Steroids & Hospice: When Do They Go Together?
Often referred to by their shortened name “steroids,” corticosteroids are a type of anti-inflammatory drug that are used in hospice and palliative care for a number of different reasons.
Some of the indications for the use of corticosteroids in hospice care include:
- Cancer-related fatigue
- Anorexia and cachexia
- Nausea/vomiting (CINV, increased ICP, unknown etiology)
- Dyspnea (COPD, asthma)
- Malignant bowel obstruction
- Metastatic extradural spinal cord compression
- Other palliative care emergencies
It should be noted that not all corticosteroids are equal. So how do we choose which one to use?
In many cases, an excellent option for a hospice or palliative care patient is dexamethasone, which you can learn about in more detail on the Crossroads Hospice & Palliative Care blog here. If you look at the chart below, you will see that dexamethasone has the benefit of no mineralocorticoid potency. In some corticosteroids, the mineralocorticoid effect can cause an increase in water retention, a progressive rise in blood pressure, hypokalemia, and alkalosis.
With no mineralocorticoid potency and a long half-life, dexamethasone is an easy treatment that can be dosed once a day in the morning.
Typical dexamethasone dosing looks as follows:
Adverse Effects of Corticosteroids
All corticosteroids have adverse effects. Early in usage, the adverse effects of corticosteroids can include:
- Increased appetite
Over time, adverse effects of corticosteroids can include:
- Poor wound healing
- Osteoporosis fractures
- Adrenal suppression
- Cushingoid appearance
- Weight gain
- Atrophic skin changes
- GI bleed
If you see adverse effects of steroid psychosis (agitation, delusion, hallucinations), speak to your physician about options to mitigate the effects. Do not stop corticosteroids without guidance on how to taper off the dosage.
Chief Corporate Pharmacist
Crossroads Hospice & Palliative Care
Crossroads supports patients with serious and terminal illness. To learn more about hospice care, please call 1-888-564-3405.
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