An ulcer regimen including an antacid should be considered as a prophylactic measure during prolonged therapy. Use the lowest possible dose of corticosteroid to control the condition under treatment, and when dosage reduction is possible, the reduction should be gradual. Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt, and water retention, and increased potassium excretion. These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may be necessary.
All corticosteroids increase calcium excretion.
Drug induced secondary adrenocortical insufficiency may be minimized by gradual dosage reduction. This type of relative insufficiency may persist for months after discontinuation of therapy, therefore, in any stress situation occurring during that period, reinstitute hormone therapy. If the patient is receiving steroids already, the dosage may have to be increased. Use ASA cautiously in conjunction with corticosteroids in hypoprothrombinemia. Fat embolism has been reported as a possible complication of hypercortisonism.