A modified (once a day) corticosteroid dosage regimen

The therapeutic results obtained in 345 patients with various allergic, dermatologic, and rheumatic diseases with a once a day dose of triamcinolone, a corticosteroid with a long plasma half‐life, are presented. Two hundred and seventy‐three of the patients were on a divided dose regimen immediately prior to being transferred to a once a day regimen with the corticosteroid equivalent total dose. Of these 273, 237 had been receiving triamcinolone in a divided dose. This modified dosage regimen was, for the most part, therapeutically comparable with the corticosteroid divided daily dosage schedule. It was effective in 164 (82 per cent) of 200 patients with dermatoses, 42 (78 per cent) of 54 patients with allergies, and 58 (64 per cent) of 91 patients with rheumatoid arthritis and connective tissue diseases. With the exception of rheumatoid arthritis, most patients under control with conventional divided daily doses of corticosteroids could be easily transferred to once a day dosage with triamcinolone. In the 58 patients with allergies and dermatoses who had not received prior divided dose therapy, but were treated initially with a single daily dose of triamcinolone starting at a suppressive dose and arriving at a maintenance dose, this regimen was effective in 91 per cent. The possible advantages of once a day corticosteroid administration given in the morning are discussed. The necessity of maintaining continuous blood levels of exogenously administered corticosteroids is questioned. The theoretical advantage of minimizing disturbance of the diurnal rhythm of the adrenal glands is discussed.