The incidence of predictable undesirable effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression correlates with the relative potency of the drug, dosage, timing of administration and the duration of treatment. (see “Special Warnings and Precautions for Use”) Endocrine/metabolic Suppression of the hypothalamic-pituitary-adrenal axis, growth suppression in infancy, childhood and adolescence, menstrual irregularity and amenorrhoea. Cushingoid facies, hirsutism, weight gain, impaired carbohydrate tolerance with increased requirement for antidiabetic therapy. Negative protein, nitrogen and calcium balance. Increased appetite. Hyperhydrosis. . Increased high –density lipoprotein and low – density lipoprotein concentrations in the blood. Anti-inflammatory and immunosuppressive effects Increased susceptibility to and severity of infections with suppression of clinical symptoms and signs, opportunistic infections, recurrence of dormant tuberculosis (see “Special Warnings and Precautions for Use”). Musculoskeletal Osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture, proximal myopathy. Fluid and electrolyte disturbance Sodium and water retention, hypertension, potassium loss, hypokalaemic alkalosis. Neuropsychiatric Euphoria, psychological dependence, depression, psychosis, insomnia, and aggravation of schizophrenia. Increased intra-cranial pressure with papilloedema in children (pseudotumour cerebri), usually after treatment withdrawal. Aggravation of epilepsy. Ophthalmic Increased intra-ocular pressure, glaucoma, papilloedema, posterior subcapsular cataracts, corneal or scleral thinning, exacerbation of ophthalmic viral or fungal diseases. Cardiac Myocardial rupture following recent myocardial infarction. Gastrointestinal Abdominal distension, oesophageal ulceration, nausea, dyspepsia, peptic ulceration with perforation and haemorrhage, acute pancreatitis, candidiasis. Dermatological Impaired healing, skin atrophy, bruising, telangiectasia, striae, acne. General Hypersensitivity including anaphylaxis, has been reported. Leucocytosis. Thrombo-embolism. Malaise. Hiccups. Withdrawal symptoms and signs Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death (see “Special Warnings and Precautions for Use”). A 'withdrawal syndrome' may also occur including; fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and loss of weight.