Corticosteroids

Corticosteroids, often known as steroids, are an anti-inflammatory medicine. They're prescribed for a wide range of conditions.

They're a man-made version of hormones, normally produced by the adrenal glands (2 small glands that sit on top of the kidneys).

What corticosteroids are used for

Corticosteroids are mainly used to reduce inflammation and suppress the immune system.

They're used to treat conditions like:

• asthma
• allergic rhinitis and hay fever
• urticaria (hives)
• atopic eczema
• chronic obstructive pulmonary disease (COPD)
• painful and inflamed joints, muscles and tendons
• lupus
• inflammatory bowel disease (IBD) – including Crohn's disease and ulcerative colitis
• giant cell arteritis and polymyalgia rheumatica
• multiple sclerosis (MS)

Corticosteroids can also be used to replace certain hormones that aren't naturally produced by the body. This is the case in people with Addison's disease.

Types of corticosteroids

Corticosteroids are available in different forms, including:

• tablets (oral steroids)
• injections – which can be into blood vessels, joints or muscles
• inhalers – like mouth or nasal sprays
• lotions, gels or creams (topical steroids)

Who can use corticosteroids?

For most people, steroid inhalers and steroid injections shouldn't cause any bad side effects. Steroid tablets are generally prescribed with more caution, as these may cause more problems.

Steroid tablets

Corticosteroid tablets are the most powerful type of steroid medication. This is because they can affect the whole body.

They shouldn't be used if you have an ongoing widespread infection. This is because they could make it more severe. However, you should continue to take corticosteroids if you develop an infection whilst taking them. This is unless you're advised otherwise.

Steroid tablets should be used with caution in people with:

• liver problems, like liver disease
• mental health or behavioural problems
• wounds – healing may be delayed

They should also be used with caution in people with certain health conditions, including:

• heart failure
• a recent heart attack
• high blood pressure
• diabetes
• epilepsy
• glaucoma
• underactive thyroid gland
• osteoporosis
• obesity
• psychosis
• stomach ulcers

In these situations, you will only be prescribed oral corticosteroids if the benefits of treatment outweigh any potential risks.

Steroid injections

Most people can safely have corticosteroid injections. However, they should be avoided or used with caution if you have an ongoing infection or a blood clotting disorder (like haemophilia).

Steroid inhalers and sprays

There's generally no reason why someone shouldn't be able to use a steroid inhaler or steroid spray. However, these should be used with caution in people with ongoing infections, like tuberculosis (TB).

Steroid cards

You may be given a steroid card from your healthcare professional. This'll depend on the dose and how long you take the steroid for.

It’s the same size as a bank card and may be blue or red. This is a card which lets healthcare professionals and emergency workers know you are prescribed a steroid and has the details of your medicine and dose. It’s useful to keep this with you.

Pregnancy

Corticosteroids are generally safe to use during pregnancy. However, they're not usually recommended unless the potential benefits outweigh the risks.

Steroid tablets may be recommended if you're pregnant and have severe asthma. This is because the risk to your baby from uncontrolled asthma is higher than from the medication.

There's no evidence to suggest that using a steroid inhaler during pregnancy increases the risk of problems like birth defects. You can usually continue to use this as normal while you're pregnant.

Breastfeeding

If a woman needs to take steroid tablets whilst she is breastfeeding, prednisolone is usually recommended. Steroid injections, inhalers and sprays aren't thought to pose a risk to babies being breastfed.

The recommended course of treatment largely depends on weighing up the benefits of corticosteroids against the side effects.

If your illness is severe and corticosteroids are effective, treatment will often continue. However, continued treatment will not be recommended if:

• your illness is mild
• corticosteroids do not help
• corticosteroids cause side effects

There aren't usually any severe side effects if you take steroid injections, a steroid inhaler, or a short course of steroid tablets. However, prolonged treatment at high doses can cause problems in some people.

Side effects

Corticosteroids are powerful medications that can sometimes have side effects.

The risk of experiencing side effects depends on:

• the type of steroid you're taking – steroid tablets (oral corticosteroids) are more likely to cause side effects
• the dose – the higher the dose, the greater the risk of developing side effects
• the length of treatment – you're more likely to develop side effects if you take steroid tablets for more than 3 weeks
• your age – young children and the elderly are more likely to experience side effects

Please take time to read the patient information leaflet that comes with your medicine. Discuss any concerns or queries with your Pharmacist or GP.

Side effects of steroid inhalers

Inhaled steroids usually have few or no side effects if used at normal doses. However, they can sometimes cause:

• a sore mouth or throat
• minor nosebleeds
• difficulty speaking or a hoarse or croaky voice
• a cough
• oral thrush

Rinsing your mouth out with water after using your medication can help to prevent oral thrush. Using a device called a spacer with your medication can help to prevent many of the other problems.

There's some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease (COPD) can increase the risk of chest infections like pneumonia. Discuss this with your health professional if you’re concerned.

A high dose of inhaled steroids can sometimes cause more serious side effects but this is rare.

Side effects of steroid injections

Steroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days.

Steroid injections can also cause muscle or tendon weakness. This means you may be advised to rest the treated area for a few days after the injection. Other possible side effects in the area where the injection is given can include:

• infections
• blushing
• thinning and lightening of the skin

Steroid injections are often only given at intervals of at least 6 weeks. A maximum of 3 injections into one area is usually recommended.

Steroids that are injected into a blood vessel (intravenous steroids) may cause more widespread side effects.

Side effects of steroid tablets

Steroid tablets that are taken for a short period of time are unlikely to cause side effects.

It’s sometimes necessary for steroid tablets to be taken for longer periods. In these cases, you may be more likely to develop troublesome side effects. However, this is not inevitable.

Steroid tablets taken for longer than 3 weeks can cause:

• increased appetite – which may lead to weight gain if you find it difficult to control what you eat
• acne
• rapid mood swings and mood changes – becoming aggressive, irritable and short-tempered with people
• thin skin that bruises easily
• muscle weakness
• delayed wound healing
• Cushing’s syndrome - causes acne, fatty deposits in the face and stretch marks across the body
• weakening of the bones (osteoporosis)
• diabetes (or they may worsen existing diabetes)
• high blood pressure
• glaucoma and cataracts (eye conditions)
• stomach ulcers
• mental health problems - like depression, suicidal thoughts, anxiety, confusion and hallucinations
• increased risk of infections, particularly chickenpox, shingles and measles
• reduced growth in children

If you need to take steroid tablets on a long-term basis, you may have regular checks and tests for conditions like:

• diabetes
• high blood pressure
• glaucoma

Stopping your medication

If you have troublesome side effects, don't stop taking your medication until your doctor says it's safe to do so. This is because you may experience withdrawal effects.

Your dose may need to be reduced slowly over a few weeks or months. If you've been taking corticosteroids for a while, you may also need tests before you stop taking them. These will make sure that your adrenal glands are still working properly.

Medicines that can interact with corticosteroids

Corticosteroids can interact with other medicines. This means that the effects of either medicine can be altered.

There is less chance of this happening with steroid injections or sprays. However, it can occasionally happen if they're used at high doses and for a long time.

If you want to check that your medicines are safe to take with your medication, ask your Pharmacist or GP.

Anticoagulant medicines

Anticoagulant medicines are medications that make the blood less sticky. They're often prescribed to people with a history of blood clots or an increased risk of developing them.

Combining corticosteroids with anticoagulant medicines can sometimes make anticoagulants less effective. Alternatively, it can increase their blood-thinning effect.

Anticonvulsants

Anticonvulsants are medicines used to prevent seizures (fits). They're often used to treat epilepsy.

Anticonvulsants can reduce the effectiveness of corticosteroids. This means you may be advised to stop taking anticonvulsants whilst you're taking corticosteroids. This will depend on:

• how frequent your seizures are
• how severe your seizures are
• the condition the steroids are being used to treat

Diabetes medication

Corticosteroids can decrease the effectiveness of medications used to treat diabetes.

If you need to take medication for diabetes with corticosteroids, your blood glucose levels will usually need to be checked more regularly. Your dose of diabetes medication may then need to be adjusted.

HIV medication

Corticosteroids can sometimes interact with a type of medication known as protease inhibitors (like ritonavir). These are used to treat HIV.

The HIV medication may increase the level of corticosteroid in your body. This might increase your risk of experiencing side effects.

Live vaccines

Some vaccinations contain a weakened form of the infection they are designed to protect against. These are known as live vaccines. Examples of live vaccines include:

• the measles, mumps and rubella (MMR) vaccine
• the BCG vaccine for tuberculosis (TB)

Corticosteroids can weaken your immune system and make you more vulnerable to infection. This means you should avoid any live vaccine until at least 3 months after your course of corticosteroids has finished.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of commonly used painkillers. Some, like ibuprofen, are available over the counter.

Combining NSAIDs and corticosteroids can increase your risk of developing:

• stomach ulcers
• internal bleeding

If you need to take both medications, you may be given a medication called a proton pump inhibitor (PPI). This helps to reduce the risk of stomach ulcers.