Corticosteroids, such as prednisone and cortisone, are a class of drugs that can effectively reduce inflammation. However, they also cause a range of side effects that limit their use.
Corticosteroids are different than the performance-enhancing drugs that some athletes and bodybuilders use. Those are anabolic steroids.
In this article, we take a look at the types of corticosteroids and their uses. We also look at how these drugs work and the possible risks of using them.
Corticosteroids have several different effects on the body, which means that they can treat a range of medical conditions. They can reduce inflammation, suppress overactive immune system responses, and help with hormonal imbalances.
Corticosteroids are fast-acting in the body, which makes them useful for treating sudden, severe symptoms. For example, they can effectively manage allergic responses.
These drugs can also suppress the immune system, which makes them helpful for treating autoimmune diseases.
Some conditions that corticosteroids can help treat include:
- chronic obstructive pulmonary disease (COPD)
- inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis
- multiple sclerosis (MS)
- Addison’s disease
- rheumatoid arthritis
Doctors may also use them to treat people who are recovering from an organ transplant.
Corticosteroids have a long history of use in the United States. Most are now available in generic forms, including:
Corticosteroids can come in the form of:
- eye drops
- lotions, creams, ointments, or gels
- nasal or mouth sprays
A doctor will prescribe different forms of corticosteroids, depending on the problem. For example, they may prescribe a cream, lotion, ointment, or gel to treat skin conditions.
Long-term use of corticosteroids can have side effects that include:
- weight gain
- mood disorders, including depression
- high blood pressure
- liver damage
Long-term corticosteroid use can cause the adrenal glands to stop producing the hormone cortisol. After stopping corticosteroid use, it may take some time for the body to start making cortisol at a normal rate.
Short-term use of corticosteroids is safer, but there are still risks. For example, these drugs can cause changes in sleep, mood, and appetite.
There are also signs that short-term use can have more serious side effects. A 2017 study involving 327,452 adults who received a prescription for corticosteroids found that within 30 days of using them, there was an increase in the risk of sepsis, blood clots, and bone fractures.
Corticosteroids mimic the effects of hormones, such as cortisol. A doctor will prescribe corticosteroids to either increase the action of these hormones above a normal level or return it to a normal level.
A person with Addison’s disease, for example, can benefit from this treatment as their body will not produce enough cortisol.
The increase in hormonal activity suppresses the immune system, which is responsible for activating inflammation in the body. By suppressing immune system activity, corticosteroids can reduce inflammation.
Corticosteroids can have substantial effects on the body by suppressing the immune system. Doctors typically use corticosteroids if other treatments are not working, or they require a rapid response.
Taking corticosteroids can cause spikes in blood sugar levels, which can be dangerous for people with diabetes.
Corticosteroids could be harmful in people with:
- substance use disorder
- glaucoma or cataracts
- a recent heart attack or heart failure
- high blood pressure
- liver problems
- ongoing infections
- large wounds
It is possible to use corticosteroid medications during pregnancy, but there are always risks with corticosteroid use. Therefore, doctors may avoid prescribing them to women who are pregnant when possible.
Corticosteroids can reduce the effectiveness of some medications and make others more potent. Before using corticosteroids, people should tell a doctor if they are taking any medications to treat the following:
- excessive blood clotting
Certain vaccines, such as those for measles, mumps, and tuberculosis, can have dangerous interactions with corticosteroids. Other vaccines, such as those for flu or pneumonia, may not work as well if a person is also taking a high dosage of a corticosteroid.
It can also be harmful to use corticosteroids alongside nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil).
The side effects may differ depending on the specific form of corticosteroid. For example, a corticosteroid cream that a person applies to the face might have different side effects than a corticosteroid tablet or injection.
Taking lower dosages over shorter periods will reduce the risk of side effects from corticosteroids. Doctors will always try to prescribe the lowest dosage that will still provide effective treatment.
Some tips to reduce the risk of problems when taking corticosteroids include:
- avoiding interactions by making sure that the doctor is aware of all other medications and supplements
- being careful to prevent infections where possible, such as by getting a flu vaccine and keeping open wounds clean and protected
- keeping the bones healthy through proper exercise, a healthful diet, and, for older adults, calcium and vitamin D supplements
- taking precautions to avoid becoming pregnant, if possible
- having regular eye exams
- watching out for signs of water retention, such as swollen ankles
- taking doses according to the doctor’s prescription
- applying a retinoid cream at the same time as corticosteroid creams, gels, or lotions to reduce the risk of thin skin
- avoiding sudden changes in dosage to reduce the risk of complications, such as withdrawal symptoms
Corticosteroids are effective in suppressing the immune system and reducing inflammation. They are useful for a variety of conditions, particularly when prompt treatment is necessary.
Both long-term and short-term use of corticosteroids can have side effects, some of which are serious. It is important only to take corticosteroids if there are no viable alternatives.
When using corticosteroids, a person should take note of any side effects or changes in symptoms. They should also make sure that their doctor is aware of any other medications and supplements that they are taking. The doctor can help them avoid harmful interactions.