May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal axis, particularly in younger children or in patients receiving high doses for prolonged periods (may lead to adrenal crisis). Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Prolonged use may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines (exposure to chickenpox should be avoided; corticosteroids should not be used to treat ocular herpes simplex, cerebral malaria or viral hepatitis). Use in active tuberculosis should be restricted. Prolonged treatment with corticosteroids has been associated with the development of Kaposi’s sarcoma. Acute myopathy reported with high-dose corticosteroids, usually in neuromuscular transmission disorders (may involve ocular and/or respiratory muscles). Corticosteroid use may cause psychiatric disturbances (depression, euphoria, insomnia, mood swings, personality changes). Pre-existing psychiatric conditions may be exacerbated by corticosteroid use. Use with caution in the following cases: heart failure (long-term use associated with fluid retention and hypertension), diabetes mellitus (may alter glucose production/regulation leading to hyperglycemia), GI disease (diverticulitis, peptic ulcer, ulcerative colitis; risk of perforation), hepatic impairment (long-term use associated with fluid retention), myasthenia gravis (exacerbation of symptoms), following acute MI (risk of myocardial rupture), cataracts and/or glaucoma (risk of increased intraocular pressure, open-angle glaucoma, and cataracts), osteoporosis (increased bone loss and osteoporotic fractures), renal impairment (risk of fluid retention), and history of seizure disorder (seizures reported with adrenal crisis). Metabolic clearance of corticosteroids increases in hyperthyroidism and decreases in hypothyroidism. Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly. May affect growth velocity in children.