ABHB Prescribing Guideline When to Issue a Steroid Treatment Card?

ABHB Prescribing Guideline
When to Issue a Steroid Treatment Card?
Health Service Circular HSC 1998/056 (Revised National Steroid Treatment Card) includes the following statements:
All patients prescribed systemic corticosteroids for periods of more than three
weeks should receive a steroid treatment card(see inset) at the outset of treatment.
For patients on systemic corticosteroids for less than three weeks*, a card may
be issued at the discretion of the doctor or pharmacist.
It is not recommended that steroid treatment cards be issued to patients
prescribed topical, inhaled(see below) or nasal corticosteroids unless considered
necessary by the prescribing doctor.
It is the responsibility of a patient’s doctor to issue a steroid treatment card if
appropriate, and to discuss its purpose with the patient.
The doctor should explain the instructions on the steroid treatment card when issuing one to the patient.
Pharmacists dispensing systemic corticosteroids should check that the patient has received a steroid treatment card and, if
not, issue one if they consider it appropriate. They should inform the prescribing doctor that they have done so.
*OR THOSE RECEIVING MORE THAN FOUR SHORT ORAL COURSES PER YEAR (ABHB additional guidance)
Steroid Treatment Cards for INHALED Steroids
The BNF (section 3.2) states: “Higher doses of inhaled corticosteroids used for prolonged periods can induce
adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in
children; excessive doses should be avoided. Patients using high doses (see below) of inhaled
corticosteroids should be given a ‘steroid card’ and specific written advice to consider corticosteroid
replacement during an episode of stress, such as severe intercurrent illness or an operation.”
If a child's asthma is not controlled on the maximum licensed dose of their inhaled corticosteroid, despite the addition of
other therapies, the child should be referred to a specialist in the management of paediatric asthma.
A Steroid Treatment Card should be issued for inhaled steroid doses greater than:
Adult (> 12 years) TOTAL
DAILY DOSE 1
Child (2 to 12 years)
TOTAL DAILY DOSE 2
BECLOMETASONE dipropionate
(including CFC‐free Clenil Modulite®)
> 800micrograms daily
> 400micrograms daily
CFC‐free Fostair® and Qvar®
> 400micrograms daily
UNLICENSED
BUDESONIDE
2
Steroid
Symbicort®
Child (< 2 years)
3
> 800micrograms daily
> 400micrograms daily
> 800micrograms of
budesonide daily
> 400micrograms of
budesonide daily
Or ALL DOSES for the 200/6 & 400/12 Turbohalers®
Ciclesonide3 (Alvesco®)
> 80micrograms daily
UNLICENSED
FLUTICASONE propionate
(Flixotide® and Seretide®)
> 400micrograms daily
> 200micrograms daily
Mometasone furoate4 (▼Asmanex®)
≥ 400micrograms daily
UNLICENSED
ALL CHILDREN LESS
THAN 2 YEARS OF AGE
ON INHALED
CORTICOSTEROIDS
SHOULD BE GIVEN A
STEROID CARD
In Gwent (Primary Care) Steroid Treatment Cards can be obtained (in packs of 100) from: BSC Stationary Stores in
Mamhilad – use the GP requisition form faxed to 01495 332476
1
STEROID TREATMENTCARDS SHOULD BE CONSIDERED AT LOWER DOSES IF THERE IS CONCOMITANT USE OF:
(i) INTRANASAL AND/OR TOPICAL CORTICOSTEROIDS or
(ii) MEDICINES THAT INHIBIT THE METABOLISM OF CORTICOSTEROIDS (cytochrome P450 inhibiting drugs
especially ritonavir, itraconazole and ketoconazole)
2
Turbohaler® and aerosol inhalation doses can be considered equivalent (SIGN/BTS British Guideline on the Management of
Asthma of November 2005).
3
Non Formulary in ABHB
PRESCRIBERS SHOULD REFER TO INDIVIDUAL SUMMARY OF PRODUCT CHARACTERISTICS FOR FULL PRESCRBING INFORMATION
Status: APPROVED
Issue Date: April 2008 Updated May 2012
Approved by: GPMTC
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Review Date: June 2014