There are different types of corticosteroids including:
- inhaled corticosteroids – you can take these using an inhaler
- oral corticosteroids – you can swallow these as tablets, or you may be able to have them as a drink (soluble tablet)
- topical corticosteroids – these include drops for your eyes, creams that you apply to your skin or sprays and drops for your nose
- injected corticosteroids – your doctor will inject these directly into your bloodstream, into a joint or around a tendon
Your doctor will advise you which type of corticosteroid is best for you.
Much like the steroid hormones your body produces, corticosteroids maintain your blood sugar levels and balance the levels of salts and water in your body. Corticosteroids can also suppress your immune system, and so reduce swelling, or inflammation.
Corticosteroids work by lowering the amount of white blood cells (T lymphocytes and neutrophils) that your body normally produces to fight off infections. They also block the action of molecules that cause inflammation, called prostaglandins.
You can take corticosteroids in many different ways. You can apply them as a cream, take them as a tablet, as an inhaler, eye drops or nasal spray. You can also take some corticosteroids as an enema − a liquid that you insert into your rectum (back passage). Alternatively, your healthcare professional may give you an injection of corticosteroids.
If you have been taking corticosteroids for more than three weeks, you should gradually begin to reduce your dose before you stop taking them completely. Speak to your doctor before you stop taking corticosteroids.
Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.
Taking corticosteroid tablets for a long time can make you more at risk of developing infections, particularly chickenpox, measles and shingles. Try to minimise how much close contact you have with anyone with chickenpox, measles or shingles if you're taking corticosteroids long-term. If you haven’t had these infections before, and you have recently come into contact with someone who has them, contact your GP for advice.
Oral corticosteroids can also reduce the effects of medicines used to control diabetes. You may find that your blood sugar levels rise for a few days after you’ve had an injection of corticosteroids. If you have diabetes and are prescribed oral corticosteroids, speak to your GP or doctor for advice.
If you're prescribed corticosteroid tablets for longer than three weeks, you will be given a steroid treatment card. This card explains how much corticosteroids you’re taking and for how long. It will also explain how to minimise your risk of getting any side-effects. Speak to your doctor if you think that you need a steroid treatment card.
Side-effects are the unwanted effects of taking a medicine. If you have side-effects, it's important to talk to your doctor before you stop taking it. This section doesn't include every possible side-effect of corticosteroids. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.
You're unlikely to get side-effects from corticosteroids if you're only taking them occasionally or if they’re only used in a specific area of your body. For example, you’re unlikely to get any side-effects if you apply a corticosteroid cream to a small area of skin. However, using some of the stronger corticosteroids as a cream long-term may make your skin thinner and increase your risk of getting stretch marks.
Inhaled corticosteroids can increase your risk of developing oral thrush. This is a fungal infection which affects your mouth. You can reduce your risk by rinsing your mouth with water after using your inhaler. Your GP may also prescribe you a spacer device to use with your inhaler, which can also help to lower your risk.
If you take a high dose of oral corticosteroids for a long time, you may be more likely to get side-effects such as:
- changes in mood
- an increase in blood pressure
- stomach ulcers
- diabetes (you may develop diabetes for the first time, or if you already have diabetes, your condition may get worse)
- weight gain
- stunted growth (in children and young people)
Taking oral corticosteroids for a long time may also cause you to develop Cushing's syndrome. This is a condition that can cause a range of symptoms including acne, puffiness around your face (moon face) and stretch marks. However, the condition usually goes away once you stop taking oral corticosteroids.
It's possible to have an allergic reaction to topical corticosteroids. This can cause your skin to become red and itchy. If you think you may be having an allergic reaction to a topical corticosteroid, contact your GP.
Check with your GP or pharmacist before you take any other medicine or herbal remedies at the same time as corticosteroids.
The main corticosteroids are shown in the table below.
All medicines have a generic name. Many medicines also have one or more brand names. Generic names are in lower case, whereas brand names start with a capital letter.
Generic names Brand names
Beclometasone, Asmabec Clickhaler, Clenil Modulite, Qvar
Betamethasone sodium phosphate
Betamethasone Valerate, Betacap, Betesil, Betnovate, Bettamousse, Diprosone, Diprosalic, Fucibet, Lotriderm
Budesonide, Rhinocourt Aqua
Clarelux, Dermovate, Etrivex
clobetasone butyrate Eumovate, Trimovate
Nerisone, Nerisone Forte
Cutivate, Flixonase, Flixonase Nasule, Nasofan, Dysmista, Avamys, Flixotide, Flutiform, Seretide
Alphaderm, Calmurid HC, Canesten HC, Daktacort, Dioderm, Fucidin H, Hydromol HC Intensive, Mildison, Nystaform-HC, Terra-Cortril, Timodine
Locoid, Locoid Crelo
Medrone, Solu-Medrone, Depo-Medrone
Asmanex, Elocon, Nasonex
Prednisolone, Predsol, Pred Forte
What are anabolic steroids, and why are they bad?
Anabolic steroids are a type of man-made (synthetic) steroids, which are related to male sex hormones, such as testosterone.
Anabolic steroids work by mimicking the hormone testosterone to increase muscle and bone growth. Doctors may prescribe anabolic steroids for conditions such as anaemia or severe burns.
Athletes and body builders often use anabolic steroids to help them 'bulk up' and improve their performance.
Anabolic steroids have many side-effects, including:
- mood changes
- infertility in both men and women
- changes in blood sugar levels
- high blood pressure
- increased breast tissue in men (gynaecomastia)
Long-term use of anabolic steroids can also increase your risk of coronary heart disease, liver disease and some cancers. Not all of the side-effects from anabolic steroids can be reversed. Because of these health risks, doctors don't usually recommend using anabolic steroids.
You may have seen anabolic steroids for sale illegally online. Be careful if you're considering buying medicines on the internet, particularly prescription-only medicines. Some reputable pharmacies offer an online service and are registered with the General Pharmaceutical Council (GPhC). Look for the GPhC internet pharmacy logo on their website, along with a unique registration number. It's still important to remember that if you buy medicines online without seeing a pharmacist or doctor first, there’s a risk they won't be safe or suitable for you.
Can I take oral corticosteroids while I'm pregnant?
If you're pregnant, you will still be able to take some corticosteroid tablets.
All oral corticosteroids are different. How easily they cross the placenta to your unborn baby will vary from medicine to medicine. If you are, or think you may be pregnant, tell your doctor.
Taking a long-term or repeated course of oral corticosteroids may affect your baby’s growth. However, it’s important to remember that your doctor will closely monitor your baby throughout your pregnancy. Taking oral corticosteroids for a short time hasn't been shown to affect your baby’s growth.
If you're breastfeeding and taking prednisolone, small amounts may get into your milk. However, if you're taking less than 40mg per day, this is unlikely to have an effect.
Topical corticosteroids (ones that you apply to your skin) haven't been shown to affect the development of your unborn baby, although the evidence is limited. You may have an increased chance of having a baby with a low birth weight if you use very strong steroid creams during pregnancy. To minimise your risks, your doctor will prescribe you a low dose for a shortest period of time possible. Talk to your doctor if you're concerned about taking corticosteroids during or after your pregnancy.
How often can I have corticosteroid joint injections?
It’s recommended that you have no more than three to four steroid injections in each joint per year. Your GP will talk about your treatment options with you, and help you to reach a decision that’s best for you.
Usually, you can have no more than three to four steroid injections in each joint per year. Doctors limit the number of injections you can have because long-term use of steroids can cause you to have side effects. Steroid treatment can affect your mood and interfere with your menstrual cycle if you’re a woman.
Repeated steroid joint injections can also damage your tendons and cause thinning or changes to the colour of your skin in the area where you receive the injection.
If you still have pain or swelling after a course of steroid joint injections, speak to your doctor about alternative treatments.
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- Chatu S. The hands-on guide to clinical pharmacology. 3rd ed. Chichester: Wiley-Blackwell; 2011
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- Sherwood L. Human physiology: From cells to systems. 8th ed. USA: Brooks/Cole; 2013
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- Ulcerative colitis. Management in adults, children and young. National Institute for Health and Care Excellence (NICE), 2013. www.nice.org.uk
- Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. National Institute for Health and Care Excellence (NICE), 2008. www.nice.org.uk
- Chronic lymphocytic leukaemia. Leukaemia and Lymphoma Research. www.leukaemialymphomaresearch.org.uk, published 16 May 2013
- Lymphomas. Lymphomas Association. www.lymphomas.org.uk, published 28 September 2012.
- Guideline on clinical investigation of immunosuppressants for solid organ transplantation. Committee for Medicinal Products for Human use (CHMP) www.ema.europa.eu, published 24 July 2008
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- Corticosteroid injections of joints and soft tissues. Medscape. www.emedicine.medscape.com, published 24 June 2013
- Chickenpox (varicella). Centers for Disease Control and Prevention. www.cdc.gov, accessed 21 November 2013
- Oral treatment with corticosteroids. The British Association of Dermatologists. www.bad.org.uk, published March 2013
- Local steroid injections. Arthritis Research UK. www.arthritisresearchuk.org, accessed 5 December 2013
- Allergic contact dermatitis. Medscape. www.emedicine.medscape.com, published 26th April 2013
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 4 December 2013 (online version)
- Consideration of the anabolic steroids. Advisory Council on the Misuse of Drugs. www.gov.uk, published 21 September 2010
- Anabolic steroid use and abuse. Medscape. www.emedicine.medscape.com, published 8 March 2013
- DrugFacts: anabolic steroids. National Institute on Drug Abuse. www.drugabuse.gov, published July 2012
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- Osteoarthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
- Brook P, Connell J, Pickering T. Oxford handbook of pain management. Oxford: Oxford University Press: 2011;47
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