3 ± 2. Treatment-related adverse effects were reported in clinical trials at rates of 58. Some side effects may occur. Anabolic steroids adverse reaction; ICD-10-CM T38. 2017. It depends on the dose of prednisone and the condition being treated. Gordon and McLean described an increase in IOP caused by the systemic. The most common chronic effects were skin rash, hypothyroidism, and joint pain. 12817. This medicine is available only with your doctor's prescription. Abstract. Weight gain is a common side effect of prednisone. lower back or side pain. 1007/s12016-013-8365-z. However, steroids can cause cataracts to develop in younger people. excess air or gas in stomach. Clinicians who prescribe these therapies must be alert to their potential for adverse effects, including psychiatric manifestations. irregular or fast heartbeat. 0 Adrenal cortical steroids causing adverse effects in therapeutic use: Antibiotics: 760. Fluticasone can affect growth in children. Side effects are most common with oral or intravenous steroids, but sometimes enough locally directed steroid is absorbed systemically to cause side effects. painful or difficult urination. Methods: We performed a literature review of the neuropsychiatric. These side effects may be temporary, lasting a few days to weeks. Short-term side effects can include acne, headaches, dizziness, and heartburn. heartburn. ). The case of an elderly lady who had 40 mg of methylprednisolone injected in each knee for treatment of suprapatellar bursitis is presented. Despite having seemingly positive effects, more than 50% of SARMs users report significant adverse effects. Anabolic steroids adverse reaction; ICD-10-CM T38. Kenalog ® -40 Injection: Each mL of the sterile aqueous suspension provides 40 mg triamcinolone acetonide, with 0. Call your doctor for medical advice about side effects. swelling of the fingers, hands, feet, or lower legs. For those patients with a visit, the risk of hospital admission for sepsis was 0. We sought to understand if inhaled corticosteroid (ICS) use in asthma is also associated with increased risk of systemic effects. The code is. Reduce your salt intake because it can cause you to retain fluid. Keywords: Addiction, phobia, topical corticosteroids. Common side effects of cortisone may include: high blood pressure; muscle pain or weakness; sleep problems (insomnia), mood changes;. Primary adrenal insufficiency (Addison disease) results from disorders of the adrenal cortex, whereas secondary and tertiary adrenal insufficiency are due to dysfunction of the pituitary gland and the hypothalamus, respectively. In children with SSNS, the spectrum of adverse effects of medication, assumed to be related predominantly to corticosteroids, was detailed in a 10-year trial follow-up cohort study of. noisy, rattling breathing. softening of the skin. Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There is no consensus on dose but the following table provides general guidance. Shakiness in the legs. Benzodiazepines belong to the group of medicines called central nervous system (CNS) depressants, which are medicines that. Side effects can include: Cartilage damage. Additional Information for Health Care Professionals . Methods MEDLINE and Embase databases were. F01-F99 - Mental, Behavioral and Neurodevelopmental disorders. Common Advair side effects may include: headache, muscle pain, bone pain, back pain; The major adverse effects seen with systemic (oral and parenteral) glucocorticoid therapy will be reviewed here. Discussion. Steroids are one of the most commonly prescribed drugs, used mainly in the treatment of various autoimmune and inflammatory conditions. T49. Steroid dementia syndrome describes the signs and symptoms of hippocampal and prefrontal cortical dysfunction, such as deficits in memory, attention, and executive function, induced by glucocorticoids. Some potential topical steroid side effects include burning, stinging, stretch marks, skin thinning, and infections. doi: 10. lack of menstrual periods. The management of bullous pemphigoid will. The second set of ICD-10 codes was more specifically symptom based. There are different types of steroids. 2016;41 (7):16-18. A full recovery can take a week to several months. Other side effects not listed may also occur in some patients. It usually occurs with oral systemic steroid treatment and is more common at higher doses, although there are case reports of occurrence with local steroid injections. vomiting. Given the adverse consequences associated with steroid. These are synthetic substances similar to the male sex hormone testosterone. This activity outlines the indications, action, and contraindications for corticosteroids as a valuable agent in managing numerous disorders. People with diabetes should check their blood sugar level more often for around five days after a cortisone shot. 1% to 1%): Diarrhea, pancreatitis, steatorrhea. Coding professionals must refer back to the tabular list rather than coding directly from the table of drugs and chemicals. Rare but serious neurologic adverse events have been reported with epidural corticosteroid injections, including spinal cord infarction. mental depression. pounding in the ears. sensation of pins and needles. 2. However, tachycardia is not one of the more common possible adverse effects of the drug. 02% (n=293 of 1 221 493) in non-users during this period. weight gain. Dementia-like symptoms have been found in some individuals who have been exposed to glucocorticoid medication, often dispensed in the form of. T49. Medications containing steroids (glucocorticoids) have been available for over 50 years. Some of the possible side effects include: fragile skin that tears or bruises easily. Although not all of these side effects may occur, if they do occur they may need medical attention. Certain drugs (eg, diuretics, antidepressants, and antiepileptics) have been implicated. This is a critical consideration for patients with diabetes. Hand surgeon Steven Goldberg, MD, answers your questions about steroid injections. Mechanisms of adverse effects — Glucocorticoids used in chronic disease (eg, prednisone or prednisolone) do not have significant mineralocorticoid, androgenic, or estrogenic. Frequent urination. Introduction. It can help reduce the symptoms of autoimmune diseases. headache. 0X5A became effective on October 1, 2023. We performed a systematic review related to dosages, effects, side effects, and safety of intrapolyp steroid injection in patients with nasal polyps. Glucocorticoid steroids are the ones used to treat the musculoskeletal problems listed above. It usually occurs with oral systemic steroid treatment and is more common at higher doses, although there are case reports of occurrence with local steroid injections. Corticosteroids are hormone mediators produced by the cortex of adrenal glands that further categorize into glucocorticoids, mineralocorticoids, and androgenic sex hormones. 99% (w/v) benzyl alcohol as a preservative, 0. sores, ulcers, or white spots on the lips or tongue or inside the mouth. The androgens also have anabolic effects and are used in catabolic or muscle wasting states. Temporarily increased blood sugar levels. Muscles and joints stiffen up if you don’t move. mild allergic reaction *. D. You may report side effects to FDA at 1-800-FDA-1088. 10. Prednisolone side effects. Low back pain (LBP) and lumbosacral radicular pain are common causes of physical and mental morbidity and they are also a significant economic burden, causing an expenditure of more than USD 100 billion per year in the United States alone [1,2]. A cortisone flare is the most common immediate side effect of a cortisone injection. Code History. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. 5. Among these adverse effects, abdominal discomfort (26. There are few reports in the literature on dexamethasone-induced hiccups and none in the dental literature [6, 15, 18, 23, 24]. 1007/s12016-013-8365-z. We identified five studies with a total of 386 patients and 2490. The key point of interest is further exploring the effect of dose and duration of steroids on the likelihood of these adverse events occurring. Background To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. It is used to treat a number of different conditions, such as inflammation (swelling), severe allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems,. This pain is. passing gas. Steroids, aka corticosteroids or glucocorticoids, are powerful medications used to treat a. Hypersensitivity reactions to corticosteroids (CS) are rare in the general population, but they are not uncommon in high-risk groups such as patients who receive repeated doses of CS. 4-4. Of these, 175 were external injury cause codes (Y40. Upset stomach. steroids. fever) followed by code T50. Steroid medication is the first line, but non-steroid immunosuppressive drugs are useful in limiting steroid side effects and maintaining long-term remission. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently. 822 Immunodeficiency due to external causes Add Code also external cause such as: ~ AddTopical corticosteroids, systemic corticosteroids, and doxycycline are the mainstays of initial treatment for bullous pemphigoid. However, one pediatric study reported adrenal suppression, which was measured by a low-dose adrenocorticotropin stimulation test, in 10% of children treated. Assign the code for the nature of the effect (e. 7X4S. Background Oral corticosteroid use increases the risk of systemic adverse effects including osteoporosis, bone fractures, diabetes, ocular disorders and respiratory infections. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and. Package insert / product label. Steroid injections can also cause muscle or tendon weakness. 22 is to “use additional code to identify stage of chronic kidney disease N18. unusual tiredness or weakness. muscle wasting. Steroid-induced psychosis is a well-documented phenomenon. While the exact cause of steroid-induced arrhythmias or irregular heartbeats is not known, it may be due to sudden electrolyte shifts within the body that result in irregular heartbeats. This is not a complete list of side effects and others may occur. 6”. lower back or side pain. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Androgenic steroids are used for male sex hormone replacement and in the therapy of malignancies. Inhaled corticosteroids, also known as steroids or glucocorticoids , are generally used on an ongoing basis to control symptoms of asthma, chronic obstructive pulmonary disease (COPD), or other chronic breathing disorders. Weight gain while taking prednisone is typically due. Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. Sudden sensorineural hearing loss (SSNHL) is a syndrome that develops rapidly with hearing loss progressing within 72 hours. Common hydroxyzine side effects may include: drowsiness; headache; dry mouth; or. However, AASs have side effects, involving all organs, tissues and body functions, especially long. Side effects of anabolic steroids used by athletes at Unaizah Gyms, Saudi Arabia: a pilot study: Almaiman AA: 2019: 12: 0: 30: Yes:Steroid-induced psychosis represents a severe psychiatric adverse effect that can occur shortly following treatment with high-dose glucocorticoids. Inhale this medication by mouth as directed by your doctor, usually twice daily (in the. Still, due to the side effects of their long-term use, a great body of research has attempted to find active compounds that could replace corticosteroids particularly as a chronic therapy. a. 995A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. There are many different types of steroids that have different onsets of action, duration, solubility, and reasons for use. By increasing the activity of the immune system, immune checkpoint blockade can have inflammatory side effects, which are often termed immune-related adverse events. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common. Unless your healthcare provider tells you to do so, don't take: Over-the-counter NSAIDs with prescription NSAIDs. The most common include: pain or swelling in the skin at the injection site; a skin reaction at the. redness of the skin. Steroid-induced psychosis is a well-documented phenomenon. Inhaled corticosteroids are the treatment of choice for all but the mildest of disease. A Cochrane meta. A quarter of patients had blood glucose levels > 180 mg/dL, and 10%-30% of these patients received peri-operative steroids versus 4%-18% of non-hyperglycemic patients. Introduction. Canadian Brand Name. ICD 10 code for Adverse effect of other drugs, medicaments and biological substances, initial encounter. Long-term use of these medicines can increase the risk of infections, high blood sugar and osteoporosis. Problems with cortisone shots can range from mild to quite serious. 1X2 T45. Take these steps to help control withdrawal symptoms: Exercise. Introduction. One prednisone side effect that can occur with high doses or prolonged use is the development of cataracts. slow growth in children. Oral corticosteroid use increases the risk of systemic adverse effects including osteoporosis, bone fractures, diabetes, ocular disorders and respiratory infections. Weaning from corticosteroids. ICD-10-CM Code for Adverse effect of glucocorticoids and synthetic analogues, initial encounter T38. hives, skin rash. This reaction can cause a skin rash, which can include: trouble breathing. Oxandrolone is a man-made steroid, similar to the naturally occurring steroid testosterone. Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Side effects can be more severe with long-term administration. Introduction. 2 - Abuse of laxatives. 11 In these cases, iodinated contrast-induced. (2018). Topical corticosteroids, systemic corticosteroids, and doxycycline are the mainstays of initial treatment for bullous pemphigoid. swelling of the stomach area. 1X4 T45. 19. More than half of SARMs users experienced side effects including mood swings, decreased testicular size, and acne. Steroid injections may be repeated but are limited to 3 or 4 injections per year due to the increased risk of side effects from cumulative steroid administration. Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Coding Guideline I. Immune globulin. Other cases of corticosteroid-induced hiccups have been reported [1, 25], and Dickerman et al. Talk with your doctor if you think your child is not growing at a normal rate while using this medication. Anabolic-androgenic steroids (AAS) are synthetic drugs derived from testosterone. Package insert / product label. increased urination or thirst. 0% of the patients. (1) They have many adverse effects, including fluid retention, mood changes, weight gain, hyperglycemia, osteopenia leading to osteoporosis, dyslipidemia, and adrenal suppression. Steroid-induced side effects were scarce. Lieberman, M. TheThe use of steroids can lead to significant ocular side effects. These side effects may go away during treatment as your body adjusts to the medicine. Generic name: methylprednisolone sodium succinate. slow or fast heartbeat. heart problems. itching, rash, or hives. Leukocytosis is a key parameter in establishing the diagnosis of sepsis and in the estimation. weight gain*. 0X5A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The administration of glucocorticoids (GC) is a common cause []. increased hunger, thirst,. Steroids. However, one pediatric study reported adrenal suppression, which was measured by a low-dose adrenocorticotropin stimulation test, in 10% of children treated. Anabolic steroid misuse. increased hair growth on the face, forehead, back, arms, and legs. The adverse effects of oral corticosteroids are dose related — they can often be predicted according to the mineralocorticoid and glucocorticoid properties. Bibliog-Yes, it would be appropriate to report a code(s) for side effects when the patient requires additional treatment or medical care such as monitoring or treatment for the side effects. Short-term flare of pain, swelling and irritation in the joint. 8%) was most common, followed by skin rash (14. Although it has numerous benefits, steroid usage can cause many adverse effects on the eye, the most important being steroid-induced glaucoma and cataract. lightening of normal skin color. Adverse drug event cause ICD-9-CM diagnosis codes; Steroids: 365. This is not a complete list of side effects and others may occur. noisy, rattling breathing. Ten cohorts were included into the meta-analysis. Alprazolam is used to relieve symptoms of anxiety, including anxiety caused by depression. This was the first year ICD-10-CM was implemented into the HIPAA code set. 0X5A is a billable diagnosis code used to specify a medical diagnosis of adverse effect of glucocorticoids and synthetic analogues, initial encounter. Although steroid treatment is effective for most patients, there are side effects that should be considered, says Kenneth V. sensitivity of the eye to light. Androgens. 5,6 These numbers are similar to the 17% identified in. Therapies that may be safe and effective given current information include DPP-4 inhibitors, metformin, and w. Precautions Side Effects Products and services Description and Brand Names Drug information provided by: Merative, Micromedex ® US Brand Name Ciprodex Descriptions. Radiation esophagitis is a common, dose-limiting, early adverse effect of radiation treatment of thoracic tumors. swelling of the arms or legs (especially ankles); frequent or persistent erections, or breast tenderness or enlargement (male patients); or. High blood sugar: Prednisone affects insulin levels and insulin resistance, so increased blood sugar is a common side effect — even with low doses. 2008. Adverse effects of anabolic androgenic steroid use are largely dose dependent and reversible upon cessation of use, although there is some evidence to suggest that carcinogenesis may arise from even short‐term use (Frankenfeld et al. Death of nearby bone. This article reviews the different aspects of ISRs, including their epidemiology and pathogenesis, and provides practical guidance to diagnose and treat. 3X3 T37. We report a case of a 35-year-old man with no previous history of psychosis who was seen for follow-up after a. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and. 61). 7X5A is grouped within Diagnostic Related Group(s) (MS-DRG v 41. Rosacea. Adverse drug event cause ICD-9-CM diagnosis codes; Steroids: 365. nausea, vomiting, upset stomach. Yes, side effects are expected to be the same with prednisolone 5-mL and 10-mL strengths. troubled breathing. 811 T38. It can take a few. 1089/jop. The main short-term side effects of steroids are acne, stomach irritation, and an increased risk of infection. , evaluated 10 children with B cell acute lymphoblastic leukemia (ALL) who received 28 day-course of high dose dexamethasone. Introduction. 74Common side effects of dexamethasone may include: fluid retention (swelling in your hands or ankles); headache, dizziness; increased blood pressure; slow wound healing; acne, thinning skin, bruising or discoloration; changes in your menstrual periods; or. Type 2 diabetes mellitus—Patients with diabetes may be more likely to develop cataracts or glaucoma with the use of corticosteroids. 0X5A for Adverse effect of glucocorticoids and synthetic analogues, initial encounter is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes . The rate of dural puncture incidence was found to be 0. Dementia-like symptoms have been found in some individuals who have been exposed to glucocorticoid medication, often dispensed in the form of. Increased blood sugar. Steroid tablets are a “systemic” medicine, which means they can affect your whole body, and not just one area of treatment (like using ointment for a cut on your finger). a seizure (convulsions). With guidance from inpatient coding experts, a list of 32 ICD-10 codes for poisoning and adverse effects related to the study drugs was created. unusual tiredness or weakness. This association was first appreciated in the 1950s, when Drs. Call your doctor at once if you have: blurred vision, eye pain or redness, seeing halos around lights; Glucocorticoid-induced osteoporosis (GIOP) is the most common cause of secondary osteoporosis, the first cause before 50 years and the first iatrogenic cause of the disease. If any of these effects last or get worse, tell. Prednisone is a type of corticosteroid (steroid) drug that reduces inflammation by suppressing the immune system. 0X5A - Adverse effect of glucocorticoids and synthetic analogues [initial encounter]. 7 percent), insomnia (1. CM as published on the NCHS website. Call your doctor for medical advice about side effects. Steroids are effective in remission induction therapy for UC and yield favorable results at 1 month after initiation, with an efficacy rate of 80% and a remission rate of 50% [1–5]. F50-F59 - Behavioral syndromes associated with physiological disturbances and physical factors. Injection site reactions (ISRs) are a local phenomenon defined as a constellation of symptoms, including swelling, erythema, pruritus, and pain around the site of injection. Cervical epidural steroid injections are usually safe, but there are risks of certain side effects and complications. 3X1 T37. Several pharmacological treatments used in internal medicine can induce psychiatric side effects (PSEs) that mimic diagnoses seen in psychiatry. Cataracts (clouding of eye lenses) Glaucoma (nerve damage in the eye that can cause loss of vision) Systemic side effects due to using nasal steroid sprays are relatively rare. Generic name: methylprednisolone sodium succinate. 10. Coding Guideline I. )Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. Take these steps to help control withdrawal symptoms: Exercise. 19. B95A, Adverse effect of other viral vaccines, initial encounter. Two cases of prednisone dependence are reviewed; the first involving a patient with inflammatory orbital pseudotumor who developed a dependent pattern of prednisone use that persisted years after the resolution of the acute episode. Glucocorticosteroids (GCS) are known to cause the hematologic effect of leukocytosis and neutrophilia. It is imp. Although any organ system can. If used in this way, they can cause serious side effects and addiction. Illegally, these drugs are regularly self-administered by body builders and power lifters to enhance their sportive performance. Oral Thrush. These conditions can be serious or even fatal in people who are using steroid medication. Amidst the ubiquitous use of steroids, psychiatric side-effects are not uncommon, though the presentation may be curiously diverse. (2016) 111:29–36. Theophylline. In ICD-10-CM (10th ed. Solution. ] WA Coding Rules are a requirement of the Clinical Coding Policy MP0056/17 Page 2 of 2. The patient should avoid vigorous activities involving the injected joint for 24 hours after the procedure. 32 Corticosteroid-induced glaucoma, residual stage 962. redness, irritation, pain, swelling of the eye, eyelid, or inner lining of the eyelid. Drugs that may lead to depressive, anxious, or psychotic syndromes include corticosteroids, isotretinoin. excess hair growth in females. This means you may be advised to rest the treated area for a few days after. 05% (n=170 of 327 452) in steroid users compared with 0. Alprazolam is a benzodiazepine. Gulliford et al. Some side effects may occur that usually do not need medical attention. swelling of the stomach area. Injection technique requires knowledge of anatomy of the targeted area. mood changes. Multiple over-the-counter NSAIDs. trouble thinking, speaking, or walking. excess facial hair in women. ICD-10-CM includes a table of drugs and chemicals; however, the columns have been restructured to group all poisoning columns together, followed by adverse effect and underdosing. , MD, MMSc, professor of ophthalmology, microbiology, and immunology and clinical director of the Lee. Figure 2. headache*. 7 percent), and vasovagal reaction (1. Inhaled steroids reduce inflammation in the lungs, allowing you to breathe better. loss of sexual desire or ability. [ 5, 6] Use of TS around eyes can rarely lead to glaucoma as penetration of TS is 300 times greater. Increased hunger or thirst. This can help avoid unpleasant side effects (withdrawal symptoms), such as severe tiredness, joint pain, being sick and dizziness. restlessness. Objective To determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use. Discussion. Systemic steroids are synthetic derivatives of the natural steroid, cortisol, produced by the adrenal glands, and have profound anti- inflammatory effects. Due to the genomic and non-genomic properties of corticosteroids, their use comes with a wide range of side-effects, both in the short and long term [75, 76]. Description Intra-articular corticosteroid injection may be associated with several adverse effects. Combination inhalers. What are the side effects of steroid medications? Steroid medications can have serious long-term side effects, and the risk of these side effects increases with higher doses and longer term therapy. It could be hypothesized that progesterone could be such an alternative. Thirty-six (8%) adverse joint events with imaging documentation were reported, with the vast majority occurring in individuals with moderate Kellgren-Lawrence grade 3 knee and hip OA on radiographs. severe lack or loss of strength. The side effects of performance-enhancing drugs (PEDs) can be dangerous and negative for athletes causing health issues including strokes. 3X6 ACTH T38. Prednisone is a glucocorticoid, which is a synthetic steroid similar to cortisol, a hormone that the adrenal glands produce. Common side effects of prednisone may include: Hirsutism: Excess hair growth, which can occur in places such as the face, chest, and back. Excludes2: Adverse effect of drug (T36-T50 with fifth or six character 5) Add Code also drug or medication such as: ~ Add encounter for antineoplastic chemotherapy and immunotherapy (Z51. Background. 0 percent for the intralaminar method. It can also sometimes worsen the underlying condition being treated. 003. Benefits of using inhaled steroids. Methods: We performed a systematic review related to dosages, effects, side effects, and safety of intrapolyp steroid injection in patients with nasal polyps. We note the bivariate subgroup analyses investigating the incidence of the four outcomes in participants who received steroids for less than seven days versus those receiving steroids for more than. Side Effects of Steroids. Unsurprisingly the CCI of the STEROID group was higher than that of the NOSTEROID group, likely due to the worsening effects of long-term use of steroids. Data of all patients with the International Classification of Diseases ICD-9 and ICD-10 discharge diagnosis of encephalitis who were treated between 2007 and 2017 at one of. increased urination. Corticosteroids have been utilized as mainstay pharmacological intervention for successful organ transplantation since the beginning. Some side effects are mild and go away, while others are more serious and need medical attention. Cookie settings. To manage long-term side effects: Choose foods high in calcium and vitamin D, including dairy, tofu, green vegetables, sauerkraut, cabbage, soybeans, rutabagas, dried beans, and salmon. 3X5 T37. Classic clinical symptoms of ocular inflammation are erythema, edema, pain, photophobia, and an itchy sensation. Steroid-induced ocular hypertension and steroid-induced glaucoma are elevated intraocular pressure (IOP), and glaucomatous optic neuropathy, respectively, which develop in the setting of corticosteroid use. The most common adverse event was accelerated OA progression, followed by subchondral insufficiency fracture, osteonecrosis, and rapid joint. , patients who had TAVI had a mean CCI of 5. Usually apparent only with prolonged courses; One study identified no increased risk of infection with less than 700 mg of prednisone or a daily dose less than 10 mg/day.