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Corticosteroids

Corticosteroids are a man-made (synthetic) type of steroid. Steroids are hormones that are made in your body.

Your doctor may prescribe corticosteroids to help reduce any inflammation or swelling in your body. They do this by suppressing your immune system. There are many different types of corticosteroids. They can be taken as tablets, through an inhaler, as an injection or used as creams, ointments and drops.

Conditions that may benefit from corticosteroids include the following.

  • Inflammatory conditions. These include conditions affecting your joints, such as rheumatoid arthritis, your bowel, such as, Crohn’s disease or your entire body, such as systemic lupus erythematosus.
  • Skin conditions. For example, eczema or dermatitis.
  • Allergic conditions. These include conditions such as asthma and hay fever.
  • Certain cancers. Some cancers of the blood or lymphatic system (part of your body's natural defence system).
  • Conditions in which your body doesn’t produce enough steroid hormones. For example, Addison's disease.

Corticosteroids can also be used to prevent your immune system from rejecting a donated organ if you have had a transplant operation.

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Details

  • Types What are the main types of corticosteroids?

    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.

  • How they work How do corticosteroids work?

    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.

  • Taking the medicine How to take corticosteroids

    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.

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  • Special care Special care

    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 Side-effects of corticosteroids

    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)
    • osteoporosis
    • 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.

  • Complications Allergies

    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.

  • Interactions Interactions of corticosteroids with other medicines

    Check with your GP or pharmacist before you take any other medicine or herbal remedies at the same time as corticosteroids.

  • Common names Names of common 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

    alclometasone
    dipropionate

    Modrasone

    beclometasone
    dipropionate

    Beclometasone, Asmabec Clickhaler, Clenil Modulite, Qvar

    Betamethasone sodium phosphate

    Betnesol, Vistamethasone

    betamethasone
    esters

    Betamethasone Valerate, Betacap, Betesil, Betnovate, Bettamousse, Diprosone, Diprosalic, Fucibet, Lotriderm

    budesonide

    Budesonide, Rhinocourt Aqua

    clobetasol
    propionate

    Clarelux, Dermovate, Etrivex

    clobetasone butyrate Eumovate, Trimovate

    deflazacort

    Calcort

    dexamethasone

    Dexamethasone

    diflucortolone
    valerate

    Nerisone, Nerisone Forte

    fludrocortisone
    acetate

    Florinef

    fludroxycortide

    Haelan

    flunisolide

    Syntaris

    fluocinolone
    acetonide

    Synalar

    fluocinonide

    Metosyn

    fluocortolone

    Ultralanum Plain

    fluticasone
    propionate

    Cutivate, Flixonase, Flixonase Nasule, Nasofan, Dysmista, Avamys, Flixotide, Flutiform, Seretide

    hydrocortisone

    Alphaderm, Calmurid HC, Canesten HC, Daktacort, Dioderm, Fucidin H, Hydromol HC Intensive, Mildison, Nystaform-HC, Terra-Cortril, Timodine

    hydrocortisone
    butyrate

    Locoid, Locoid Crelo

    methylprednisolone

    Medrone, Solu-Medrone, Depo-Medrone

    mometasone furoate

    Asmanex, Elocon, Nasonex

    prednisolone

    Prednisolone, Predsol, Pred Forte

    triamcinolone

    Kenalog

    triamcinolone
    acetonide

    Aureocort, Nasacort

  • FAQs FAQs

    What are anabolic steroids, and why are they bad?

    Answer

    Anabolic steroids are a type of man-made (synthetic) steroids, which are related to male sex hormones, such as testosterone.  

    Explanation

    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
    • acne
    • baldness
    • 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?

    Answer

    If you're pregnant, you will still be able to take some corticosteroid tablets.

    Explanation

    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?

    Answer

    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.

    Explanation

    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.

  • Resources Resources

    Further information

    Sources

    • Corticosteroids - oral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2010
    • Chatu S. The hands-on guide to clinical pharmacology. 3rd ed. Chichester: Wiley-Blackwell; 2011
    • McKay LI, Cidlowski JA. Physiologic and pharmacologic effects of corticosteroids. 6th ed. Hamilton(ON): BC Decker; 2003
    • Sherwood L. Human physiology: From cells to systems. 8th ed. USA: Brooks/Cole; 2013
    • Corticosteroids - topical (skin), nose and eyes. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2010
    • Simon C Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press 2010;521−4, 634−5
    • 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
    • Corticosteroids - inhaled. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2010
    • 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
    • Local corticosteroid injections. The British National Formulary. The National Institute for Health and Care Excellence. www.evidence.nhs.uk, accessed 9 January 2014
    • 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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  • Author information Author information

    Reviewed by Hemali Parekh, Bupa Health Information Team, June 2013.

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