Corticosteroids

Corticosteroids: Overview

Corticosteroids are medicines that are similar to the natural hormone cortisone and belong to the family of drugs called steroids.

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Corticosteroids reduce inflammation throughout the body.  This class of drugs also helps normalize your immune system.  Corticosteroids can carry major side effects in some people, including weight gain and mood changes.  Some people may see a rise in blood sugar while taking corticosteroid medications.

Source

Corticosteroids are used in several forms, to treat many different conditions.  Examples include inhalant corticosteroids that are used to prevent asthma attacks, and corticosteroid ointments, creams and gels that are used to treat skin problems.  Common varieties include beclomethasone (Beconase, Vancenase, Vanceril), betamethasone (Diprolene, Lotrisone), hydrocortisone, mometasone (Elocon), prednisone (Deltasone, Orasone), and triamcinolone (Azmacort, Nasacort).

Function; Why it is Recommended

They affect many body processes, including the breakdown of protein, fat, and carbohydrate; the activity of the nervous system; the balance of salt and water; and the regulation of blood pressure.

Due to their widespread effects, these drugs are useful in treating many medical conditions, but they can also have serious side-effects.

Because they reduce itching, swelling, redness, and allergic reactions, they are often used in treating skin problems, severe allergies, asthma, and arthritis.  These drugs also suppress the body's immune response, so they are used in patients who have received organ transplants, to reduce the chance of rejection.  In people whose bodies do not produce enough natural corticosteroids, the drugs can raise the levels of those hormones.  Corticosteroids also are used to treat certain cancers (along with other drugs), and to reduce inflammation in other medical conditions.

Instructions

Gargling and rinsing the mouth with water after using inhalant corticosteroids helps prevent hoarseness and throat irritation.

Patients who take corticosteroids regularly should not stop taking them suddenly, even if their symptoms improve.  Gradually tapering the dose before stopping the drug completely can allow the body time to adjust.  If directed by a physician to reduce the dose, follow directions exactly and see the physician as often as directed.

Corticosteroid ointments, creams and gels can be absorbed through the skin and travel into the bloodstream.  This is not a problem unless large amounts are absorbed.  When this occurs, unwanted side-effects in other parts of the body are possible.  To reduce the chance of that happening, do not spread the medicine over too large an area and do not cover it with plastic wrap, adhesive bandage, or any other type of airtight covering unless told to by your physician.

Side-Effects; Counter-Indicators and Warnings

Side-effects are generally rare when corticosteroids are used for a short time.  However, with prolonged use and/or in high doses, corticosteroids have many predictable – and unpredictable – side-effects.  Common side-effects include:

  • Lowering the body's ability to fight off infections or may making infections harder to treat
  • Changes in appetite (increase or decrease)
  • Nervousness, restlessness
  • Sleep problems
  • Indigestion

These problems often go away as the body adjusts to the drug and do not require medical treatment.

Less common side-effects may occur with some forms of corticosteroids.  Inhalants may cause dry throat, headache, nausea, skin bruising or thinning, and an unpleasant taste.  Nasal spray forms may irritate the nose or throat, and ointments, gels, or creams may irritate the skin.  Again, these side-effects do not need medical attention unless they don't go away or they interfere with normal activities.

More serious side-effects are not common but may occur, especially at higher doses.  If breathing problems, wheezing, or tightness in the chest occur, call a physician immediately.  Additional side-effects do not need emergency care, but should have prompt medical attention.  Anyone who is taking corticosteroids and has any of the symptoms listed below should check with the physician who prescribed the medicine as soon as possible:

  • White, curd-like patches in the mouth or throat
  • Pain when swallowing or eating
  • White patches or sores inside nose or in the anal area
  • Swelling/puffiness of the face, eyelids, or lips
  • Eye pain or vision problems
  • Cataracts
  • Watery eyes (continuing over time)
  • Loss of sense of taste or smell
  • Stuffy, dry, or runny nose (continuing over time)
  • Facial hair growth
  • Stomach or abdominal pains, upset stomach, nausea, or vomiting
  • Significant increase in appetite and weight
  • Rash, acne, or other skin problems
  • Leg swelling
  • Unusual marks or bruises; easy bruising
  • Muscle cramps, weakness, or pain
  • Unusual tiredness or weakness
  • Bone disease such as osteoporosis, especially in older women
  • Black, tarry stools
  • Irregular heartbeat
  • High blood pressure
  • Menstrual problems
  • Increased risk of infection
  • Wounds that won't heal
  • Worsening of diabetes
  • Confusion, excitement, restlessness, mood swings, or unusual or disturbing thoughts or feelings
  • Sensitive emotions
  • Hallucinations
  • Sweats

A rare complication of cortisone medications is severe bone damage (avascular necrosis) which can destroy large joints, such as the hips and shoulders.  In addition, abruptly stopping corticosteroids can cause flares of the disease and result in other side-effects including nausea, vomiting and decreased blood pressure.

In children and teenagers, these medicines can stop or slow growth and affect the function of the adrenal glands (small glands located above each kidney, which secrete natural corticosteroids).  Another possible problem for children is that corticosteroids may make infections such as chickenpox and measles more serious.

Corticosteroids may interact with a variety of other medicines.  When this happens, the effects of one or both of the drugs may change, or the risk of side-effects may be greater.  Anyone who takes corticosteroids should let the physician know all other medicines he or she is taking.  Among the drugs that may interact with corticosteroids are: Insulin and diabetes medicines; Heart medicine such as digitalis; Diuretics (water pills); Medicine containing potassium or sodium; Immunizations (vaccinations); Cyclosporine (Sandimmune); Blood thinners, such as warfarin (Coumadin); Estrogen drugs, such as conjugated estrogens (Premarin) or oral contraceptives; Antacids (if taken frequently).

Patients taking corticosteroids over long periods may need to follow special diets, reducing the amount of sodium or increasing the amount of protein they eat, for example.

People with certain medical conditions or who are taking certain other medicines can have problems if they take corticosteroids.  Corticosteroids can also cover up the symptoms of some medical problems: if the condition gets worse, the patient has no way of knowing it.  Before taking these drugs, be sure to let the physician know about any of these conditions:

  • Allergies: Anyone who has had unusual reactions to corticosteroids in the past should let his or her physician know before taking the drugs again.  The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
  • Pregnancy: Too much use of corticosteroids during pregnancy may cause problems in the baby after it is born, such as slower growth.  Nasal and inhalant forms of the drugs are considered safer to use in pregnancy than are corticosteroids taken by mouth or injection.  When used properly, corticosteroid ointments, creams, and gels – used to treat skin conditions – are not known to cause any problems if used during pregnancy.
  • Breastfeeding: The safety of using corticosteroids while breastfeeding depends on the type of corticosteroid and the form in which it is being used.  When taken by mouth or injection, for example, the drugs pass into breast milk and may cause growth problems in nursing babies.  Creams, gels, and other forms that are applied to the skin are not known to cause problems in nursing babies whose mothers use them.  However, these medicines should not be applied to the breasts just before breastfeeding.  In general, women who are breastfeeding should ask their physicians before using any type of corticosteroid.
  • Diabetes: Corticosteroids may affect blood sugar levels.  Any person with diabetes who notices changes in blood or urine test results while taking corticosteroids should check with a physician.
  • Other medical conditions: Before using corticosteroids, people with any of the following medical problems should make sure their physicians are aware: Osteoporosis or any other bone disease; Current or past tuberculosis; Glaucoma or cataracts; Infections of any type (virus, bacteria, fungus, amoeba); Sores in the nose or recent nose surgery (if using nasal spray forms of corticosteroids); Underactive or overactive thyroid; Liver disease; Stomach or intestine problems; Heart disease; High blood pressure; High cholesterol; Kidney disease or kidney stones; Myasthenia gravis; Systemic lupus erythematosus (SLE); Emotional problems; Skin conditions that cause the skin to be thinner to bruise more easily.
  • Use of certain medicines: Taking corticosteroids with certain other drugs may affect the way the drugs work or may increase the chance of side-effects.

On This Page

Corticosteroids:

Corticosteroids can help with the following:

Autoimmune

Oral Lichen Planus

Corticosteroids (topical, oral or by injection) may reduce the inflammation caused by oral lichen planus.

Musculo-Skeletal

Polymyositis

Polymyositis is generally treated with high doses of corticosteroids initially, administered orally or intravenously.  They are very good at decreasing muscle inflammation but are usually are required for years.  Their continued use will be based on what a doctor finds in terms of symptoms and muscle enzyme blood test results.

Respiratory

Asthma

Inhalant forms of corticosteroid drugs will reduce the frequency and severity of asthma attacks when taken every day, but will not relieve an asthma attack once it has started.  To relieve asthma symptoms, patients must use airway-opening medications (bronchodilators).  When using inhalant forms of both a bronchodilator and a corticosteroid, use the bronchodilator first and then wait several minutes before using the corticosteroid.

Skin-Hair-Nails

Alopecia (Hair Loss)

Topical corticosteroids (medium to very high potency) or subcutaneous steroid injection.

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