Sometimes in the treatment of certain diseases and conditions, higher dosages of drugs are required. These elevated dosages should not be used for a long period of time. The consequences of extended use should be thoroughly explained so users understand the risks involved with straying from doctors’ orders.
Stress Dose of Steroids — What Does it Mean?
Stress dose is an increased dosage of corticosteroids that can be used in case of serious illnesses for rapid elimination of symptoms, as well as after surgery. They have been routinely used as a perioperative care standard. However, modern scientists, in particular, Kristin N. Kelly and Bastian Domajnko (Clin Colon Rectal Surg., 2013) suggested that this practice may not be needful.
A case presented by Lewis, Robinson, Yee, and others in the 1950s described a 20-year-old female suffering from rheumatoid arthritis and having knee surgical operation. The woman had developed hemodynamical instability leading to the lethal outcome just five hours after the operation. Similar to other cases, the woman had been on cortisone meds for five months before the surgery. This therapy had been discontinued one day prior to the surgery. According to the autopsy, bilateral adrenal atrophy & hemorrhage were developed in the body of this woman. This sad occasion led to the recommendation that individuals on taking steroid pills permanently should take perioperative “stress-dose” steroids (up to 4 times baseline dosage) to prevent the occurrence of adrenal (Addisonian) crisis.
Stress Dose: Instructions for Corticosteroid Use
This guide is for patients, who take steroids (glucocorticoid hormones) regularly as a part of the treating scheme. There is a variety of steroids, including hydrocortisone (cortef) or dexamethasone (decadron), and others. (Read more on cortisone vs hydrocortisone). These steroid drugs prevent the patient’s adrenal glands from reacting to stress adequately. Besides, they do not allow them to secrete cortisol (the stress hormone our body produces) in enough quantity. When the stress attacks our body, for example in case of inflammation and our body is not able to produce cortisol as much as we need right now, extra doses of it in form of steroid drugs come to save us. If we do not consume extra stress doses some light side effects may appear from the beginning, such as energy lack, the feeling of weakness. Later it may progress to lethargy, shock, vomiting and even the fatal outcome. The consultation with a doctor before taking stress dose is obliged.
This instruction is also suitable for those, who consume steroids in high dosages for more than a week or use them in middle or low dosages a few weeks or a month. Anyway, to know more detailed information, see your endocrinologist.
Corticosteroids Stress Dose and Drug Interactions
Increased doses of corticosteroids can lead to an undesirable reaction with other medicines. For example, there are the following interactions:
- Antacids (drugs that reduce the acidity of gastric juice) reduce the absorption of glucocorticoids taken orally.
- Barbiturates, carbamazepine (Carbaprol, Epitol, Equetro, Tegretol), rifampicin (Rifadin, Rimactane, Rimaped, Rimapen, Rimactan, Rifoldin, Aptecin), accelerate the metabolism (transformation) of glucocorticoids in the liver, and Erythromycin and Isoniazid slow it down. Glucocorticoids accelerate the excretion of butanedione (diacetyl), salicylates, barbiturates.
- The combined use of mineralocorticoids and glucocorticoids increases hypokalemia and hypernatremia. In the case of hypokalemia, there may be side effects of cardiac glycosides. Laxatives (“stool softeners”) can increase hypokalemia.
- Using hormones together with azathioprine (Imuran, Azasan, Azafalk, Aza-Q, Azaimun), Methandrostenolone and hingamin (Chingaminum) increase the risk of developing cataracts and other adverse reactions.
- Glucocorticoids reduce the effect of cyclophosphamide, the antiviral effect of idoxuridine (Idodine, Virexen, Herplex, Herpidu), the effectiveness of sugar-reducing drugs.
- Estrogens can enhance the action of glucocorticoids, which can allow one to reduce their dosage.
Specific Stress Dose Instructions and Warnings
How to apply when you ill with fever? If you suffer from fever less than 103 degrees, your regular dose should be doubled-up. For instance, if your child’s dose is 5 mg of cortef two times a day, increase it to 10 mg to turn it into the stress doping. If the fever is over 103 degrees, increase it in three times. Use this dose in case of fever up to 103 for a lethargic patient. In case of illness, which is accompanied by weakness, but not febrility, double your dose. In any cases consult your doctor.
In case of suffering from vomiting and/or diarrhea, contact the doctor immediately. The risk of inability to not retain or absorb the steroid in oral form also exists. In cases of vomiting and diarrhea, the best workaround is to take hydrocortisone in injectable form in the muscle. Your child can be given it before having medical attention or one time in the emergency room. Here it is possible that the children will be given endovenous fluid hydration.
The intramuscular dose of hydrocortisone injection is the same as the dose given before the surgery. Children, aged from 1 or earlier to 3 years old should apply 25 mg of the drug; those children, who are from 3 to 10 years old — 50 mg and the children who are over 10 years should take from 50 to 100 mg according to the body weight. In case of having elective surgery, it is important to consult anesthesiologist and surgeon to determine the necessary dose before the surgery starts. Do the same in case of durable dental procedures.
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