Mild nasopharyngeal irritation following the use of beclomethasone aqueous nasal spray has been reported in up to 24% of patients treated, including occasional sneezing attacks (about 4%) occurring immediately following use of the spray. In patients experiencing these symptoms, none had to discontinue treatment. The incidence of transient irritation and sneezing was approximately the same in the group of patients who received placebo in these studies, implying that these complaints may be related to vehicle components of the formulation.
Intravenous corticosteroids are sometimes needed in patients who need aggressive management of the inflammation, as in a patient with optic nerve involvement, severe VKH, sympathetic ophthalmia, serpiginous choroiditis or in case of panuveitis. The most commonly used drug is methylprednisolone. The usual dosage is 500 mg to 1 gm intravenous infusion with % normal saline or sodium lactate solution over 30 to 60 minutes daily for 3 consecutive days, followed by high dose of oral corticosteroids. Caution should be taken as intravenous methylprednisolone can cause cardiac arrhythmias and cardiovascular collapse. Intravenous methylprednisolone should be followed by high dose oral steroid or immunosuppressive agent
Because of these side effects, doctors frequently choose safer medications, such as the 5-ASA drugs and antibiotics, as initial therapy. But there are a number of ways to reduce the risk of developing side effects. These include rapid but careful tapering off of steroids; alternate-day dosing; rectally applied corticosteroids; and rapidly metabolized corticosteroids such as budesonide (described above). To help prevent osteoporosis, many doctors routinely prescribe calcium supplements as well as multivitamins that contain vitamin D. Another option is the use of bisphosphonates, such as risedronate (Actonel®) and alendronate (Fosamax®). These compounds, which have been shown to help avert bone loss, are effective in treating and preventing steroid-induced osteoporosis.