When to try alternate-day corticosteroid therapy

Treatment with a corticosteroid aims to achieve the remission of disease or satisfactory relief of symptoms with the least unwanted effects. With continuous long-term corticosteroid therapy these include adrenal cortical atrophy due to hypothalamic-pituitary suppression, growth retardation in children, obesity, Cushingoid appearance, bruising, muscle wasting and weakness, osteoporosis, sodium and water retention, diabetes and cataracts. Some of these are inevitable if the daily dose exceeds 10 mg of prednisolone or its equivalent, but the risk can be reduced by giving the drug on alternate days.1a b This regimen is not mentioned in most data sheets for oral corticosteroid preparations.