Glucocorticoids for therapeutic immunosuppression: Clinical pearls for the practicing neurologist

Published:September 23, 2021DOI:


      • Glucocorticoids have widespread anti-inflammatory and non-inflammatory effects.
      • Glucocorticoids carry risk of toxicities with opportunities for risk mitigation.
      • Surveillance is needed to minimize risk of steroid-associated adrenal suppression.
      • Glucocorticoid taper benefits from stable and predictable dose reduction over time.


      Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal.


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