Severe Cardiovascular Adverse Effects in Association with Acute, High-Dose Corticosteroid Administration

Abstract

Severe cardiovascular adverse reactions including death have been associated with high-dose intravenous corticosteroid therapy. Some of the patients appeared to have acute hypersensitivity reactions to the corticosteroid, with rashes and bronchospasm; other problems included arrhythmias and myocardial infarctions. Most of the patients had underlying renal disease and/or were undergoing renal transplantation. All of the patients having the cardiovascular reactions associated with the corticosteroid received individual doses of at least 250 mg of methylprednisolone or its equivalent. The doses were usually administered over a 30-minute period or less. A cause-effect relationship between high-dose corticosteroid therapy and severe cardiovascular reactions has not been scientifically proved by a controlled trial, but caution is advised when high-dose corticosteroid therapy is administered.

Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid Association

“…a greater than fourfold upper normal limit), severe cardiovascular morbidity, severe hypertension, uncontrolled diabetes mellitus and glaucoma, use of i.v.GC therapy should be avoided. When alternative treatments are not indicated, weekly pulses with doses lower than 250 mg appear to be less commonly associated with adverse events, in particular cardiac arrhythmias (20). A slow rate of i.v.GC infusion (60-90 min) should be used and pulse rate and rhythm should be recorded during the infusion.…”

“…High-dose i.v.GC pulse therapy is used in several disorders, including multiple sclerosis and systemic lupus erythematosus; severe cardiovascular adverse events, including death, have been reported in a few cases, mostly related to short infusion rate, ventricular arrhythmias, and/or myocardial infarction (19,20,21,22). An increase in systolic and diastolic blood pressure and in fluid retention might account for the occurrence of severe cardiovascular and cerebrovascular events in patients treated with i.v.GC pulses (12).…”

Atrial fibrillation following therapy with high-dose i.v. methylprednisolone: A brief case-based review

“…It is likely that very high doses (i.e., 1 g/day), rapid infusion rates, and/or underlying cardiac diseases may concur in eliciting cardiac arrhythmias. In this regard, it is interesting to note that methylprednisolone doses of less than 250 mg/day have not been associated with cardiovascular adverse events, although, in likely predisposed individuals, even low oral doses may trigger onset of atrial fibrillation (8,10). It should also be considered that subclinical myocarditis may be difficult to detect in SLE patients; therefore, a likely predisposing condition may even go undetected.…”

Allergic hypersensitivity to topical and systemic corticosteroids: a review

“…Other IgE-independent mechanisms involve the release of histamine by mast cells. Acute cardiovascular toxic reactions have also been described in patients who receive high and rapidly infused doses of CSs (22,125). These reactions seem to be due to an a-adrenergic blockage and the drugÕs negative inotropic effect, rather than to an immunological phenomenon.…”