Corticosteroids
Your health expert: Madeeha Waheed, Oncology Pharmacist at Bupa, Clinical and Operational Improvement
Content editor review by Pippa Coulter, October 2021
Next review due October 2024
Corticosteroids are a type of medicine that can help control many functions in your body. These include reducing inflammation in your body and activity in your immune system. There are lots of different types of corticosteroids, and they can help treat many different medical conditions. You may just hear them called ‘steroids’.
Uses of corticosteroids
Corticosteroids can help to treat conditions that involve inflammation or an overactive immune system. These include the following.
- Inflammatory bowel conditions, such as Crohn’s disease and ulcerative colitis.
- Skin conditions, for example, eczema or dermatitis.
- Allergic conditions and reactions, including hay fever.
- Respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD).
- Conditions affecting your joints such as rheumatoid arthritis and systemic lupus erythematosus.
- Certain cancers, for example some cancers of the blood (leukaemia).
Your doctor will also prescribe corticosteroids if your body doesn’t produce enough of its own steroid hormones. This can happen in conditions such as Addison’s disease. Corticosteroids can also stop your immune system from rejecting a donated organ if you’ve had a transplant operation. They can also be used to help reduce side-effects of some cancer treatments.
Although they can be a very effective treatment, corticosteroids can also have a lot of different unwanted effects on your body. See our section below on side-effects for more information. Your doctor will only recommend corticosteroids if the benefits outweigh the risks.
How corticosteroids work
Corticosteroids are synthetic (man-made) versions of steroid hormones 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 by blocking the action of certain substances in your body that cause inflammation. They also reduce activity of your immune system by interfering with a type of white blood cells called T cells.
These actions mean that corticosteroids can help in medical conditions where there is inflammation, swelling and an overactive immune system.
Types of corticosteroid
There are different forms of corticosteroid, depending on what you’re taking them for. They include the following.
- Inhaled corticosteroids. You take these using an inhaler device to get the medicine directly into your lungs. They’re often used to treat asthma.
- Oral corticosteroids. These come as tablets that you swallow, tablets that dissolve in water and solutions. Oral medicines are absorbed, so they can treat all different parts of your body via your bloodstream.
- Topical corticosteroids. These include drops for your eyes or ears, creams and ointments 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. These may be injected directly into your bloodstream if you have a severe flare-up of a condition or need rapid treatment. They also include injections directly into a joint or around a tendon. You may have these for conditions such as rheumatoid arthritis.
- 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 (by mouth) or by injection into a vein or muscle. Topical corticosteroids just affect the area of your body where they’re applied. But systemic corticosteroids reach all parts of your body.
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. You might have a high dose for a very short time to help with a serious or life-threatening complication. Or you could take corticosteroids for a long time at low doses. 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 it. 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, don’t stop taking them suddenly unless your doctor advises you to. You’ll usually need to gradually reduce your dose to allow your body’s steroid production to get back to normal. This is important as it prevents serious side-effects, and stops your condition from returning. Speak to your doctor before you stop taking corticosteroids.
Avoiding infections when taking corticosteroids
Taking corticosteroid tablets for a long time puts you at greater risk of getting infections, especially if you’re taking higher doses. You may also get more severe forms of infection. These include measles, chickenpox and shingles. Try to avoid close contact with anyone with these infections 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.
Corticosteroids and vaccines
There are certain vaccines that you shouldn’t have if you’re taking high doses of corticosteroids. This includes the flu vaccine. You may need to wait for three months after you’ve stopped corticosteroid treatment to have these vaccines. This doesn’t include the COVID-19 vaccination. It’s safe to have the COVID-19 vaccination if you’re taking corticosteroids. In fact, if you have a weakened immune system due to taking corticosteroids, you’re considered to be in a priority group for COVID-19 vaccination.
If you need 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.
Corticosteroids and diabetes
If you have diabetes, taking oral corticosteroids can cause your blood sugar levels to 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. You may be able to stop this once your corticosteroid treatment ends.
Corticosteroids and pregnancy
Let your doctor know if you’re pregnant or there’s a chance you could be. Some corticosteroids can cross the placenta to reach your baby – particularly those you take by mouth. Taking steroid tablets repeatedly or for a long time may affect your baby’s growth, so this will be monitored carefully. Short-term steroids and inhaled steroids don’t seem to have this effect. Your doctor will only recommend corticosteroids in pregnancy if the benefits outweigh the risks. They will discuss these with you.
Your doctor is likely to recommend you only take low doses of corticosteroids if you’re breastfeeding too. Small amounts may get into your breast milk.
Steroid treatment cards
Your doctor or pharmacist may give you a steroid treatment card to carry. This includes the details of what you’re taking, the dose and for how long. Show the card to anyone who gives you medical treatment so that they know you’re taking corticosteroids. They’ll be able to take this into account when deciding the best treatment for you.
Interactions of corticosteroids
Corticosteroids can interact with a lot of other medicines. These include the following.
- Anticoagulants (‘blood thinners’).
- Certain anti-arrhythmic drugs.
- Diabetes medicines.
- Epilepsy drugs.
- HIV treatments.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Corticosteroids may increase or reduce the effects of these other medicines. This tends to be more of a problem with high doses of corticosteroids, and ones you take by mouth (oral corticosteroids).
It’s important that your doctor knows about any medicines you’re already taking when they prescribe you oral corticosteroids. If you're taking corticosteroids, check with your pharmacist or doctor before you start a new medicine or herbal remedy. If you have a steroid card, always show this to anyone treating you.
Side-effects of corticosteroids
Corticosteroids can cause a range of different side-effects. Your chance of getting side-effects mainly depends on:
- the type – tablets cause more side-effects than inhaled or topical corticosteroids
- the dose – the higher your dose, the greater the chance of side-effects
- the duration and frequency –taking them regularly, or for a long time, increases your risk
Because of this, your doctor will try to prescribe the lowest effective dose for the least amount of time possible.
Side-effects from topical corticosteroids
Topical corticosteroids can cause side-effects in the area where you apply them. You may get a burning or stinging sensation over the treated area for a few days, but this usually passes. Using some of the stronger corticosteroid creams long term may make your skin thinner. They may also cause allergic reactions and stretch marks. You’re unlikely to get side-effects in other parts of your body. But this can happen if you use strong corticosteroids over a large area, and for a long period of time.
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. Try not to use them for too long either.
Side-effects from inhaled corticosteroids
Inhaled corticosteroids can sometimes make you sound a bit hoarse, 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 to prevent this. Your GP may offer you a spacer device to use with your inhaler, which can help to lower your risk of side-effects.
As with topical corticosteroids, you’re unlikely to have side-effects affecting other parts of your body. But this can happen if you use high doses for a longer period of time.
Side-effects from oral corticosteroids
You may get side-effects from oral corticosteroids if you take them for a long time (more than three weeks) or you need frequent courses. They can include:
- fluid retention
- fat build-up, especially around your neck and shoulders, and on your face – causing a puffy, rounded face (known as Cushing’s syndrome)
- high blood pressure
- osteoporosis (weakening of your bones)
- diabetes (you may develop diabetes for the first time or, if you already have diabetes, your condition may get worse)
- changes in mood and behaviour
- disturbed sleep
- thinning of your skin and delayed wound healing
- indigestion and stomach ulcers
- weight gain
- eye problems, including glaucoma and cataracts
- increased risk of infections (see Taking corticosteroids for more information about this)
- stunted growth in children and young people
Your doctor will want to monitor you if you’re taking long-term oral corticosteroids. They may want to regularly measure your blood pressure and weight. They’ll also check for signs of diabetes, osteoporosis and eye problems. They may also prescribe medicines to help prevent side-effects, such as a proton pump inhibitor to protect your stomach.
The main types of corticosteroids include oral corticosteroids, inhaled corticosteroids and topical corticosteroids. Oral corticosteroids are ones that you take by mouth. Inhaled corticosteroids go straight into your lungs. You apply topical corticosteroids directly to the affected area (eg your skin). See our section on Types of corticosteroid for more information.
Steroid joint injections
If you have a painful joint from an injury or arthritis, for example, your doctor may offer you a joint injection of a corticosteroid (steroid) medicine.
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