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Clinical Guide - Oral Steroids

There follows some brief information about oral steroids, their uses and some information about contraindications and side effects. Detailed information is available in the Formulary (BNF). This advice does not apply to topical nasal steroid sprays. The information applies only to All Ears Cambodia clinicians.


General Information


Oral steroids can be considered in Bell’s Palsy, Ramsay Hunt Syndrome, and in unilateral or bilateral nasal polyps. You should consult your other tutorials and guidance in each of these cases before you prescribe oral steroid.


Oral steroids are potentially very dangerous but, used correctly, can offer relief for the patient when no other medication is effective.


Contraindications to steroid use


Oral steroids should not be used in the following circumstances:


  1. In diabetic patients OR those with diabetic relatives

  2. In patients with a stomach ulcer OR pains in the abdomen

  3. In patients with high blood pressure or recent heart attack

  4. Pregnancy – especially the first trimester

  5. Glaucoma

  6. Psychiatric disease


Side effects of oral steroids

When used for short periods of time steroids may cause:


  1. Stomach pain or ulceration – STOP IMMEDIATELY

  2. Change in personality, depression or mania – STOP IMMEDIATELY

  3. Disturbance in vision – STOP IMMEDIATELY


Do not prescribe oral steroid to children. If they have a disease that may benefit from oral steroid refer them to the hospital.


Prednisolone and Dexamethasone


This is the oral steroid of choice. One mg / kg / day for ten days is recommended but I suggest that you do not exceed 40mg per day. You do not have to taper this short course.


Dexamethasone 6mg daily can be used as an alternative if prednisolone is unavailable.


The patient should take the medicine in the morning. Warn them of possible side effects and tell them to stop the medicine if they feel unwell.

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