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Muscle weakness after short course of steroids

Queen Mary's Hospital, Sidcup, UK

To the Editor:

Nava et al. 1 have shown acute weakness of respiratory and skeletal muscles after a short course of methylprednisolone given for acute lung rejection after transplantation. As many chest physicians commonly use other corticosteroids, it is interesting to compare equivalent doses. Over a 5-day course of methylprednisolone 1 a 70 kg male would have received 3.9 g. This is approximately equivalent to 4.9 g prednisolone or 19.5 g hydrocortisone 2.

I have previously suggested there is a dose effect with hydrocortisone in causing myopathy in ventilated asthmatics, with weakness more likely if >5 g hydrocortisone was used 3. Those patients were paralysed with neuromuscular blocking agents (which might predispose to myopathy), but severe weakness has also been described with 10.0 g hydrocortisone over 10 days in a nonparalysed ventilated asthmatic 4. Methylprednisolone is often given in doses of 1.0 g and theoretically even 2 days treatment (equivalent to 10.0 g hydrocortisone) might be enough to cause weakness. Nava et al. 1 have usefully highlighted the need to be aware of acute muscle weakness following high-dose steroids.

References

1. Nava S, Fracchia C, Callegari G, Ambrosino N, Barbarito N, Felicetti G. Weakness of respiratory and skeletal muscles after a short course of steroids in patients with acute lung rejection. Eur Respir J 2002;20:497–499.[Abstract/Free Full Text]
2. British National Formulary 43. British Medical Association and Royal Pharmaceutical Society of Great BritainLondon, Royal Pharmaceutical Society of Great Britain, 2002; p. 343.
3. Shee CD. Risk factors for hydrocortisone myopathy in acute severe asthma. Respir Med 1990;84:229–233.[Web of Science][Medline] [Order article via Infotrieve]
4. Knox AJ, Mascie-Taylor BH, Muers MF. Acute hydrocortisone myopathy in acute severe asthma. Thorax 1986;41:411–412.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shee, C.D. Search for Related Content PubMed PubMed Citation Articles by Shee, C.D.