May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal axis, particularly in younger children or in patients receiving high doses for prolonged periods, which may lead to adrenal crisis. Prolonged use of corticosteroids may also increase incidence of secondary infection, mask acute infection (including fungal infections) or prolong or exacerbate viral infections. Exposure to chickenpox should be avoided. Corticosteroids should not be used to treat ocular herpes simplex, cerebral malaria or viral hepatitis. Use with caution in tuberculosis. Prolonged treatment with corticosteroids associated with development of Kaposi’s sarcoma (case reports). Acute myopathy reported with high dose corticosteroids, usually in neuromuscular transmission disorders (may involve ocular and/or respiratory muscles). Prolonged use of corticosteroids may result in glaucoma. Damage to optic nerve (not indicated for treatment of optic neuritis), defects in visual acuity and fields of vision, and posterior subcapsular cataract formation may occur. Use following cataract surgery may delay healing or increase incidence of bleb formation. Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Pre-existing psychiatric conditions may be exacerbated. Use with caution in heart failure (long-term use associated with fluid retention and hypertension), in diabetes mellitus (may alter glucose production/regulation leading to hyperglycemia), and in gastrointestinal diseases (diverticulitis, peptic ulcer, ulcerative colitis) due to perforation risk. Use with caution in hepatic impairment, including cirrhosis (long-term use associated with fluid retention), in myasthenia gravis (exacerbation of symptoms), following acute myocardial infarction (risk of myocardial rupture), and in osteoporosis (high doses and/or long-term use of corticosteroids associated with increased bone loss and osteoporotic fractures). Use with caution in renal impairment (fluid retention may occur), and in history of seizure disorder (seizures reported with adrenal crisis). Metabolic clearance of corticosteroids increases in hyperthyroidism and decreases in hypothyroidism. Due to risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly. May affect growth velocity. Withdrawal of corticosteroids may result in salicylate toxicity.