Also called glucocorticoids or just “steroids,” they mimic a hormone called cortisol that the body produces at times of stress. Steroids rapidly reduce inflammation and an overactive immune response.
Corticosteroids can be taken by mouth, applied to the skin or eyes, inhaled, or injected into a muscle, joint, or vein. While extremely effective, they are typically used for a short period of time to avoid potentially serious side effects.
For certain chronic conditions, like multiple sclerosis or asthma, low-dose oral or inhaled corticosteroids can be used safely on an ongoing basis.
This article discusses corticosteroids, how they work to relieve inflammation, and what they are used to treat. It also goes over the side effects of steroids and includes tips for managing side effects.
Uses
Corticosteroids were first used to relieve symptoms of arthritis back in 1948 at the Mayo Clinic in Rochester, Minnesota. The drugs are synthetic versions of cortisol produced by the adrenal glands, which attach to the cortisol receptors on organs to elicit the same effects.
Corticosteroids have different therapeutic uses:
Anti-inflammatory: The drugs act on the immune system by blocking the production of substances that trigger inflammation, such as prostaglandins. This can help rapidly relieve redness, warmth, swelling, and pain either locally (in a specific area) or systemically (throughout the entire body). Immunosuppressive: Corticosteroids can suppress the action of the immune system when it acts against it (such as occurs with autoimmune diseases) by impairing the production of defensive white blood cells, called T-cells. Vasoconstrictive: The drugs block an inflammatory compound called histidine and, by doing so, can reduce mucus secretions that can congest airways and other organs.
These properties can be applied to numerous medical conditions to relieve or manage symptoms and prevent disease progression. Among them:
Some of the more commonly prescribed corticosteroids are cortisone, hydrocortisone, prednisone, prednisolone, and methylprednisolone. Most corticosteroids are available by prescription only (with the exception of over-the-counter nasal sprays or topical steroids like hydrocortisone 1%).
In some cases, the brand name of the drug will be the same irrespective of the route of administration; in others, the brand name can differ.
If overused or administered in excessively high doses, some corticosteroids can mimic the symptoms of Cushing’s syndrome, an adrenal disease characterized by the overproduction of cortisol.
Moreover, the immunosuppressive effects of corticosteroids (while beneficial to organ transplant recipients and people with autoimmune diseases) can leave the body vulnerable to a wide array of bacterial, fungal, parasitic, and viral infections.
Bone loss (osteoporosis) is a serious side effect of prolonged corticosteroid use. To prevent osteoporosis, the American College of Rheumatology recommends the following supplements:
Calcium: 1,000 mg to 1,200 mg dailyVitamin D: 600 IU to 800 IU of vitamin D daily
Weight-bearing or resistance training exercise can also help to preserve bone strength. Daily exercise, such as walking, jogging, or lifting weights is recommended for people on long-term corticosteroid treatment. Regular exercise can also help to minimize weight gain, a common side effect of steroids.
Corticosteroids can lower your immune system and make you more susceptible to illness. Be sure to wash your hands frequently, avoid people who are sick, and wear a mask in crowded public spaces.
Some people experience mood changes when taking corticosteroids. Exercise, yoga, deep breathing, and meditation can help balance your mood. If you have severe mood changes, talk to your doctor.
Contraindications
Steroid therapy is not appropriate for everyone. Contraindications include:
Congestive heart failureDiabetesGlaucomaHerpes simplex keratitisHypersensitivity to any component of the medicationJoint infectionOsteoporosisPeptic ulcer diseaseSystemic fungal infectionUncontrolled hyperglycemiaUncontrolled hypertensionVaricella infectionViral or bacterial infections not controlled by medication
Drug Interactions
Corticosteroids can interact with several different medications. Make sure your doctor is aware of all medications you are taking. Common types of medications that interact with steroids include:
Anticoagulants Antiviral medicationsDiabetes medicationNonsteroidal anti-inflammatory medication
Live or live-attenuated vaccines should not be given to people who are taking immunosuppressant doses of corticosteroids. Wait at least three months after stopping corticosteroids before getting vaccinated.
Discontinuation of Treatment
Once exposed to a corticosteroid drug, the body will be fooled into thinking there are ample quantities of cortisol in the body and no longer produce the hormone itself. The longer you are on treatment, the more the adrenal glands will stop functioning and effectively go into hibernation.
If the corticosteroid drug is suddenly discontinued, it can take a long time for the adrenal glands to start working again and meet the body’s cortisol needs. Without enough cortisol to keep the body functioning normally, an adrenal crisis can occur, manifesting with a range of potentially severe symptoms, including:
Abdominal pain or flank pain Headache High fever Dizziness or lightheadedness Severe weakness Sluggish movements Excessive sweating Dehydration Fatigue Confusion Nausea or vomiting Rapid heart rate Rapid respiration rate Loss of consciousness Coma
Another possible complication is steroid withdrawal syndrome in which symptoms of the treated condition suddenly return once the treatment is stopped. Although this is mainly associated with oral steroids, it can occur when topical steroids are used for a long time.
To avoid these complications, healthcare providers will gradually taper the dose if the drug has been used for more than two weeks or if a high-dose steroid was used. Depending on the dose and the duration of therapy, the tapering period can last anywhere from weeks to years and must be supervised by an experienced physician.
A Word from Verywell
Corticosteroids are powerful drugs that can improve symptoms of many inflammatory or autoimmune diseases. However, the risks may outweigh the benefits if the drugs are overused or used inappropriately.
Always take corticosteroids as prescribed. If symptoms develop during treatment, let your healthcare provider know, but do not stop treatment until your healthcare provider tells you to do so. Alternative therapies can often be found if the side effects are intolerable or potentially irreversible.
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