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Corticosteroids


Expert reviewer, Justin Hayde-West, Pharmaceutical Manager at Bupa UK
Next review due May 2022

Corticosteroids, also known as steroids, are anti-inflammatory medicines which are used to treat many different medical conditions.

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

Knee strapping treatment

Uses of corticosteroids

Your doctor may offer you corticosteroids if you have one of the following.

  • Inflammatory conditions, including 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, including hay fever.
  • Respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD).
  • Certain cancers, for example some cancers of the blood.
  • Conditions in which your body doesn’t produce enough of its own steroid hormones, such as 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.

How corticosteroids work

Corticosteroids are synthetic versions of steroids that your body makes naturally. They have many different effects in the body.

One of the main ways that corticosteroids work is by reducing inflammation (swelling). They do this partly 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.

Together with other effects, this means that corticosteroids may be helpful in medical conditions where there is inflammation, swelling and an over-active immune system.

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Types of corticosteroid

There are different forms of corticosteroid, including the following.

  • Inhaled corticosteroids – you take these using an inhaler. This is a way of getting the 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 so it gets to your whole body.
  • Topical corticosteroids. These include drops for your eyes or ears, creams that you apply to your skin, and 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, foams and suppositories that you insert into your rectum (bottom).

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 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.

Taking corticosteroids

Read the patient information leaflet that comes with your medicine and follow the instructions about how to take your medicine. If you have any questions, ask your pharmacist or doctor for advice.

Below are some important things to be aware of.

Stopping corticosteroids safely

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 reduce your dose. This is important – speak to your doctor before you stop taking corticosteroids.

Avoiding infections when taking corticosteroids

Taking corticosteroid tablets for a long time makes you more at risk of getting infections. And you may get a more severe form of infection. This is particularly true of measles, chickenpox 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 one of 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 corticosteroid treatment. If you need a vaccination, tell the doctor or nurse about your steroid treatment. They can then discuss with you whether or not you should have that particular vaccine at that time.

Corticosteroids and 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 take medicines for diabetes, you may need a higher dose while on corticosteroids or you may need to start having insulin injections. The insulin may be stopped later if you don’t need it after your corticosteroid treatment is finished.p>

Interactions of corticosteroids

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. And if you have a steroid card (see our FAQ: What is a steroid treatment card?), always show this to anyone treating you.p>

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 will only recommend corticosteroids if the benefits of treatment outweigh the risks.

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

  • the form 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 – 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 your doctor about the chances of side-effects in your particular circumstances. And always read the patient information which comes with your treatment.

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 less likely to get side-effects from topical corticosteroids if you apply a small amount, to a small area of skin, for a short period of time. Some people get some a burning or stinging sensation over the treated area for a few days, but this usually passes.

However, using some of the stronger corticosteroid creams long term may make your skin thinner and increase your risk of getting stretch marks.

Side-effects from inhaled corticosteroids

Inhaled corticosteroids can alter your voice and affect your sense of taste. They can also increase your risk of developing oral thrush, a fungal infection which affects your mouth. Rinsing your mouth with water after using your inhaler may help you avoid this. Your GP may offer you a spacer device to use with your inhaler, which can help to lower your risk.

Side-effects from oral corticosteroids (tablets)

Side-effects of long-term use of oral corticosteroids can include:

  • fluid retention
  • puffiness around the face
  • high blood pressure
  • osteoporosis
  • diabetes (you may develop diabetes for the first time or, if you already have diabetes, your condition may get worse)
  • changes in mood, disturbed sleep
  • thinning of your skin, stretch marks, acne
  • indigestion or stomach ulcers
  • weight gain
  • eye problems including glaucoma and cataracts
  • increased risk of infections (for more information about this, see our section: Avoiding infections when taking corticosteroids)
  • stunted growth (in children and young people with long-term use)

If you have side-effects from your medicine, you can report these through the Yellow Card Scheme. Any information can help the MHRA (Medicines and Healthcare products Regulatory Agency) to track adverse effects and stop these from happening again.

Frequently asked questions

  • Anabolic steroids are another type of synthetic steroid. They work by mimicking the hormone testosterone to increase muscle growth. They are not the same as corticosteroids. Doctors may prescribe anabolic steroids for conditions such as anaemia or severe burns.

    Against medical advice, athletes and body builders may use anabolic steroids (‘roids’, ‘juice’) to help them ‘bulk up’ and improve their performance.

    Anabolic steroids can have many side-effects, including:

    • mood changes, irritability, aggression
    • acne
    • baldness
    • infertility
    • changes in blood sugar levels
    • high blood pressure
    • increased breast tissue in men (gynaecomastia)

    Not all of the side-effects from anabolic steroids can be reversed.

    If you’re taking anabolic steroids and are concerned about the side-effects, contact your GP. For more information and confidential advice about taking anabolic steroids, you can also contact FRANK (helpline 0300 1236600)

  • Your pharmacist may give you a steroid treatment card to carry if you take long-term or high-dose corticosteroid treatments. These include tablets, potent (strong) creams for your skin, and inhalers.

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

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

  • If you need corticosteroids while you’re pregnant, you can usually have them but ask your doctor to discuss the risks and benefits with you.

    Some corticosteroids can cross the placenta to reach your baby. Taking steroid tablets repeatedly or for a long time may affect your baby’s growth, so this will be monitored carefully. Short-term steroids don’t seem to have this effect.

    If you’re breastfeeding and need corticosteroids, your doctor may recommend one called prednisolone. Small amounts of this 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.


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Related information

    • Corticosteroids and corticosteroid replacement therapy. PatientPlus. patient.info/patientplus, last edited January 2015
    • Allergic rhinitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2018
    • 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 November 2017
    • Chronic obstructive pulmonary disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2019
    • Corticosteroids – topical (skin), nose, and eyes. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2018
    • Corticosteroids, general use. NICE British National Formulary. bnf.nice.org.uk, accessed March 2019
    • Corticosteroids, replacement therapy. NICE British National Formulary. bnf.nice.org.uk, accessed March 2019
    • Corticosteroids, inflammatory disorders. NICE British National Formulary. bnf.nice.org.uk, accessed March 2019
    • Beclometasone dipropionate. NICE British National Formulary. bnf.nice.org.uk, accessed March 2019
    • Prednisolone. NICE British National Formulary. bnf.nice.org.uk, accessed May 2019
    • Contraindications and special considerations: the green book, chapter 6. Public Health England. www.gov.uk, last updated 2017
    • Anabolic steroid use and abuse. Medscape. emedicine.medscape.com, updated October 2017
    • Anabolic steroids. Frank. www.talktofrank.com, accessed March 2019
    • Oral treatment with corticosteroids. British Association of Dermatologists. www.bad.org.uk, updated September 2016
    • Personal communication, Justin Hayde-West, Pharmaceutical Manager at Bupa UK, May 2019

  • Reviewed by Dr Kristina Routh, Freelance Health Editor, May 2019
    Expert reviewer, Justin Hayde-West, Pharmaceutical Manager at Bupa UK
    Next review due May 2022



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