May cause hypercorticism or suppression of HPA axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal should be carried out slowly and carefully. May increase risk of infection and/or limit response to vaccinations. Restrict use in active tuberculosis (only in conjunction with antituberculosis treatment). Use with caution in heart failure (use may be associated with fluid retention, edema, weight gain and hypertension), sodium retention and potassium loss, hepatic impairment, including cirrhosis. Use with caution following acute MI. Use with caution 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 might occur). Should be used cautiously in the elderly (risk of adverse effects). Glucocorticoids, especially in large doses, increase susceptibility to and mask symptoms of infection. Edema and congestive heart failure (in susceptible patients) may occur. Increased calcium excretion and possible hypocalcemia. Prolonged use may result in posterior subcapsular cataracts, exophthalmos, and/or increased intraocular pressure which may result in glaucoma or occasionally damage the optic nerve. Administration over a prolonged period may produce various endocrine disorders, including hypercorticism (cushingoid state) or menstrual difficulties. With long-term use, may delay growth and maturation in children and adolescents. Exaggerated glucocorticoid response in cirrhosis.