Might cause hypercorticism or suppression of hypothalamic-pituitary-adrenal axis, particularly in younger children or in patients receiving high doses for prolonged periods. Withdrawal and discontinuation of corticosteroid should be done slowly and carefully. Prolonged use of corticosteroids may increase incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Corticosteroids should not be used to treat ocular herpes simplex, cerebral malaria or viral hepatitis. Acute myopathy reported with high-dose corticosteroids, usually in neuromuscular transmission disorders. Prolonged treatment with corticosteroids associated with development of Kaposi’s sarcoma (case reports). Might cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes, and pre-existing psychiatric conditions may be exacerbated. Use with caution in heart failure, diabetes mellitus, or gastrointestinal disease (diverticulitis, peptic ulcer, ulcerative colitis). High-dose corticosteroids should not be used for management of head injury. Use with caution in hepatic impairment (including cirrhosis), myasthenia gravis, or following myocardial infarct, in cataracts and/or glaucoma (increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use), in osteoporosis (increased bone loss and osteoporotic fractures), in renal impairment (fluid retention may occur), and in history of seizure disorder (seizures reported with adrenal crisis). Metabolic clearance of corticosteroids increases in hyperthyroid, and decreases in hypothyroid patients. Use cautiously in the elderly. May affect growth velocity in pediatric patients. Withdraw therapy with gradual tapering of dose.