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Corticosteroids

Steroids are hormones that are made in your body. Corticosteroids are a man-made (synthetic) type of steroid which are used to treat many different medical conditions.

If your doctor has recommended that you take corticosteroids, or if you’re currently taking them, we hope you’ll find this information helpful. Our information includes:

  • the different types of corticosteroids, and how they work
  • why your doctor may recommend you take them
  • the special care you may need to take when you have been prescribed certain types of corticosteroids
  • the side-effects of corticosteroids

Corticosteroids can be very effective medicines, but can also have side-effects. If after reading our information you have further questions about your medicines, ask your pharmacist or your doctor.

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  • Why take corticosteroids? Why has my doctor advised me to take corticosteroids?

    Corticosteroids are used to treat many different medical conditions. Doctors often use them to reduce inflammation or swelling in your body. Your doctor will discuss with you why they think a corticosteroid is the best medicine in your particular circumstances.

    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. See our section on types of corticosteroids below for more information.

    Your doctor may offer you corticosteroids if you have one of 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’ve had a transplant operation.

  • Ways of taking corticosteroids What forms of corticosteroid will my doctor prescribe for me, and why?

    There are different forms of corticosteroids including:

    • inhaled corticosteroids – you can take these using an inhaler. This is a way of getting the right amount of medicine directly into your lungs.
    • oral corticosteroids – you can swallow these as tablets, or you may be able to have them as a drink (soluble tablet). You absorb the medicine and so it gets to your whole body.
    • topical corticosteroids. These include drops for your eyes or ears, creams that you apply to your skin or sprays and drops for your nose. The medicine goes directly onto the place where it’s needed to ease your symptoms.
    • injected corticosteroids – your doctor will inject these directly into your bloodstream, into a joint or around a tendon.
    • corticosteroid enemas (rectal) – a liquid that you insert into your rectum (back passage).

    You may have heard the term ‘systemic’ corticosteroids. This is another way of describing corticosteroids given orally (tablets) or by injection into a vein or muscle. Unlike topical corticosteroids, which are used just in one place in the body, systemic corticosteroids reach all parts.

    Corticosteroids also come in a variety of strengths. They may be used for different lengths of time and in different doses according to what medical condition you have. Your doctor will recommend the type of corticosteroid which is best for you.

    If you’ve been taking corticosteroids for more than three weeks, you shouldn’t stop them suddenly unless your doctor advises you to. If you intend to stop taking them completely you should gradually begin to reduce your dose. It’s important to speak to your doctor before you stop taking corticosteroids.

    With some steroid prescriptions your pharmacist may give you a steroid card to carry. See our FAQ below for more information.

    Always read the patient information leaflet that comes with your medicine carefully. If you have any queries about taking your medicines ask your pharmacist for advice.

  • How corticosteroids work How do corticosteroids work?

    Much like the steroid hormones your body produces, corticosteroids have many different effects in the body. One of the main ways that corticosteroids work is by reducing inflammation (swelling). They do this by blocking the action of molecules that cause inflammation, for example prostaglandins. They also suppress your immune system by affecting special white blood cells called T-lymphocytes.

    Corticosteroids have other effects, such as constricting small blood vessels and slowing the rate at which cells divide. In allergic reactions they inhibit substances called cytokines which are responsible for inflammation. Together, these effects mean that corticosteroids may be helpful in medical conditions where there is inflammation, swelling and an over-active immune system.

  • Avoiding infections Why must I avoid infections when taking corticosteroids?

    Taking corticosteroid tablets for a long time can make you more at risk of developing infections. It can also mean you’ll get a more severe form of infection. This is particularly true of chickenpox, measles and shingles. Try to avoid close contact with anyone with chickenpox, measles or shingles if you’re taking corticosteroids long term. If you haven’t had these infections before, and you’ve recently come into contact with someone who has them, contact your GP for advice.

    If you’ve been taking a high dose of corticosteroids, there are some vaccines you shouldn’t have until three months after you’ve stopped the treatment. If you’re having a vaccination, tell the doctor or nurse about your steroid treatment. They can then discuss with you whether you should have that particular vaccine at that time.

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  • Corticosteroids in diabetes How will taking corticosteroids affect my diabetes?

    If you have diabetes and you start taking oral corticosteroids, your blood sugar levels may go up. Discuss with your doctor the best way to manage this. If you’re taking medicines for diabetes you may need a higher dose while you’re taking corticosteroids. Some people may need to start insulin injections.

  • Side-effects Side-effects of corticosteroids

    Corticosteroids can work well as a treatment, but they can also have a lot of different unwanted effects on your body. Your doctor knows about these effects and will only recommend corticosteroids if the benefits of treatment outweigh the risks. Always read the information that comes with your medicines carefully. If you have any queries about your medicines you can ask your pharmacist.

    Your chance of getting side-effects from corticosteroids mainly depends on:

    • the type of corticosteroid you’re taking – tablets are more likely to cause side-effects than inhaled or topical medicine
    • how high your dose is – the higher your dose, the greater the chance of side-effects
    • how often you take it, and for how long. For instance you’re more likely to get side-effects if you take corticosteroid tablets for more than three weeks.

    Because of this your doctor will try to prescribe the lowest effective dose for the minimum time possible to treat your medical condition. Ask them about the chances of side-effects in your particular circumstances.

    Side-effects from topical corticosteroids

    Topical corticosteroids come in different strengths from mild to very potent. You should use the lowest strength that will work for your medical condition.

    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. Some people get some burning or stinging over the treated area for a few days but this usually passes.

    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. Always follow the advice that comes with your topical corticosteroid.

    Side effects from inhaled corticosteroids

    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 help to lower your risk.

    Inhaled corticosteroids can also hoarsen your voice.

    Side effects from oral corticosteroids (tablets)

    If you take a high dose of oral corticosteroids for a long time (over three weeks), you may be more likely to get side-effects such as:

    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.

  • Interactions Interactions of corticosteroids with other medicines

    Corticosteroids can interact with a lot of other medicines you may be taking. So it’s important that your doctor knows what medicines you’re already taking when they prescribe oral corticosteroids (tablets) for you. Check with your pharmacist or doctor before you start taking any other medicine or herbal remedies at the same time as corticosteroids.

  • FAQ: Steroid treatment cards I’m taking corticosteroids – why have I been given a card to carry?

    If your doctor prescribes corticosteroid tablets for you for longer than three weeks, your pharmacist will give you a steroid treatment card. You may also be given a card if you’re taking high doses of inhaled or potent topical corticosteroids over much of your body. This card explains how much corticosteroid you’re taking and for how long. It will also explain how to reduce the chance of getting any side-effects.

    You should always carry this card with you and make sure it’s up to date. Show the card to anyone who gives you medical treatment so that they know you’re taking corticosteroids. This is so they can take your steroid treatment into account when deciding the best treatment for you. For one year after you stop treatment you should still mention that you’ve taken corticosteroids.

    If you don’t have a steroid treatment card and you think that you should be carrying one, speak to your pharmacist.

  • FAQ: Anabolic steroids What are anabolic steroids, and why are they bad?

    Anabolic steroids are a type of man-made (synthetic) steroid, which are related to male sex hormones, such as testosterone. Anabolic steroids work by mimicking the hormone testosterone to increase muscle growth. Doctors may prescribe anabolic steroids for conditions such as anaemia or severe burns.

    Athletes and body builders often use anabolic steroids (‘roids’, ‘juice’) to help them ‘bulk up’ and improve their performance.

    Anabolic steroids have many side-effects, including:

    • mood changes, irritability
    • 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. 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.

  • FAQ: Corticosteroids in pregnancy Can I take oral corticosteroids while I’m pregnant?

    If you’re pregnant, you’ll still be able to take some corticosteroid tablets. When recommending corticosteroid treatment, your doctor will weigh up the possible risks and the potential benefits. Make sure your doctor knows that you are, or may be pregnant. And let them know if you’re breastfeeding.

    All oral corticosteroids are different. How easily they cross the placenta to your unborn baby will vary from medicine to medicine. 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 (less than three weeks) doesn’t seem to affect your baby’s growth.

    If you’re breastfeeding and need corticosteroids your doctor may recommend one called prednisolone. Small amounts may get into your milk. However, if you’re taking less than 40mg per day, this probably won’t have an effect on your baby.

    Doctors believe that most topical corticosteroids (ones that you apply to your skin) can be safely used in pregnancy if necessary. However, using very strong steroid creams for a long time during pregnancy may increase your chance of having a baby with a low birth weight. To reduce this chance, your doctor will prescribe you a low dose for the shortest period of time possible.

    Talk to your doctor if you’re concerned about taking corticosteroids during or after your pregnancy.

  • Other helpful websites Other helpful websites

    Further information

    • The British National Formulary has online information about medicines: www.bnf.org.uk
    • Arthritis Research UK has information on their website about medical conditions affecting the joints, including those treated with corticosteroids: www.arthritisresearchuk.org
    • Arthritis Care has information on their website about arthritis. They also have an online forum and a helpline you can ring for advice and support: 0808 800 4050
    • The British Association of Dermatologists has information on their website about a wide range of skin conditions, including those treated with topical corticosteroids: www.bad.org.uk

    Sources

    • Corticosteroids and corticosteroid replacement therapy. PatientPlus. patient.info/patientplus, last checked 20 January 2015
    • Adrenal insufficiency and Addison’s disease. PatientPlus. patient.info/patientplus, last checked 8 April 2015
    • Corticosteroids – inhaled. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2015
    • Corticosteroids – oral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2015
    • Corticosteroids – topical (skin), nose, and eyes. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2015
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 1 November 2016
    • Kumar, P, Clark, M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012
    • Contraindications and special considerations: the green book, chapter 6. Public Health England, 2013. www.gov.uk
    • Ulcerative colitis. PatientPlus. patient.info/patientplus, last checked 24 June 2016
    • Anabolic steroid use and abuse. Medscape. emedicine.medscape.com, updated 27 May 2015
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    Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, November 2016
    Expert reviewer, Alastair Bovell, Lead Clinical Pharmacist, Bupa Cromwell Hospital
    Next review due November 2019

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