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Drugs & Supplements

Corticosteroids

(Also Called 'Prednisone')

What are corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term "steroids." Corticosteroids are different from the male hormone-related steroid compounds that some athletes abuse.

When inflammation normally occurs, chemicals from the body’s white blood cells are released to protect us from foreign substances. Sometimes, however, the white blood cells and inflammatory chemicals cause damage to the body’s tissues.

What are some types of steroids?

Some corticosteroid medicines include cortisone, prednisone, and methylprednisolone. Prednisone is the most commonly used type of steroid to treat certain rheumatologic diseases.

How are steroids given?

Steroid medications are available in several forms that vary in how easily they dissolve or how long they stay in the body.

Steroids might be given locally, to the precise place where a problem exists, or systemically, which means throughout the "system" or body.

Examples of local steroid treatments include joint injections, eye drops, ear drops, and skin creams. Systemic steroid treatments include oral medicines (given by mouth) or medicine that is delivered directly into a vein (intravenously or IV) or muscle (intramuscularly). Systemic steroids circulate through the bloodstream to various body sites.

When possible, local steroid treatments are prescribed instead of systemic steroids.

How do steroids work?

Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body's white blood cells and chemicals can protect against infection and foreign substances such as bacteria and viruses. In certain diseases, however, the body's defense system (immune system) doesn't function properly. This might cause inflammation to work against the body's tissues and cause damage. Inflammation is characterized by redness, warmth, swelling, and pain.

Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells.

When are steroids given?

Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are the main therapy for certain diseases. For other conditions, steroids might only be used sparingly or when other measures have not been successful.

Steroids are used as the main treatment for certain inflammatory conditions, such as:

  • Systemic vasculitis (inflammation of blood vessels)
  • Myositis (inflammation of muscle)

Steroids might also be used selectively to treat inflammatory conditions such as:

  • Rheumatoid arthritis (chronic inflammatory arthritis occurring in joints on both sides of the body)
  • Systemic lupus erythematosus (a generalized disease caused by abnormal immune system function)
  • Sjögren's syndrome (chronic disorder that causes dry eyes and a dry mouth)

How are steroids beneficial?

When inflammation threatens to damage critical body organs, steroids can be organ-saving and in many instances, life-saving. For example, steroids may prevent the progression of kidney inflammation, which could lead to kidney failure in people who have lupus or vasculitis. For these patients, steroid therapy might eliminate the need for kidney dialysis or transplantation.

Low doses of steroids might provide significant relief from pain and stiffness for people with rheumatoid arthritis. Temporary use of higher doses of steroids might help a person recover from a severe flare-up of arthritis.

How will my doctor decide if steroids are the right treatment?

The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, physical activity, and other medicines you are taking. Your doctor will also make sure you understand the potential benefits and risks of steroids before you start taking them.

The potential benefits and risks of steroids vary with:

  • The nature and severity of the disease being treated
  • The presence or absence of other treatment alternatives
  • The presence or absence of other significant medical problems

What are the possible side effects of steroids?

The occurrence of side effects depends on the dose, type of steroid, and length of treatment. Some side effects are more serious than others. Common side effects of systemic steroids include:

  • Increased appetite, weight gain
  • Sudden mood swings
  • Muscle weakness
  • Blurred vision
  • Increased growth of body hair
  • Easy bruising
  • Lower resistance to infection
  • Swollen, "puffy" face
  • Acne
  • Osteoporosis (bone weakening disease)
  • Worsening of diabetes
  • High blood pressure
  • Stomach irritation
  • Nervousness, restlessness
  • Having difficulty sleeping
  • Cataracts or glaucoma
  • Water retention, swelling

Please note: These side effects are the most common side effects. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.

Does everyone have side effects?

Not all patients will develop side effects. How often any side effect occurs varies from patient to patient.

If steroid use is brief (from a few days to a few weeks), it is possible that none of the listed side effects will occur. The side effects listed here generally do not occur when occasional steroid injections are given for arthritis, tendonitis, or bursitis. However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects might occur. The prolonged use of high dose steroids is justified only for severe illnesses that represent serious risks to the patient.

How can the side effects of steroids be minimized?

To minimize the side effects of steroids, doctors follow several guidelines:

  • Use steroids only when necessary.
  • Monitor the patient closely to detect the development of serious side effects.
  • If possible, use local steroids for local problems.
  • Use the minimal dose required to gain control of the disease.
  • Reduce the dose gradually as long as the disease remains under control.
  • Monitor blood pressure often and treat if necessary.
  • Prescribe calcium supplements to help maintain bone density.

There are other ways to prevent certain side effects, and these should be discussed individually with your physician

References

Crohn’s & Colitis Foundation of America. Corticosteroids. www.ccfa.org Accessed 9/16/2010

Prednisone. AHFS® Consumer Medication Information. © Copyright, 2010. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Accessed through Medline Plus on 9/16/2010. www.nlm.nih.gov

National Center for Biotechnology Information. Prednisone. www.ncbi.nlm.nih.gov Accessed 9/16/2010.

© Copyright 1995-2014 The Cleveland Clinic Foundation. All rights reserved.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/16/2010...#4812