Glucocorticosteriod Replacement
Glucocorticosteriod Replacement Guidelines#
| History of systemic use of more than 7.5 mg/day of prednisone for more than 3 weeks. | Presently using more than 7.5 mg/day of systemic prednisone. | Glucocorticosteroid use on alternating days. | |
|---|---|---|---|
| Minimally stressful procedures | If within 2 weeks after cessation of glucocorticosteroid therapy: Give previous maintenance dose on morning of appointment. | No supplementation of glucocorticosteroids needed. | No supplementation of glucocorticosteroids needed. Provide dental care on same day patient is taking glucocorticosteroids. |
| Stressful procedures | If within 3 weeks after cessation of glucocorticosteroid therapy: Give previous maintenance dose on morning of appointment. | Double daily dose on day of procedure and give an additional single dose on first postoperative day if pain is anticipated. | Double daily dose and provide dental care on same day patient is taking glucocorticoteroids. |
Always monitor blood pressure during the procedure.
Always prevent any intraoperative pain.
Always provide postoperative analgesia.
Different organizations, such as UK Medicines Information Pharmacists, have put forth modifications to these recommendations.#
References/Websites#
- References
- Glick M. Glucocorticosteroid replacement therapy: a literature review and suggested replacement therapy. Oral Surg Oral Med Oral Pathol. 1989;67(5):614-20
- Miller CS, et al. Supplemental corticosteroids for dental patients with adrenal insufficiency: reconsiderations of the problem. J Am Dent Assoc 2001;132:1570-1579.
- Websites