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 Page 1 of 1 Review Date: June 2014