Principles of corticosteroid use

There should always be a clear indication to justify starting corticosteroids and benefits should always be balanced against the side effects.

  • There should be a clear indication to justify starting corticosteroids.
  • Doses should be tailored to the individual.
  • Regular review is essential as responses may not be prolonged.
  • Each stage of the corticosteroid plan should be documented and shared with relevant health care professionals, e.g., indication(s), expected outcome(s), and expected response time.
  • Dexamethasone is the corticosteroid of choice. There are however few trials on which to base guidance for indications and dosing.
  • Use a 5–7 day corticosteroid ‘trial’ and unless desired effect achieved, corticosteroid should be stopped.
  • If beneficial, corticosteroids should only be continued at a set dose for a maximum of 2–4 weeks, with planned review date to consider withdrawal.
  • Where possible prescribe as a single morning dose. If not practical, use twice daily doses with last dose before 2 pm. (This reduces suppression of hypo-pituitary adrenal axis and may prevent corticosteroid induced insomnia).
  • Aim to prescribe the lowest dose that controls the symptoms.
  • Side effects include candidiasis, diabetes, proximal myopathy, osteoporosis, pseudo rheumatism, peptic ulceration, salt and fluid retention, cushingoid features, sleep and psychiatric disturbance.
  • Prescribe a gastro-protective agent such as a PPI.
  • Vigilance for oral thrush is needed.
  • Steroids are contraindicated in:
      • Systemic infection, unless considered to be lifesaving and specific anti-infective therapy is employed.
      • Active GI bleeding.
      • Previous steroid-induced psychosis.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.