Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, inflammatory bowel disease and asthma. But these drugs also carry a risk of various side effects.

How do corticosteroids work?

When prescribed in doses that exceed your body’s usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis, asthma or skin rashes.

Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues.

How are corticosteroids used?

Corticosteroid drugs are used to treat rheumatoid arthritis, inflammatory bowel disease (IBD), asthma, allergies and many other conditions. These drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients. Corticosteroids also treat Addison’s disease, a relatively rare condition where the adrenal glands aren’t able to produce even the minimum amount of corticosteroid that the body needs.

Corticosteroids are administered in many different ways, depending on the condition being treated:

• By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as rheumatoid arthritis and lupus.
• By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies.
• In the form of eyedrops. This form helps treat swelling after eye surgery.
• Topically. Creams and ointments can help heal many skin conditions.
• By injection. This form is often used to treat muscle and joint signs and symptoms, such as the pain and inflammation of tendinitis.

What side effects can corticosteroids cause?

Corticosteroids carry a risk of side effects, some of which can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact.

Side effects of oral corticosteroids

Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive and may include:

• Fluid retention, causing swelling in your lower legs
• High blood pressure
• Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium
• Upset stomach
• Weight gain, with fat deposits in your abdomen, your face and the back of your neck

When taking oral corticosteroids longer term, you may experience:

• Elevated pressure in the eyes (glaucoma)
• Clouding of the lens in one or both eyes (cataracts)
• A round face (moon face)
• High blood sugar, which can trigger or worsen diabetes
• Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
• Thinning bones (osteoporosis) and fractures
• Suppressed adrenal gland hormone production that may result in a variety of signs and symptoms, including severe fatigue, loss of appetite, nausea and muscle weakness
• Thin skin, bruising and slower wound healing

Side effects of inhaled corticosteroids

When using an inhaled corticosteroid, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

• Fungal infection in the mouth (oral thrush)
• Hoarseness

If you gargle and rinse your mouth with water — don’t swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Some researchers have speculated that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma.

Side effects of topical corticosteroids

Topical corticosteroids can lead to thin skin, red skin lesions and acne

Side effects of injected corticosteroids

Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient’s situation.

Reduce your risk of corticosteroid side effects

To get the most benefit from corticosteroid medications with the least amount of risk:

• Ask your doctor about trying lower doses or intermittent dosing. Newer forms of corticosteroids come in various strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
• Talk to your doctor about switching to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body’s exposure to them and leading to fewer side effects.
• Ask your doctor if you should take calcium and vitamin D supplements. Long-term corticosteroid therapy may cause thinning bones (osteoporosis). Talk with your doctor about taking calcium and vitamin D supplements to help protect your bones.
• Take care when discontinuing therapy. If you take oral corticosteroids for a long time, your adrenal glands may produce less of their natural steroid hormones. To give your adrenal glands time to recover this function, your doctor may reduce your dosage gradually. If the dosage is reduced too quickly, your adrenal glands may not have time to recover and you may experience fatigue, body aches and lightheadedness.
• Wear a medical alert bracelet. This or similar identification is recommended if you’ve been using corticosteroids for a long time.
• See your doctor regularly. If you’re taking long-term corticosteroid therapy, see your doctor regularly to check for side effects.

Weigh the risks and benefits of corticosteroids

Corticosteroids may cause a range of side effects. But they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. Talk with your doctor to help you better understand the risks and benefits of corticosteroids and make informed choices about your health.

Dec. 15, 2020