Management of steroid medication

  • A dose reduction of approximately 1/4 to 1/3 is suggested if intolerable or non-manageable side effects occur, with a reassessment by phone or clinical visit in one month to assess control of side effects.
  • If a daily dosing schedule results in unmanageable and/or intolerable side effects that do not improve when the dose is reduced, then it is appropriate to change to an alternative regime.
  • Steroid therapy should not be abandoned even if side effects are NOT manageable and/or tolerable until at least one dosage reduction and change to an alternative regime have been pursued. This recommendation holds for both ambulatory and non-ambulatory individuals.
  • Should adjustments to the steroid dosing and/or schedule regimens prove ineffective in making any significant side effects sufficiently manageable and tolerable, then it is necessary to discontinue steroid therapy. These decisions need to be made individually in partnership with the child and family. Steroids should never be stopped suddenly.

Steroid management and side effects

Attentive management of steroid-related side effects is crucial once a boy has started on long-term steroid therapy. While steroid therapy is currently the mainstay of medication therapy for DMD, it should not be undertaken casually by the doctor or family, and should be undertaken only by doctors with appropriate expertise.

Information based on consensus statement (published in January 2010)