Corticosteroids

Corticosteroids, also known as glucocorticoids or steroids, aren’t the same as the anabolic steroids athletes misuse. Corticosteroids are used to treat a variety of inflammatory diseases like asthma, allergies, rashes, rheumatoid arthritis, lupus, and inflammatory bowel disease, as well as many other conditions. Because corticosteroids are so strong, most of them are only available by prescription. While they can be extremely beneficial, steroids can also have serious side effects. It’s a good idea to understand the benefits and risks of corticosteroids and discuss your treatment options with your doctor.

Common Names

Corticosteroids come in several forms, including:

• Oral: Capsules, tablets, or syrups are commonly used for chronic diseases like rheumatoid arthritis, severe allergies, and lupus.
• Inhaler: This form helps control asthma.
• Nasal spray: This type is used for allergies.
• Topical: Creams, ointments, or lotions are used for skin conditions.
• Injection: This is best for localized joint and muscle pain.
• Eye drops or ointments: These are used to treat eye inflammation and prevent long-term damage to the eye, as well as to treat redness, swelling, and itching.

There are many corticosteroids. Some examples of each type include:

Oral:

• cortisone (Cortone Acetate) 
• dexamethasone (Decadron, Dexamethasone Intensol, DexPak Taperpak) 
• hydrocortisone (Cortef) 
• methylprednisolone (Medrol) 
• prednisolone (Bubbli-Pred, Flo-Pred, Prelone, others) 
• prednisone (Prednisone Intensol, Sterapred) 
• triamcinolone 

Inhaler:

• fluticasone (Flovent, Armonair) 
• budesonide (Pulmicort) 
• mometasone (Asmanex) 
• beclomethasone (Qvar) 
• ciclesonide (Alvesco)

Nasal spray:

• budesonide (Rhinocort) 
• ciclesonide (Omnaris, Zetonna) 
• flunisolide 
• triamcinolone (Nasacort) 

Topical:

• betamethasone (Diprolene, Luxiq, Sernivo) 
• fluocinonide (Lidex, Vanos) 
• hydrocortisone (Ala-Cort, Cortizone-5, Dermtex HC, others) 
• triamcinolone (Aristocort A, Kenalog, Pediaderm TA, Triderm) 

Injection:

• betamethasone (Celestone Soluspan) 
• dexamethasone 
• hydrocortisone (Solu-Cortef) 
• methylprednisolone (Solu-Medrol) 

Eye drops/ointments:

• dexamethasone (Maxidex) 
• loteprednol (Alrex, Inveltys, Lotemax) 
• prednisolone (AK-Pred, Pred Forte, Pred Mild) 

How They Work (Method of Action)

Corticosteroids are a man-made version of a hormone your body makes called cortisol. They reduce inflammation, which can lessen symptoms like redness, itching, swelling, warmth, and pain. They also have the ability to suppress your immune system’s activity, which is why they’re often prescribed if you have a disease or condition that causes your immune system to attack itself. Which of the two effects the medication has depends on your dosage. 

Corticosteroids are used for three purposes: 

1. As a replacement therapy for people with Addison’s disease or congenital adrenal hyperplasia, who are unable to make enough cortisol on their own
2. As a treatment for the symptoms of certain diseases and conditions
3. As a prophylactic to prevent organ rejection in people who’ve had a transplant and speed up lung development in babies who are at risk for pre-term labor

Your doctor may prescribe corticosteroids for a short time to treat an acute condition like an allergic reaction or an exacerbation of an autoimmune disease.  Or you may need to take them long-term to reduce inflammation caused by a chronic condition or to suppress your immune system.

Side Effects and What to Do About Them

Like all medications, corticosteroids can cause side effects and some of them may be severe. Below is an overview of general side effects for each type, but since each medication has its own list, be sure to check out specific information on the corticosteroid you’re concerned with. The number of side effects you experience will also depend on the dose you’re on and how long you’re on corticosteroids. If you’re only taking a steroid for a short amount of time, you may not have any side effects, but if you’re taking it long-term, you’re more likely to experience these negative effects.

Oral:

Corticosteroids that you take by mouth affect your whole body rather than just one area, so side effects are more likely to occur with these than with other types. The larger your dosage, the higher your risk of side effects, which can include:

• Weight gain
• Increased appetite
• Upset stomach
• High blood pressure
• Heartburn
• Swelling, especially in your lower legs and/or face
• Mood changes
• Blurry vision
• Glaucoma

If you take oral corticosteroids for a longer period, possible side effects include:

• Weakened bones (osteoporosis)
• High blood sugar
• Bruising easily and healing more slowly from wounds
• Cataracts
• Higher risk of infections
• Decreased hormone production of the adrenal glands

Inhaler:

Some of the medication you inhale can stay in your mouth and throat, which can cause:

• Hoarseness
• Thrush, a fungal infection in your mouth

If you use a steroid inhaler, you should always rinse and gargle with water, then spit it out immediately afterward. This reduces the amount of medication that builds up in your mouth and throat and decreases your risk of side effects.

Nasal spray:

Using a steroid nasal spray may cause:

• Burning
• Itching
• Dryness
• Throat irritation
• Itching
• Sneezing

Topical:

Topical steroid creams, lotions, and ointments can cause these side effects: 

• Acne
• Thin skin
• Raised, red sores
• Rash or bumps

Injection:

Most people only get three or four corticosteroid injections per year. Temporary side effects occur around the injection site and include:

• Thinning skin
• Pain
• Loss of skin color

Other potential side effects are:

• Insomnia
• High blood sugar
• Flushing of the face

Eye drops/ointments:

Using a steroid eye ointment can temporarily cause mild blurry vision, but this should go away.

Both steroid eye drops and ointments can have these less common side effects:

• Burning
• Redness
• Watering
• Stinging
• Worse vision
• Nausea
• Vomiting
• Eye pain
• Eye infection

How to Reduce Your Risk of Side Effects

If side effects are a problem or you’re worried about them developing, here are some strategies to help.

• Talk to your doctor about a different dosage. Maybe you could try a lower dose or take your medication less often.
• Communicate regularly with your doctor. Keep all your follow-up appointments and let your doctor know immediately about any side effects or problems you’re experiencing.
• Follow your doctor’s instructions. This particularly applies if and when your doctor decides that it’s time to discontinue your corticosteroid. The dose needs to be reduced gradually so you don’t experience nasty side effects and so that your doctor can make sure you’re doing well without the medication.
• Consider non-oral corticosteroids. Since oral corticosteroids have the greatest risk of side effects, if you can switch to another type, like an inhaler or injection, this will help reduce your risk.
• Ask your doctor about other ways you can lessen your chance of side effects. For instance, eating a healthy diet, exercising regularly, and taking supplements can help you keep excess weight off, strengthen your muscles and bones, and boost your immune system.

User Experiences

Injections

When Kaye Carson was 60, she had six injections of a corticosteroid for severe muscle spasms she developed from a chronic condition called cervical radiculopathy. The injections were each given in the same session in six different locations on her body after an anesthetic injection. She says she was unable to sleep for more than a couple of hours each night for three weeks and her appetite increased drastically for about three months, which caused her to gain 15 lbs. Carson says the medication ultimately helped, though the pain relief wasn’t immediate. She thinks the injections eventually reduced the inflammation so that her muscle spasms subsided enough that she could control them with prescription medication. Still, Carson says she wouldn’t do it again simply because of the side effects she experienced.

Oral corticosteroids and nasal spray

Rick S., 55, has taken  for years to treat Crohn’s disease and sinus issues, as well as fluticasone nasal spray every day for his sinuses. He was on mostly small maintenance doses for Crohn’s disease for more than 20 years and currently, he takes the oral medications for his sinuses about two to four times a year. He says that while he was taking the oral medications for Crohn’s, he did have oily skin and bad acne, especially when he was on higher doses, but otherwise, side effects weren’t very noticeable. “I am much more outgoing, sarcastic, and witty when I’m on (prednisone), and I have much more energy,” he notes. More recently, when Rick is taking short courses of oral medications for his sinuses, he does notice that his appetite increases, he needs less sleep, and people comment that he gets a lot more sarcastic. 

The medications have helped Rick’s symptoms tremendously. He’s even noticed that when he takes them for his sinuses, he also has positive changes in his Crohn’s disease symptoms, “which is now generally ignored because the symptoms ‘aren’t that bad,’” he says. Rick plans to be tested in the next few months for adrenal insufficiency, which he believes he may have developed from being on corticosteroids for so long.

Oral corticosteroids

Krista Seurer, 44, took Decadron to treat aseptic meningitis that resulted from dermoid cysts that had ruptured when she fell on the ice and hit her head. “I had the cysts since birth and nothing ever happened until I fell,” she says. She took Decadron for six weeks while she went through radiation and says she had a lot of side effects. “I was hungry all the time, I couldn’t sleep, my face was puffy, and I had gained weight, getting to almost 200 lbs.,” says Seurer. She didn’t have the nausea or heartburn some people get though. “I definitely wouldn’t go on them again, not for that long, anyway,” she says. As a physician assistant, “I hesitate even to prescribe a week-long steroid taper (a large dose of steroids followed by a five- to seven-day taper) to my patients for their back and leg pain after my experience,” Seurer says.

Asthma inhaler

Anita Meyer, 51, has used Advair, an inhaler that contains a corticosteroid and a long-acting beta-agonist, to treat her asthma for more than 16 years. The only time she experienced any side effect was when her doctor increased her dosage because she was having a harder time breathing and a cough that wouldn’t go away. She lost her voice for an extended time, so she asked to have the dose lowered again. Overall, though, “I’ve been very happy with the way Advair has allowed me to largely maintain control over my asthma,” she says.

Drug Interactions

Other medications and substances that corticosteroids can interact with depend largely on the type you’re using. However, it’s important to note that there are many potential drug interactions for any corticosteroid, particularly oral formulations. Be sure to tell your doctor about all the prescription medications you’re taking, as well as over-the-counter medications, vitamins, supplements, and herbal remedies.

A great source of information on drug interactions and side effects is the U.S. National Library of Medicine’s MedlinePlus site. 

Effectiveness and Considerations

Corticosteroids can be quite effective for a variety of conditions. Sometimes, they’re even lifesaving. They can prevent further inflammation in people with chronic diseases, relieve pain and stiffness, control allergy and asthma flareups, and prevent damage to organs. Keep in mind too that everyone’s experience with corticosteroids will likely be different.

Your doctor will take into consideration your overall health, age, amount of physical activity, and the other medications you’re taking before prescribing a corticosteroid. He or she will weigh the benefits of corticosteroids against the potential risks you might have. For instance, you might have other medical issues that increase your risk of side effects enough that the benefits probably wouldn’t be worth the risks. There could also be alternative treatments for your condition that don’t carry the risks that corticosteroids have (see below).

Alternatives to Corticosteroids

Depending on your health, there may be alternatives to consider. You may also want to look at alternative therapies as add-ons to your current treatment plan.

Anti-inflammatory diet

If you have a condition that causes inflammation, such as an autoimmune disease, asthma, or allergies, consider trying an anti-inflammatory diet. Avoiding foods that are known to cause inflammation — like red meat, white bread and pastries, fried foods, shortening, margarine, and beverages sweetened with sugar — and increasing your intake of anti-inflammatory foods — tomatoes, nuts, fatty fish, olive oil, green leafy vegetables, and fruits — can help keep inflammation in check.

Herbs and supplements

Some studies have found that there are certain herbs and supplements that may help lower inflammation with fewer side effects than corticosteroids. You can ask your doctor about taking these: 

• Omega-3 fatty acids (fish oil)
• Green tea
• White willow bark
• Turmeric
• Chili pepper (capsaicin)
• Cat’s claw
• Resveratrol
• Frankincense

Lifestyle changes

Lifestyle changes are a good idea for anyone, plus they have the added benefit of potentially helping to reduce inflammation. If you aren’t already doing the following, try implementing one change at a time:

• Exercise regularly
• Eat a healthy diet that focuses on fruits, vegetables, and whole grains
• Avoid smoking
• Practice good sleep hygiene
• Manage stress with approaches like deep breathing, meditation, or journaling

Mind-body therapies

Studies on the effects of mind-body therapies on inflammation have shown mixed results, so it’s unclear yet if these practices help or not. That said, they are known to reduce stress, improve the overall quality of life, and reduce symptoms, so don’t rule them out as an additional therapy in your treatment. 

Examples of mind-body therapies include:

• Yoga
• Tai Chi
• Meditation
• Acupuncture
• Massage therapy
• Spinal manipulation

For chronic, potentially life-threatening conditions like lupus, asthma, or rheumatoid arthritis, it’s critical that you are under a doctor’s care. Don’t use alternative therapies to manage your condition on your own. 

Be sure you talk to your doctor before you stop or replace your corticosteroid, especially if you’re taking it orally. If you want to stop taking your medication, your doctor needs to wean you off slowly so that you don’t have side effects or put too much strain on your kidneys.

You should also get your doctor’s input before you replace your corticosteroid or add another treatment. There may be risks or interactions with other medications that you aren’t aware of. Your doctor can help you navigate the best treatment options for your individual needs.