Corticosteroid-induced bradycardia

Abstract

High-dose or “pulse” corticosteroid therapy is used to treat a vast array of conditions. There is considerable evidence for their use in musculoskeletal diseases, such as rheumatoid arthritis, as well as dermatological diseases, such as psoriasis. They are also used in the treatment of a variety of other conditions, including some renal, hematological, ophthalmic, neurological, nephrological, pulmonary, gastrointestinal and neoplastic diseases. Pulse therapy typically refers to the administration of more than 250 mg prednisone (or equivalent) per day in an intermittent fashion to enhance the therapeutic effect and lessen the long-term adverse effects.1 Although the association between bradycardia and high-dose corticosteroids was first documented in 1986,2 it is not a commonly reported adverse effect.1 Cardiac arrhythmias have been reported to occur in 1% to 82% of patients receiving high doses of corticosteroids.3,4 These adverse effects, which include atrial fibrillation/flutter, ventricular tachycardias and sinus bradycardia,5 are usually associated with the intravenous route of administration. New reports have emerged, however, indicating that oral pulse steroids have a similar risk of inducing bradycardia and other arrhythmias.5-7 This is of significance because the oral route of administration is becoming increasingly more common due to the improved patient convenience and cost and similar efficacy.1 In this report, we describe a patient who developed bradycardia after receiving a course of oral corticosteroids for the treatment of a multiple sclerosis exacerbation. We hope that this case serves as a reminder of the critical role that pharmacists can play in preventing and monitoring for corticosteroid-induced bradycardia.