Corticosteroids

What are corticosteroids?

Corticosteroids are a class of medicines that are similar to the corticosteroid hormones that the body makes in the adrenal glands. (The adrenal glands sit on top of the kidneys.) The body makes a number of different corticosteroids. One type is called glucocorticoid hormones. Glucocorticoid hormones control carbohydrate, fat, and protein breakdown in the body. These hormones also have an anti-inflammatory effect and help to control the immune system and the body's response to stress. Cortisol is an example of this type of hormone.

Another name for corticosteroids is steroids.

When are they used?

Corticosteroid medicines are used to reduce inflammation and help control the immune system. Some common corticosteroids are:

• betamethasone
• cortisone
• dexamethasone
• hydrocortisone
• methylprednisolone
• prednisolone
• prednisone
• triamcinolone.

Corticosteroids are useful in the treatment of many common conditions, such as:

• asthma
• juvenile arthritis
• inflammatory bowel disease
• scleroderma
• giant cell arteritis
• polymyalgia rheumatica
• ankylosing spondylitis
• Behcet's disease
• chronic lung disease
• rheumatoid arthritis
• lupus
• colitis (ulcerative colitis and Crohn's disease)
• psoriasis
• eczema (also called atopic dermatitis) and other allergic conditions.

These medicines may also be taken to prevent rejection of a transplanted organ, such as a kidney or heart.

How are they used?

Corticosteroids can be taken or given in a variety of ways:

• by mouth
• with shots
• on the skin
• by inhaling through the nose or mouth
• in the rectum
• into the veins.

Mild forms (low concentrations) used as skin creams, such as hydrocortisone, do not require a prescription, but you need a prescription from your healthcare provider for most corticosteroids. Prednisone is the most commonly prescribed corticosteroid taken by mouth.

Sometimes corticosteroids are ingredients in various types of medicines, such as eye products, inhalers, ear drops, nasal drops, nasal sprays, and creams put on the skin.

Corticosteroids can be used for long-term or short-term treatment. When they are used for short-term treatment the medicine is used for several days for quick treatment of symptoms. When the therapy is long term, the medicines are taken for several months or years, for example, for severe cases of rheumatoid arthritis or other chronic diseases.

Steroids are a strong medicine. To help avoid problems, always take them exactly as prescribed.

Is it OK to suddenly stop taking corticosteroids?

Follow your healthcare provider's directions exactly when you are taking steroids. Whether you can safely stop taking them quickly depends on the dose (based on your weight) and how long you have been taking them. You should never stop taking corticosteroids earlier than recommended by your provider without checking with your provider first.

For some illnesses and conditions your provider will prescribe a brief course of treatment, usually just a few days. However, if you are taking a longer course of treatment (more than several days), you should not stop the treatment quickly. Follow your healthcare provider's instructions for slowly reducing the dosage, decreasing it a little at a time. If you stop steroids too fast, serious problems can happen, such as:

• Adrenal crisis. When this happens, your adrenal glands do not produce enough natural cortisol, causing your body to not have enough cortisol. This can hurt your body's ability to respond to an emergency, such as injuries from an auto accident. You will be much more likely to go into shock.
• Steroid withdrawal syndrome or rebound. This is another reaction to stopping the medicine too soon. You may have fever, muscle pain, and joint pain.

What are the risks or side effects?

When corticosteroids are used as prescribed as inhalers or creams for the skin, they usually have few, if any, side effects. However, taking them by mouth or getting shots on a regular basis can lead to side effects that include:

• fat deposits in chest, face, upper back, and stomach
• growth of hair on women's faces
• thinning of the skin
• stretch marks
• acne
• black and blue marks on the skin from easy bruising
• changes in body minerals (electrolytes), especially potassium
• depression
• high blood pressure
• osteoporosis (bone thinning)
• increased risk of certain types of infections, especially yeast or fungal infections
• higher blood sugar, leading to type 2 diabetes
• more appetite
• weight gain
• mood swings, including aggressive behavior
• increased sweating.

The side effects depend on the dosage and how long you take the medicine, as well as your medical history and conditions. Your healthcare provider will try to have you use the lowest dose possible to keep side effects to a minimum. Although steroids can cause many side effects, they can be very effective, even lifesaving.

What about corticosteroid shots into joints?

Steroids can be given as a shot into a joint to reduce pain and swelling in the joint. Getting a shot into a specific area reduces the chance of side effects in the rest of the body. Rare side effects of steroid shots are:

• joint infection
• lightening or wasting away of the skin where you got the shot.

Also, too many shots in one joint can cause cartilage or tendon damage. Your healthcare provider will use steroid shots sparingly and will try to limit the number of shots.

When should I call my healthcare provider?

If you develop side effects, call your provider for instructions. Do not stop taking the medicine without your provider's approval. You may have to gradually reduce your dosage. If you have any questions about these medicines, ask your provider or pharmacist.