sudden increases in dosage, even if they are within the prescribed limits, can lead to fluctuations in blood levels of the medication, which may increase the risk of side effects. It is advisable to consult your physician if you find yourself frequently needing to adjust your schedule, as they may suggest alternative dosing strategies or adjustments to your regimen.

2. Assessment of Steroid Dosage
Regarding whether your current dosage constitutes "high" steroid use, it is essential to consider both the total daily dose and the duration of treatment. A daily dose of 25 mg of prednisolone (康素龍錠) is generally considered moderate to high, especially when taken over an extended period. Long-term use of corticosteroids can lead to several side effects, including weight gain, hypertension, diabetes, and osteoporosis.

Given that you have been on this regimen for nine years, it is crucial to monitor for these potential side effects. Regular follow-ups with your healthcare provider can help assess your overall health and adjust your treatment plan as necessary.

3. Long-Term Effects and Bone Health
Long-term corticosteroid use is associated with an increased risk of osteoporosis, particularly in individuals who are younger and have been on high doses for extended periods. Given your age (31 years) and the duration of steroid therapy, it is advisable to undergo bone density testing (DEXA scan) to evaluate your bone health. This is especially important if you have risk factors for osteoporosis, such as a family history of the disease, low body weight, or a history of fractures.

In addition to monitoring bone density, your healthcare provider may recommend lifestyle modifications such as weight-bearing exercises, adequate calcium and vitamin D intake, and possibly medications to protect your bone health if necessary.

Conclusion
In summary, while your current steroid regimen is necessary for managing your lupus, it is essential to adhere to the recommended timing and dosage to minimize side effects. Regular monitoring for potential complications, including bone health assessments, is crucial for long-term management. Always communicate openly with your healthcare provider about any concerns or changes in your routine, as they can provide personalized advice and adjustments to your treatment plan.

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