Adrenal Suppression
Glucocorticosteroid Replacement Guidelines#
| History of systemic use of more than 7.5 mg/day of prednisone for more than 2 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 2 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 intra-operative 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