Adverse Events of Glucocorticoids and Their Prevention

Glucocorticoids are widely used for the treatment of various autoimmune, allergy, and neoplastic diseases. While they are indispensable for the treatment of many diseases, they have a lot of adverse effects. The aim of this article is to review the unwanted effects of glucocorticoids, providing information about their prevention. Glucocorticoids affect the balance of electrolytes and metabolism of carbohydrates and lipids. Thus, they can alter the distribution of adipose tissue to form Cushingoid facial and body shape and can precipitate hypertension and atherosclerosis to increase the risk of cardiovascular disorders. Glucocorticoids also affect the musculoskeletal system increasing the risk of osteoporosis, avascular necrosis, and myopathy and also contribute to neurological disorders such as mood change, psychosis, and memory loss. Cataract and glaucoma are common ophthalmological complications of glucocorticoid therapy. Combined use with cytotoxic agents and glucocorticoid will substantially raise the risk of bacterial infection and rate of opportunistic infection, and appropriate prophylaxis will be needed. In addition, glucocorticoids can cause problems of the reproductive system including menstrual disorders and changes in fertility. Although these adverse reactions of glucocorticoids are clear at higher doses, even at low doses, they can produce substantial toxicities. To prevent above adverse events, physicians should monitor the complications of glucocorticoids more cautiously and should reduce the medication meticulously.