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Children who are on immunosuppressant drugs are more susceptible to infections than healthy childrenChicken pox and measlesfor examplecan have a more serious or even fatal course in children on immunosuppressant corticosteroidsIn such childrenor in adults who have not had these diseasesparticular care should be taken to avoid exposureIf exposedtherapy with varicella zoster immune globulinVZIGor pooled intravenous immunoglobulinIVIGas appropriatemay be indicatedIf chicken pox developstreatment with antiviral agents may be considered.

Patients should not be vaccinated against smallpox while on corticosteroid therapyOther immunization procedures should not be undertaken in patients who are on corticosteroidsespecially on high dosebecause of possible hazards of neurological complications and a lack of antibody response.

When fludrocortisone is used in the small dosages recommendedthe glucocorticoid side effects often seen with cortisone and its derivatives are not usually a problemhowever the following untoward effects should be kept in mindparticularly when fludrocortisone is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.

Dosage depends on the severity of the disease and the response of the patientPatients should be continually monitored for signs that indicate dosage adjustment is necessarysuch as remissions or exacerbations of the disease and stresssurgeryinfectiontraumasee WARNINGS and PRECAUTIONSGeneral

The lowest possible dose of corticosteroid should be used to control the condition being treatedA gradual reduction in dosage should be made when possible.

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