When to issue a Steroid Treatment Card – FACTSHEET
Background
1
The Department of Health has issued guidance around the use of steroid treatment cards. Exogenous steroid use can cause
suppression of endogenous cortisol release. Patients receiving either oral and/or inhaled glucocorticosteroid medications should
have their risk for adrenal suppression assessed and receive a steroid treatment card if deemed necessary
When should steroid treatment cards be issued?
 Oral/systemic corticosteroids
Patients prescribed oral steroids for periods of more than 3 weeks Or
those receiving more than four short oral courses per year
 Inhaled corticosteroids (ICS)
Patients receiving high dose inhaled corticosteroids – see below
 Other forms of corticosteroid
Patients receiving topical or nasal corticosteroids do not routinely
require a steroid card unless systemic absorption likely to be increased
i.e. Crohn’s/Ulcerative colitis flare/prolonged usage/multiple
formulations prescribed/drug interactions
Who should issue them?
DH guidance states: It is the responsibility of a patient’s doctor to issue a steroid treatment card if appropriate, to discuss its
purpose and explain the instructions on the card. Appropriate Read codes: steroid card issued 8B317; steroid card 9K3
The BNF considers the following to be high dose inhaled corticosteroid
2
Adult (> 12 years)
TOTAL DAILY DOSE
Child (2 to 12 years)
TOTAL DAILY DOSE
Clenil Modulite®
> 800micrograms daily
> 400micrograms daily
Fostair® and Qvar®
> 400micrograms daily
Unlicensed – give with any
dose
> 800micrograms
> 400micrograms
Name of inhaled Steroid
Child (< 2 years)
BECLOMETASONE dipropionate
BUDESONIDE
Pulmicort®
Symbicort®
Give with all 200/6 and 400/12 preparations
DuoResp Spiromax®▼
All doses
Licensed in >18 years
Unlicensed – give with any
dose
> 400micrograms daily
> 200micrograms daily
FLUTICASONE propionate
ALL CHILDREN LESS
THAN 2 YEARS OF AGE
ON INHALED
CORTICOSTEROIDS
SHOULD BE GIVEN A
Flixotide® , Seretide®, Flutiform®▼
STEROID CARD
Non Formulary Inhalers
3
Ciclesonide
Alvesco®
3
Mometasone furoate
Asmanex®▼
3
Fluticasone furoate
Relvar®▼
> 80micrograms daily
≥ 400micrograms daily
Unlicensed – give with any
dose
All strengths
Points to consider
2
Patients may require increased corticosteroid cover during periods of stress (e.g. surgery, severe intercurrent illness).
High dose inhaled corticosteroids have been associated with lower respiratory tract infections (including pneumonia)
Bone mineral density may be reduced – preventative measures should be considered
Ordering
Steroid treatment cards can be ordered via the stationary order form. For further advice please contact Eleri Plummer, Contractor
Stores Manager on 01743 277519
References: 1. Department of Health- Health Circular ‘Revised National Steroid treatment Card’ 1998/056
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4011730.pdf ; 2. BNF 66 March 2014
http://www.medicinescomplete.com/mc/bnf/current/2985.htm ; 3. Non formulary item – see formulary group decision May 2014 ; 4.NPC
MeReC Rappid Review ‘Inhaled corticosteroids and the risk of diabetes, http://www.npc.nhs.uk/rapidreview/?p=2485
With thanks and acknowledgment to NHS Bolton and ADHB Wales. Shropshire CCG Practice Support Team. June 2014