Tag Archives: prednisone

What to Do If You Have Allergic Reactions to Antibiotics?

What started out as a few pinprick-sized dots on my forearms on Christmas Day turned into a huge allergic reaction that would go on — in various forms — until the 4th of July.

The culprit was the antibiotic dicloxacillin, a member of the penicillin family.

Though antibiotics can be lifesaving, I was taking this one mostly out of convenience. I am prone to mastitis, which occurs when a lactating woman’s milk duct clogs and becomes infected. The symptoms include fever and body aches.

Lactating women — as I was at the time — are typically busy moms with at least one very young child. My youngest was 11 months old. My other two sons were 3 and 8. I had no time to deal with my own illnesses, so if there was a quick fix, I took it.

I now know that was a big mistake.

This was not my first time taking dicloxacillin. I had developed mastitis 6 times over the previous 3 years, and dicloxacillin had quickly cured it with no ill effects.

My seventh round of this antibiotic was the unlucky one. By the time the rash popped up, I had already finished taking the 10-day antibiotic series. I was having a delayed reaction.

Allergies May Be Immediate or Delayed

Drug allergies are still somewhat of a mystery, says Dr. Min Jung Lee, an assistant professor of pediatrics and internal medicine at the University of Texas Southwestern. However, there are indications that frequent antibiotic use does make patients more susceptible to developing allergies.

“The most common symptoms of the immediate reactions occur a half an hour to an hour after taking the medication,” she says. “Symptoms include swelling, vomiting, coughing and anaphylaxis.”

Then there is the delayed reaction, which can happen after the entire series of antibiotic has been consumed. While still dangerous and often lengthy, delayed reactions move more slowly and any life-threatening symptoms usually can be treated with antihistamines and steroids.

Those pinprick spots on my forearms gave way to huge hives all over my body. The last week of December 2010, I went to the emergency room 3 times. Once in an ambulance, I developed large hives, fainted, had swollen lips, mouth sores, gum swelling, fullness in my throat, body aches and more.

Unlike food and seasonal allergies, drug reactions are difficult to understand and predict, says Dr. Corinna Bowser, an allergist at Narberth Allergy and Asthma clinic in Narberth, Penn.

“The difficulty we are facing is that we just don’t know what gets broken down into our bodies,” she says. “It’s unpredictable. What’s the mechanism? Does it happen right away, will it happen later?”

I continued to develop smaller rashes, experienced joint pain, mouth sores and swelling in my fingers, as well as other strange symptoms, like parosmia, a disorder where your brain can’t identify common odors.

Adding to the confusion, many drug allergy symptoms can be confused for symptoms caused by the bacteria that the drug has been prescribed to treat. Bacterial infections can cause rashes.

In my case, it was clear that my reaction, which was becoming serious, was caused by a drug allergy. I was prescribed a massive dose of the corticosteroid prednisone, which tapered over the next 20 days. The steroid did get the rash under control, but my symptoms would continue for weeks.

I continued to develop smaller rashes, experienced joint pain, mouth sores and swelling in my fingers, as well as other strange symptoms, like parosmia, a disorder where your brain can’t identify common odors.

To make matters worse, while going through this process I developed mastitis an eighth and final time. This time I took clindamycin, a drug that comes from a completely different antibiotic family.

I reacted again. And as a result, I finally had to stop breastfeeding.

Multiple Drug Allergy Syndrome

This time though, I noticed the mild rash after just 1 day. I stopped taking the drug, but the symptoms continued. Rashes popped up on my stomach and feet. I had a fever, mouth sores, back pain and swelling around the eyes.

Later, I discovered natural therapies to treat mastitis through my neuropathologist. Heat and cold compresses, lecithin, garlic, and I actually put cabbage leaves in my bra, which for some reason dries up the milk production. The problem is that there is no magic bullet and it takes longer. So instead of feeling sick for a day, nursing moms will feel sick for a week.

All my reactions and symptoms finally came to a sudden end in mid-July, 7 months after they started. But the fear lingered. I was afraid I’d be allergic to other antibiotics and was terrified to try another.

Seeking answers, I began doing research. I found a name for my condition: Multiple Drug Allergy Syndrome.

I finally made an appointment at the Mayo Clinic in Rochester, Minn., where I met with one of the few doctors who specialize in multiple drug allergies.

He was considerably less concerned than I was, and that gave me hope. He put together a plan so that the next time I needed antibiotics I had some reasonable options.

Photograph Visible Allergy Symptoms

Any visible allergy symptoms should be documented with a photograph, says Dr. Maria Castells, physician at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School.

The antibiotics most likely to cause reactions are penicillins, cephalosporins and sulfonamides, Dr. Castells says.

A Kaiser Permanente study in 2009 found that 7.9% of the population is allergic to penicillin, 4.3% to sulfanimides, and 1.2% to macrolides. Females are more likely to be affected, Dr. Lee says.

The good news is that a lot of research is being done on this topic, she says, “especially on genetic determinants and tests to predict allergies.”

Adding more hope for sufferers, antibiotic allergies are often transient, meaning one can be allergic at one time in their lives and then grow out of it 10 years later, Dr. Lee says.

Also, multiple drug allergies does not mean ALL drug allergies.

“Patients can be allergic to multiple medications, but that is rare,” says Dr. Castells. “Most of the time two or three medications are responsible. There is always an antibiotic that a patient can take.”

Two types of tests are available to determine if you might be allergic to penicillin or cephalosporins: A skin test and graded challenge. The skin test involves inserting a small amount of penicillin under the skin. If a red, itchy bump forms, then the patient is allergic. If not, it doesn’t necessarily mean they are not allergic. The patient could still have a non-immediate, delayed reaction. The graded challenge takes place in a doctor’s office with a low dose of penicillin. The dose is increased. If no reaction, the doctor feels it’s safe to prescribe the antibiotic.

As for me, I’m happy to report that I have since been able to take the antibiotics Levaquin (levofloxacin) and Zyvox (linezolid) with no reaction. However, I do avoid antibiotics whenever possible. If there’s another way to treat a condition, I choose that route.

Serious Side Effects Associated with Short-Term Corticosteroid Use

People who took corticosteroids even for a relatively short period of time were more likely to break a bone, have a blood clot or develop sepsis compared to those who didn’t take the medication, according to results of a new study.

Researchers examined data from 1.5 million non-elderly American adults. Over the 3-year study period, about 20% of them filled a short-term prescription for an oral corticosteroid, such as prednisone. Rates of serious adverse events were highest in the first 30 days after receiving a prescription, the researchers reported in the BMJ. Even more concerning, the risk of such events was still high 3 months later.

“We see a clear signal of higher rates of these 3 serious events within 30 days of filling a prescription,” lead study author Akbar Waljee, MD, of the University of Michigan School of Medicine, said in a statement. “We need to understand that steroids do have a real risk and that we may use them more than we really need to.”

Results also indicated that around half of the people that received an oral steroid got the drug for 6 diagnoses related to back pain, allergies or respiratory tract infections.

Waljee also advised that doctors prescribe and patients use the lowest amount of corticosteroid possible. “If there are alternatives to steroids, we should be using those when possible,” he added.

Feeling Anxious? Depressed? Check Your Meds

If you find yourself feeling on edge for no apparent reason while taking a cold medicine or diuretic, you most likely wouldn’t connect the two. However, anxiety happens to be just one of many mood-altering symptoms that can be brought on by certain meds.

“Many medications, whether prescribed or found over the counter, can cause psychiatric symptoms,” says Shiyun Kim, PharmD, BCACP, BCPP, CDE, a clinical pharmacist and clinical assistant professor at the University of Illinois Hospital & Health Sciences System, and a spokesperson for the American Pharmacists Association.

She explains that a wide range of factors influence the way a drug affects each person, including things like metabolism, underlying illness, and interactions with other drugs. “Any variations that occur, such as with improper doses or individual reactions, can result in undesirable psychiatric symptoms,” though they are relatively uncommon.

If you feel that you may be suffering from these side effects, notify your providers immediately. “Keep in mind that some medications can be stopped abruptly, while others need to be tapered to prevent further adverse effects,” Dr. Kim emphasizes. “Your provider can make the best decision with you.”

Take note of the following medications that can have these kinds of effects, and read on to find out how to minimize the risks.

Oxycontin and Similar Pain Medications

“Most prescription pain medication, such as oxycodone (OxyContin) or hydrocodone, can cause drowsiness, which can make one feel ‘cloudy’ and lack motivation — and these symptoms closely mimic depression,” according to Bree Meinzer, PharmD, CTTS, a pharmacy practice resident at Ohio Northern University. Opioids can also lead to more severe symptoms like paranoia, hallucinations, psychosis and dementia, especially at high doses. Signs that you may have taken too much of an opioid include trouble breathing and unconsciousness. People with opioid dependence and those who suffer from HIV, liver or lung disease or suffer from depression may be more susceptible to these effects, according to the World Health Organization. If you are on a pain medication that makes you drowsy or “cloudy” and you do not like how it makes you feel, you should talk to your doctor about other ways to adequately manage your pain.

Lasix, Microzide and Other Diuretics

Medications that reduce fluid retention and swelling, including furosemide (Lasix) and hydrochlorothiazide (Microzide), increase urination. This can lead to dehydration, especially in the elderly, and can result in hallucinations and dizziness, says Dr. Meinzer. SGLT2 inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance), which are drugs used to treat diabetes, can also increase urination and cause dehydration. If you are taking these types of medication, be sure to drink plenty of water to stay sufficiently hydrated. The amount of water to drink should be discussed with your doctor and is dependent on your weight. “These medications should also be taken in the morning or early afternoon to avoid frequent urination at night,” which could disrupt sleep, she advises.

Ask your doctor to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.

Requip and Other Dopamine Agonists. Medications like ropinirole (Requip), often prescribed for restless leg syndrome and Parkinson’s disease, increase the brain chemical dopamine, which helps regulate mood and behavior. Too much dopamine can cause hallucinations, notes Dr. Meinzer, and more extreme potential side effects include confusion, mania, depression and impulse control disorders like compulsive gambling or eating. “There are other options for restless leg syndrome that don’t increase dopamine, though medications like ropinirole typically work best.” There are also different medications for Parkinson’s, though you and your doctor should carefully consider your particular treatment needs. If you experience these kinds of symptoms while taking this type of medication, it may be that your dose is too high.

Ritalin, Adderall and Other Stimulants

Drugs that are commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD) include those sold under the brand names Ritalin and Adderall. Although these stimulant medications “help children and adolescents focus and stay on task, side effects include increased heart rate and insomnia, which can often cause anxiety and restlessness,” says Dr. Meinzer. Stimulants “excite the central nervous system and can disrupt normal communication between cells in the brain,” adds Dr. Kim. “This class of drugs may also cause bizarre behavior, agitation, mania, paranoia and nightmares.” Dr. Meinzer suggests talking to your healthcare provider if you feel extremely restless and anxious while taking this type of medication. Again, it is possible that your dose is simply too high.

Corticosteroids

Medications like prednisone, cortisone and methylprednisolone are often prescribed “to help respiratory symptoms and decrease inflammation with chronic diseases,” Dr Meinzer explains. They are typically only “used for a short term to help alleviate symptoms, but if you are on these medications for a long time, they can cause some unwanted side effects.” Use of these drugs for more than a few months can increase the chances of experiencing mania, anxiety, depression, paranoia and psychosis, which have mostly been reported by patients using high doses or abusing the medication, says Dr Kim. Though experts are unclear about the exact reasons for such side effects with these drugs, research suggests that it may have to do with the way steroids work in the area of the brain that influences memory and emotion. It is also possible that “high levels of steroids result in brain damage and cause cognitive dysfunction.”

Zarontin and Other Anticonvulsants

Medications such as ethosuximide (Zarontin), which are used to control seizures in people with epilepsy, can cause symptoms resembling depression. These drugs have also been found to increase suicidal thoughts and behavior. “If you start to experience these symptoms on an anticonvulsant, you should talk to your doctor about other regimens,” Dr. Meinzer recommends. “There are other medications in the same class that are less likely to cause this side effect,” though your doctor may want you to stay on the medication because it may be the one that is most effective for you. “Anticonvulsants are usually tricky to dose and may need lab monitoring to make sure they are in the proper range.”

Dr. Kim offers the following general tips to help prevent or deal with these side effects:

  • When you are prescribed a drug, ask your provider about potential side effects that are commonly noted and reported.
  • Ask your provider to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.
  • Withdrawal of some drugs can cause symptoms such as anxiety, agitation or depression. Therefore, call your doctor before stopping medications on your own.
  • When purchasing an over-the-counter (OTC) medication, take the time to read the instructions on the package. If anything is unclear, ask the pharmacist for guidance.

Long-Term Effects of Corticosteroids

Corticosteroids are used to treat many different medical conditions, from rheumatoid arthritis to allergies to lupus and more. The prescribed medicines include: Celestone (betamethasone), Cortone (cortisone acetate), Decadron/Hexadrol (dexamethasone), Acticort/Aristocort/Cortef (hydrocortisone), Medrol (methylprednisolone), Prelone (prednisolone) and Deltasone/Sterapred (prednisone).

Some concerns patients have over long-term side effects of corticosteroids include:

  • uclers / gastrointestinal bleeding
  • osteoperosis
  • increase risk of heart disease
  • decrease in bone density
  • increased risk of infections
  • thin skin, bruise easily, slower healing of wounds

These are just some of the concerns, please visit the resources section of this page for more information.

See also:

Because of the wide variety of medical conditions that corticosteroids treat, it is very important that any conversations with your medical provider include understanding the long-term effects.  Remember that long-term effects of drugs are relevant to prescription dose and length of treatment, and MedShadow encourages discussions that give you enough information to make an educated decision about your healthcare.  Effects, both positive and negative, have long lasting repercussions on our quality of life.

Studies

Studies on corticosteroids tend to lean toward the extreme use, rather than the average use.  For example, some studies look at corticosteroids for extreme and rarer cases of eczema.  This makes it harder to research what long-term studies are out there on steroid use.  To complicate things further, corticosteroids can be oral, topical, injected, or inhaled, and this dramatically changes the benefits and risks, and in turn the short-term and long-term effects.  Speak with your doctor and pharmacist on what, if any, long-term studies out there are relevant to your own medical treatment.

Here are some studies, but we encourage you to look at our Organizations and Other Resources section below to complement your own search for more information.

Study of Asthma and Steroid Study (STAN)

This study found that long-term use (24 weeks) of nasal steroid was not better at improving asthma control in adults or children. There are also studies here on the short- and long-term use of topical steroids for eczema.

Inhaled Corticosteroids for Cystic Fibrosis

A recent Cochrane review found that clinical trials cannot prove that inhaled corticosteroids reduce inflammation in the lungs of cystic fibrosis patients. However, one trial revealed that inhaled corticosteroids can inhibit a child’s growth when used in high doses.

Corticosteroids for Rheumatoid Arthritis

Another Cochrane review found that while there is convincing evidence that corticosteroids can reduce the rate of erosion progression in rheumatoid arthritis, unfortunately, there is also concern that the long-term effects of corticosteroids, such as increased cardiovascular risk and osteoporosis, may outweigh their benefits.

Corticosteroids and Staph Infection Risk

A study found that when used over the long term, systemic glucocorticoids, a type of corticosteroids, may make patients more susceptible to life-threatening staph blood infections.

There are also studies here on the short and long-term use of topical steroids for eczema.

Articles We Like

Prednisone and Other Corticosteroids: Balance the Risks and Benefits

A good guide from the Mayo Clinic outlining the risks and benefits of taking many types of corticosteroids.

Corticosteroids

A nice overview of corticosteroids from the Cleveland Clinic

Steroid Side Effects: How to Reduce Corticosteroid Side Effects

A physician from New York’s Hospital for Special Surgery describes drug-related side effects for different kinds of corticosteroids and provides self-care tips to minimize the chances of experiencing them.

Nasal and Oral Corticosteroids for Allergies

A nice review of corticosteroids used to treat allergies, including side effects and adverse events to be aware of

Inhaled Corticosteroids Not Linked to Pneumonia

A meta-analysis of 31 studies that included 11,615 children with asthma found that use of inhaled corticosteroids did not lead to an increase in pneumonia or other respiratory diseases.

Common Medicines Should Mimic Timing of Body’s Natural Systems to Prevent Side-Effects

“Debilitating side effects associated with prescription medication for some of today’s most common conditions could be eradicated if they mimicked the body’s natural hormone secretion cycles, a new report has said.” – Science Codex

Steroid Shots for Tennis Elbow Miss the Mark: Study

and With Elbows, Cortisone Shots May Hurt More Than Help

A corticosteroid shot and physical therapy have no long term benefits in the treatment of “tennis elbow”, a new study (Australia) confirms.

Asthma and Arthritis Medications are Drug Muggers

A pharmacist explores the ways that different drugs “mug” the body of important nutrients.

Researchers Discover Genetic Bias for Eczema, New Avenue to Therapies

A University of Oregon study discovered an “underlying genetic cause of atopic dermatitis”, opening up avenues to alternative treatments that may bypass the use of topical steroids.

Organizations and Other Resources

Why are steroids used in medicine?

Access Science by McGraw Hill answers this question from a scientific perspective, but succinctly lays out the breadth of uses of different steroids in medicines.

Asthma Health Center

WebMD has a great page with information on use of inhaled corticosteroids for the long-term control of asthma.

5 Drug Classes That May Cause Depression

Depression can be a complex disorder with many causes, but depressive feelings can also result as a side effect of medication. For most medications, the risk is small, but if you have experienced depression in the past, you may be more likely to develop depression again when you take one of these drugs.

It can be difficult to tell whether depression is due to a drug, says Linda Lang, MD, chair of the Department of Psychiatry at Christiana Care Health System in Delaware, especially if a person also has an illness that itself can lead to depression. “We have to be mindful of the potential that somebody who has breast cancer is put on tamoxifen and they’re depressed,” she says.

“You might say ‘Well of course they’re depressed, they have breast cancer’ but it might be the tamoxifen.” For the same reason, researchers have a hard time concluding whether the drug causes depression because a lot of patients with a cancer diagnosis might develop depression anyway.

Depression isn’t just sadness. Symptoms to watch out for include feelings of hopelessness, change in appetite, thoughts of death, difficulty sleeping, or irritability. You probably won’t feel these effects right away, but they may set in after a few weeks.

Cardiovascular Drugs

Beta-blockers reduce your blood pressure by blocking the effect of the hormone epinephrine, also known as adrenaline. Researchers have suspected a connection between this class of drugs and depression for nearly 50 years, without strong evidence to answer the question either way. The risk for depression, if it exists, is probably small.

Statins, the cholesterol-lowering drugs, are also possibly linked with depression. Statins can interfere with the way the body uses serotonin, and serotonin is important to the brain’s functioning. As with beta-blockers, studies looking for the connection have had mixed results, with some even finding that statins may have an antidepressant effect.

Hormonal Agents

Drugs that interfere with the way hormones operate in the body can affect mood. Corticosteroids, for example, can lower serotonin levels and might be able to cause depression. This class of drugs includes cortisone and prednisone.

Tamoxifen, a breast cancer treatment, also has possible connections with depression. Tamoxifen interferes with estrogen, with different effects in different parts of the body. It’s possible, though not fully proven, that this can lead to depression.

Birth control pills have also been linked with depression, but again the relationship is hard to untangle. A recent study of Danish women found that those on contraceptives were slightly more likely to fill a prescription for an antidepressant. But women who go to the doctor for birth control may have simply been more likely to have an opportunity to get their depression diagnosed.

Antiepileptic Drugs

Antiepileptics are drugs used to treat seizure disorders, and may also be used for other purposes. Topamax (topiramate) can be used to prevent migraines, for example. These drugs both act on neurotransmitters and their receptors in the brain.

Both of these drugs have been linked with depression, even though topiramate can also be used to treat certain kinds of depression. Topiramate was one of the drugs associated with an increased risk of committing suicide in one Danish study. People taking that drug were twice as likely to commit suicide as people who were not taking it. That means the numbers are still small — very few people commit suicide — but the risk is still concerning.

Other anticonvulsants share this risk, and may be worse than topiramate. Since 2008, the FDA has required all anti-epileptic drugs to carry a warning about an increased risk of suicidal thoughts and actions. The agency notes that the increased risk applies to eleven different drugs, that work in different ways and are prescribed for different reasons, so they consider the warning to apply to all antiepileptic drugs.

Parkinson’s Disease Medications

Parkinson’s disease is often treated with drugs like levodopa that increase the amount of dopamine in the brain. That makes sense, since Parkinson’s results from the death of dopamine-generating cells in the brain. “But as a result of increasing dopamine we can induce depression,” Dr. Lang says.

Dopamine, serotonin, and norepinephrine are neurotransmitters that all have some link to depression, so drugs that change the amounts of these chemicals in the brain may cause depression.

Retin-A (Isotretinoin)

Retin-A (isotretinoin) is a form of retinoic acid used to treat acne. The FDA received a large number of reports of suicides and suicidal thoughts while people were using this drug. As with many of the other drugs linked to depression, it is unclear whether isotretinoin truly causes an increased risk of depression and suicidal thoughts.

For any of these drugs, Dr. Lang says, your doctor should be monitoring your mental health, for example through depression screenings questionnaires. People taking these drugs are often at increased risk for depression, whether due to the drug itself or to the condition it causes.

If a medication seems to be causing any symptoms of depression, talk to your doctor about your options. In many cases, they can change your medication. If you need to stay on that medication, they can help you manage the depression, for example with anti-depressants or other therapy.

6 Dangers Unique to People with Diabetes

If you have diabetes, you probably know all about how food affects your blood sugar, including what, when, how often and how much you eat. Skipping meals, for example, can be a clear recipe for disaster, and overdoing starchy foods can cause glucose to soar. There are several other substances and scenarios that you may not be aware can cause dangerous dips or spikes in your glucose levels. Some experts weigh in so you can learn more about these risks and make sure you don’t end up in any danger.

1. Over-the-counter meds. While most OTC drugs are generally safe for use with diabetes medications, there are a few that can pose risks. Aspirin can lower blood sugar, though it typically takes quite a large quantity to have that effect, and other OTC meds can drive glucose up.

“The most common offenders are the allergy and decongestion products, which include pseudoephedrine or other decongestants that can increase a diabetic patient’s blood sugar level,” according to Kevin M. Pantalone, DO, a staff endocrinologist and director of clinical research at the Cleveland Clinic. Some cough syrups can also boost glucose because they contain sugar. Again, standard doses are unlikely to make a big difference, but “if this is a real concern for a particular patient, a sugar-free cough syrup could be purchased instead.

2. Other prescription drugs. “The medications that patients really need be concerned about raising their blood sugar levels are steroids such as prednisone,” says Pantalone. “It is not unusual for patients to receive an injection of steroid into a joint for pain relief, for example, only to then notice their blood sugar levels spiraling out of control a few days later.”

The injectable and oral varieties tend to have the largest impact, but inhaled and topical steroids can also have glucose-raising effects. Steroids are typically prescribed to treat conditions including asthma, inflammatory bowel disease (Crohn’s disease, ulcerative colitis) and joint/muscle diseases, such as rheumatoid arthritis. To avoid a potential emergency, alert your physician if you have been or will be prescribed steroids. Also, antibiotics, especially the class called fluoroquinolones (e.g., Cipro/ciprofloxacin), can cause significant glucose fluctuations in either direction, leading to hypoglycemia in some people and hyperglycemia in others.

3. Dieting. Diabetes meds reduce blood sugar regardless of how much or little food a patient is eating at a given time, explains Pantalone. During times of decreased appetite or limiting food intake by choice, a person taking such drugs may experience drops in glucose that can cause levels to become dangerously low when combined with the medication. Don’t attempt to tweak your dosage on your own, though.

“Patients should review with their doctors which medications need to be adjusted, if any, prior to making any self-adjustments,” he recommends. “Patients with insulin-dependent diabetes cannot simply skip doses of long-acting basal insulin, as doing so could result in an emergency situation, and maintenance medications usually need to be continued, albeit often times at a lower dose.”

4. Illness. While a cold medicine can raise blood sugar, the “cold itself is likely to increase glucose levels too,” says Matthew Freeby, MD, director of the Gonda Diabetes Center at David Geffen UCLA School of Medicine. People taking diabetes drugs might require a higher dosage when experiencing bodily stress caused by illness.

The disease-fighting hormones your body releases in response to the stress of illness can boost glucose and interfere with your medication. In type 1 diabetes, this can lead to a life-threatening condition called ketoacidosis, and may result in diabetic coma. Though less likely to affect individuals with type 2 diabetes, illness may still lead to excessive blood glucose levels in both groups.

Alternatively, some patients may need a lower dosage of diabetes medication while sick because of decreased appetite.

Talk to your doc or diabetes educator about creating a “sick-day plan,” so you’ll know exactly what to do in case of illness.

5. Herbal supplements. “Most patients don’t think to tell their clinician or pharmacist that they’re using herbal supplements because they appear ‘safe’ and natural,” notes Amy Gustafson, PharmD, manager of ambulatory pharmacy at the Cleveland Clinic Twinsburg Family Health Center. But many natural products can decrease blood sugar and lead to too-low levels when combined with diabetes meds, she says, including garlic, ginseng, fenugreek and cinnamon. No need to worry about the herbs when used as spices, the concern is the concentrated amounts found in supplements.

“Other agents that could interact with diabetes drugs are aloe vera, andrographis paniculata, karela (Momordica charantia), Lycium, St. John’s wort, and herbs with glucosamines, isoflavones or levocarnitine,” adds Mohamed A. Jalloh, PharmD, assistant professor at Touro University California College of Pharmacy and a spokesman for the American Pharmacists Association. “St. John’s wort and ginseng are the worst because they induce the same enzyme that processes most diabetes drugs” and therefore decrease their effectiveness.

6. Alcohol. Hitting the sauce can mess with your meds and your glucose, though maybe not in the way you would expect. It is well-known that alcohol can increase blood sugar in small amounts, but in larger doses, it “can increase the risk of hypoglycemia by reducing the liver’s natural glucose production — and alcohol plus medication can add up to a low glucose level,” explains Freeby. “Therefore, patients taking diabetes medications should be cautious with alcohol intake and need to consult their doctor” regarding safe limits for their specific situation.

In many cases, people with diabetes can drink alcohol in moderation, but you should never do so on an empty stomach or when you know your blood sugar is already low. People taking insulin or sulfonylureas are especially vulnerable to the glucose-lowering effects of alcohol.

How to Stay Safe

One of the most important ways to minimize such risks is to keep close track of all drugs you are taking, including OTC drugs and natural supplements, advises Jeff McClusky, BS, RPH, a hospital pharmacy manager and American Pharmacists Association spokesperson in Houston, Texas. “Verify that both your physician and pharmacist have these details, and ask them first if you are looking to change any OTC or medication practices,” he says.

It is best to use just one pharmacy so that they can maintain up-to-date and accurate records, and this helps the pharmacist get to know you as a patient and fully understand the various medications you may be taking. “Having all of these details in one place allows them to provide comprehensive medication reviews every time you visit them,” McClusky adds.

Need to Know: Corticosteroids

Corticosteroids are often used in the treatment of joint pain or inflammation (arthritis), as well as irritable bowel disease (ulcerative colitis and Crohn’s disease), skin diseases, allergies, asthma and even brain tumors. However, this class of drugs can cause many complications. Knowing and understanding the facts can improve corticosteroid use.

Common Names

Celestone (betamethasone), Cortone (Cortisone acetate), Decadron (dexamethasone), Cortef (hydrocortisone), Aristocort (hydrocortisone), Medrol (methylprednisolone), Prelone (prednisolone), Deltasone (prednisone)

Side Effects and What to Do About Them

Corticosteroids can be taken in tablet form or through inhalation, and the side effects will differ based on what form of medication is used.

The most common side effects of inhaled corticosteroids include a sore mouth, hoarse voice, and infections in the throat and mouth. To avoid or reduce these side effects, it’s highly recommended to rinse the mouth out with water after taking the medication.

The most common side effects of corticosteroids in tablet form include bruising of the skin, weight gain, weakening of the bones, high blood sugar levels, cataracts, and swelling of the feet or ankles. Side effects can lessen during treatment as your body adjusts to the medicine, but if these side effects continue or are bothersome, you may want to check with your doctor to discuss alternative medications.

Diet is very important if you take a corticosteroid for a long time. Doctors might want you to follow a low-sodium or a potassium-rich diet.

Before giving corticosteroids to children or teenagers, doctors should discuss the possible side effects. They may cause infections like chickenpox or measles, or slow growth in children and teenagers.

According to a Cochrane review, clinical trials cannot prove that inhaled corticosteroids reduce inflammation in the lungs of cystic fibrosis patients. However, one trial reveals that inhaled corticosteroids can inhibit a child’s growth when used in high doses.

Older patients who take corticosteroids may be at risk of high blood pressure or osteoporosis. Women, in particular, are at risk of developing bone disease. Because of this, women should ensure they are getting enough calcium and vitamin D in their diet. If not, they should consider taking supplements. In severe cases, bisphosphonates may be prescribed to treat the osteoporosis.

In another Cochrane review, there is convincing evidence that corticosteroids can reduce the rate of erosion progression in rheumatoid arthritis. Unfortunately, there is some concern that the long-term effects of corticosteroids, such as increased cardiovascular risk and osteoporosis, may outweigh the benefits.

Drug Interactions

Other medicines can interact with corticosteroids, and as a result the side effects of either medicine can be altered.

Mixing corticosteroids and anticoagulant medicines (such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban) can make anticoagulants less effective. Additionally, it can cause bleeding inside the digestive system.

If you need to take both corticosteroids and a diabetes medication, then your blood glucose levels should be checked regularly and your dose of diabetes medication might need to be adjusted.

Combining NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, Voltaren (diclofenac), naproxen and corticosteroids increases your risk of developing stomach ulcers and internal bleeding. If you need to take both medications, you may be given a proton pump inhibitor (PPI) to minimize the risk of stomach ulcers.

Effectiveness & Considerations

Corticosteroids are intended to provide relief for inflamed areas of the body. They are used to lessen swelling, redness, itching, and allergic reactions. Typically, corticosteroids are used to treat severe allergies or skin problems, asthma, and arthritis.

The body naturally produces cortisone-like hormones to maintain good health, but if your body doesn’t produce enough cortisol, then your doctor might suggest corticosteroids to help make up the difference. This type of medicine is available by prescription only. The duration of corticosteroid treatment depends on the condition being treated.

Alternatives to Corticosteroids

Corticosteroids are the most popular therapy to treat inflammation, but patients should consider the safety concerns. Herbs and dietary supplements might offer just as effective results as prescribed corticosteroids. Natural anti-inflammatory treatments include omega-3 fatty acids (fish oil), white willow bark, curcimin (turmeric), and green tea. Always make sure your health care providers know all the medicines, herbs and supplements you are taking or considering taking. Every product you put in your body can cause interactions you may not know to expect.

Since the late 18th century, fish oil has been used to treat muscular, skeletal, and discogenic diseases. The therapeutic benefits of fish oil have shown to be an effective, natural anti-inflammatory agent. The active ingredients in fish oil can directly reduce inflammation in cartilage. There have been positive clinical studies that show the efficacy of fish oil in treating arthritis.

One of the oldest herbal remedies for pain and inflammation is bark from a white willow tree.  White willow bark works similarly to aspirin by blocking swelling. Usually, the dose of white willow bark is 240 mg/day. White willow bark is available as a supplement in a pill form, as well as a liquid extract.

Curcumin is yellow in pigment and derived from turmeric, a plant of the ginger family. Curcumin is considered to inhibit inflammation by suppressing NF-kB, a protein complex that controls transcription of DNA. Clinical studies have shown that curcumin has anti-inflammatory effects. It’s possible to be a viable natural alternative to nonsteroidal agents.

Green tea is used in the treatment of arthritic disease as an anti-inflammatory agent. The constituents of green tea have shown to inhibit aggrecanases, enzymes found in cartilage, which degrade cartilage. Research on green tea demonstrates anti-inflammatory effects.

How They Work (Method of Action)

Corticosteroids imitate the effects of cortisol, a natural hormone in your body, to suppress inflammation. They also lower the activity of your immune system by reducing white blood cells, which help to prevent damage to body tissue.

What Worked for You?

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MedShadow Coverage on Corticosteroids

Further Reading

Corticosteroids Method of Action