Review: Ocular side effects of anti-rheumatic medications: what a rheumatologist should know. Psychiatric Adverse Effects of Corticosteroids. Mayo Clinic Proceedings. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Factors associated with the initiation of proton pump inhibitors in corticosteroid users.
Pharmacoepidemiol Drug Saf. Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency. Endocrinol Diabetes Metab. Hepatitis C virus HCV reactivation caused by steroid therapy for dermatomyositis.. Intern Med. Screening for Latent Tuberculosis Infection in Adults. Prevalence, screening and treatment of latent tuberculosis among oral corticosteroid recipients. European Respiratory Journal. Clinicial Infectious Diseases. J Cutan Med Surg. The Etiology of Steroid Cataract.
J Ocul Pharmacol Ther. A Different Look at Corticosteroids. Am Fam Physician. Barnes PJ. Inhaled Corticosteroids.. Pharmaceuticals Basel, Switzerland. Intralesional steroid injections: look before you leap!. Indian J Dermatol. Effects of triamcinolone acetonide injections with and without preservative..
Br J Ophthalmol. Clinical Pharmacology. Holland-Frei Cancer Medicine. Glucocorticoid inhibition of fibroblast proliferation and regulation of the cyclin kinase inhibitor p21Cip Mol Endocrinol. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. Anti-inflammatory actions of glucocorticoids: molecular mechanisms.
Clin Sci Lond. The value of glucocorticoid co-therapy in different rheumatic diseases - positive and adverse effects. Arthritis Res Ther. Effects of androgenic-anabolic steroids in athletes. Sports Med. The multifaceted mineralocorticoid receptor. Compr Physiol. Causal relationship between acute pancreatitis and methylprednisolone pulse therapy for fulminant autoimmune hepatitis: a case report and review of literature.
Journal of Pharmaceutical Health Care and Sciences. Open Orthop J. Effect of glucocorticoids on bone density. Med Pediatr Oncol. Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging.. J Endocrinol. Side-effects of topical steroids: A long overdue revisit.
Indian Dermatol Online J. Corticosteroids in acute respiratory failure. Updated: December 15, Accessed: February 14, Circadian rhythm of adrenal glucocorticoid: Its regulation and clinical implications. Biochim Biophys Acta. Internal Medicine. Herold G ; Triamcinolone Rx. Updated: February 20, Accessed: February 20, Shatsky M. Steroid hormone. Updated: February 11, Cortisone acetate: Drug information. In: Post TW, ed. Last updated: January 1, Accessed: March 30, Updated: March 30, Corneal abrasions.
Updated: January 1, Accessed: February 25, Polymyalgia rheumatica and giant-cell arteritis. Open in Read by QxMD. Prednisone : oral Prednisolone : Oral Injectable. Injectable    Topical. Poor wound healing , skin atrophy , and stretch marks due to impaired fibroblast activity and thus, impaired collagen synthesis Purpura Steroid acne Hypertrichosis Increased risk of squamous and basal cell carcinomas.
Hypertension , most likely due to Increased sensitivity to catecholamines due to the upregulation of alpha-1 receptors Mineralocorticoid activity at high concentrations. Weight gain with truncal obesity , buffalo hump , and moon face Cushingoid appearance Proteolysis and lipolysis : proteolysis contributes to hyperglycemia whereas lipolysis leads to hyperlipidemia and eventually to redistribution of fat tissue towards the trunk.
Increased appetite Peptic ulcers and gastrointestinal hemorrhage Possibly pancreatitis . Mood disorders Cognitive disorders Psychosis. Cataract Glaucoma. Skin manifestations as in systemic glucocorticoids Allergic dermatitis. Oral candidiasis can be prevented by using a spacer or by rinsing out the mouth after inhalation Lung infections Hoarseness Allergic dermatitis.
As in systemic glucocorticoids. Growth inhibition Osteoporosis Adrenal suppression. Any systemic, high-dose topical, or high-dose inhaled corticosteroid therapy. Systemic therapy for at least 7—28 days increases the risk of bleeding. Increased risk of hyperglycemia within 24—48 hours of starting systemic treatment. Hypertension can result from any medium- to high-dose systemic steroid regimen. Glaucoma can result from several weeks of any form of steroid administration.
Typically within 2 weeks of starting systemic therapy, particularly with very high-dose therapy. Educate patients on sick day rules. Solution: Work closely with your doctor to monitor your blood sugar level. If you already have diabetes, your doctor will try to find an alternative to steroid therapy. Bone loss osteoporosis may be one of the most serious consequences of corticosteroid therapy; thin, brittle bones can lead to fractures. Another problem, bone death osteonecrosis , can occur as well.
Solution: Daily, weight-bearing or resistance training exercise such as walking, jogging or weight lifting is critical to keeping bones strong. Additionally, the American College of Rheumatology recommends getting between 1, mg to 1, mg of calcium and IU of vitamin D every day; some people at moderate- to high-risk of fractures may need to take osteoporosis medication. Also, quit smoking, eat a balanced diet, limit alcohol consumption and maintain a healthy weight.
Corticosteroids affect the way your body stores and uses fat. Solution: Watch calories and exercise regularly to help prevent weight gain. Reduce your salt intake because it can cause you to retain fluid. Most people lose the extra pounds once they come off steroids, though it can take up to a year to get your former self back. Solution: You should have a complete eye exam by an ophthalmologist before starting steroids and regular eye exams during and after you take them. The hormone cortisol helps regulate the balance of water, sodium and other electrolytes in your body.
When you take corticosteroids, you may retain excess fluid leading to a corresponding spike in blood pressure. Look for low-salt versions of prepared foods, chips, canned soups and salad dressings or avoid them altogether. Your doctor should check your blood pressure often. Corticosteroids suppress your immune system, making you more vulnerable to infection. Even minor infections can become serious. Solution: Wash your hands often and stay away from crowds and people you know are sick.
If you notice any signs of infection — a fever, cough or painful urination — call your doctor right away. People rarely think of corticosteroids as mood-altering drugs, but in fact, they can cause a rollercoaster of emotions, ranging from agitation, anxiety, aggression or mania to deep depression. Solution: Mood problems are much more common with high doses. Be sure to tell you doctor about your symptoms.
Exercise, yoga, deep breathing and meditation might be helpful. This can lead to very thin skin as well as poor wound healing, easy bruising, broken blood vessels and stretch marks. But if you use topical steroids, applying a retinoid cream at the same time might help prevent some thinning.
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Corticosteroids Whether taken by mouth, topically, intravenously, or injected into a joint, steroids relieve inflammation fast. Corticosteroids are also called glucocorticoids or steroids. No matter what you call them, they are potent, fast-working anti-inflammatories.
Although their popularity has decreased over the years due to the introduction of newer drugs with fewer side effects, they still have a role in managing some arthritis symptoms. Why Corticosteroids? Corticosteroids are both anti-inflammatory and immunosuppressive, meaning they reduce the activity of your immune system.
Doctors often prescribe them for fast, temporary relief while waiting for disease-modifying antirheumatic drugs DMARDs or biologics to take full effect or during a severe flare of symptoms. Creams and ointments are used to treat various skin conditions, including psoriasis that occurs with psoriatic arthritis PsA. Steroid eye drops are often the best way to bring down inflammation in uveitis.
Tablets, capsules or syrups may help reduce inflammation and pain in people with RA and lupus. Oral steroids should not be used for PsA, however; they can trigger severe forms of the disease.
The goal was to improve clinical understanding of risks associated with these injections. Existing data suggest there is significant individual variability in the amount of systemic absorption and clinical effects of locally injected glucocorticoids. However, it is clear that both intra-articular and epidural injections can have systemic effects for weeks and that complications may be associated with their use, including Cushing syndrome, loss of bone density, infection, and hyperglycemia.
The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used all are important considerations in estimating risks. The total dose calculation of cumulative glucocorticoid exposure should include all local injections. Caution should be exercised when local glucocorticoid injections are used in higher risk patients, such as postmenopausal women, people with diabetes, and those considering surgery in the near term.
Better provider awareness of possible systemic risks should improve decision making and informed consent with patients when considering intra-articular and epidural steroid injections for painful conditions. You may need an ultrasound scan to find where the inflammation is, so the steroid can be injected into a precise spot and have maximum benefit.
An ultrasound scan uses high-frequency sound waves to create an image of part of the inside of a body. Many injections can be given without the need for ultrasound. This would mean your pain should be relieved within minutes. You may have some numbness from the anaesthetic that could last up to 24 hours.
You might be advised to wait for 10 to 15 minutes in the clinic after your steroid injection. If you do have any kind of reaction to the injection, it would be helpful to be around healthcare professionals. For some conditions, such as inflammatory types of arthritis, steroid injections are often useful in the short term while you and your doctor find the right medications to control your arthritis in the long term.
In this case, once your arthritis is well controlled the need for injections should be reduced. It is important you monitor your blood sugar levels after a steroid injection. There is evidence that having too many steroid injections into the same area can cause damage to the tissue inside the body. You may be advised to have less than that depending on your symptoms. There is a small risk that if you exercise a joint too much immediately after a steroid injection you could damage the tendon.
Tendons are strong cords that attach muscles to bones. Start off gently and gradually increase the amount you do. Most people have steroid injections without any side effects. They can be a little uncomfortable at the time of injection, but many people feel that this is not as bad as they feared. Occasionally people notice a flare-up in their joint pain within the first 24 hours after an injection.
This usually settles by itself within a couple of days, but taking simple painkillers like paracetamol will help. The risk of side effects is greatest with the stronger mixtures — methylprednisolone and triamcinolone. Injections can occasionally cause some thinning or changes in the colour of the skin at the injection site, particularly with the stronger ones. Very rarely you may get an infection in the joint at the time of an injection.
If your joint becomes more painful and hot you should see your doctor immediately, especially if you feel unwell. People are often concerned about the possibility of other steroid-related side effects such as weight gain. One of the advantages of steroid injections compared to tablets is that often the dose can be kept low.
This means that these other side effects are very rare unless injections are given frequently, more than a few times per year. This may be more likely if you have a history of mood disturbance. If you've had a steroid injection into a joint or muscle, your healthcare professional may give you a steroid card for you to carry around.
This will have details of the treatment you've had. Steroid injections can stop the body producing natural hormones, which can be dangerous if you get ill, have an accident or need an operation. There is evidence that this can be a risk for up to one month after just one steroid injection.
If you've had three steroid injections over the course of 12 months, this risk could last for a further 12 months. Keeping the card with you will help any other doctor who treats you to manage your care correctly.
If you have any questions or concerns about this, talk to the healthcare professional who prescribed your steroids. You can take other medicines with steroid injections. This is because of the risk of bleeding into the joint. You should mention that you take anticoagulants to the person giving the injection. You may be advised to adjust your warfarin dose before having the steroid injection. This is how they reduce inflammation.
Some vaccines work by giving you a very small dose of a particular disease, so that you then become immune to it.
Systemic glucocorticoids are used for hormone replacement therapy e. Local glucocorticoids are used to treat conditions like dermatoses, asthma , and anterior uveitis. Adverse effects include metabolic and endocrine disturbances, weight gain, skin reactions, hypertension , and psychiatric disorders; using the lowest dose possible for the shortest period of time, patient education, and regular screening can help lower the incidence of adverse effects and ensure early detection if they do occur.
Contraindications for systemic glucocorticoids include systemic fungal infections and, in the case of dexamethasone , cerebral malaria. Status asthmaticus is a contraindication for inhaled glucocorticoids. Topical and ophthalmic glucocorticoids are usually contraindicated if there are preexisting local infections. This article describes the pharmacology of synthetic glucocorticoids in detail; accordingly, glucocorticoids refer here to the drug class rather than the endogenous hormone.
Intermediate-acting 12—36 hours. Fludrocortisone is not used for glucocorticoid activity but as a mineralocorticoid substitute in the management of adrenal insufficiency. Both acute and long-term effects of glucocorticoids lead to inhibition of inflammatory processes and to immunosuppression.
References:     . Glucocorticoid toxicity depends on the dose that is administered over a certain period of time. Therefore, even low doses can have toxic effects if administered long-term. If glucocorticoids are administered once or only briefly e. Many of the adverse effects listed above are also features of iatrogenic Cushing syndrome. Local side-effects of inhaled glucocorticoids can be avoided by reducing the dose to the lowest effective amount, rinsing with mouthwash after each puff , improving the inhalation technique and compliance, and keeping vaccinations up to date.
We list the most important adverse effects. The selection is not exhaustive. References: . We list the most important contraindications. If the Cushing threshold is exceeded over a longer period of treatment, the glucocorticoid dose should be gradually decreased to minimize the risk of adrenocortical insufficiency.
An intratendinous injection carries the risk of bacterial spread and iatrogenic bacterial arthritis. References:  . Complications are most common with long-term systemic treatment but can also occur with higher-dose topical and inhaled steroids.
The risk of complications can be reduced by keeping treatment durations short or doses low. Interested in the newest medical research, distilled down to just one minute? Trusted medical expertise in seconds. Find answers fast with the high-powered search feature and clinical tools. Try free for 5 days Evidence-based content, created and peer-reviewed by physicians.
Read the disclaimer. Glucocorticoids Last updated: June 3, Summary Synthetic glucocorticoids are a group of drugs with antiinflammatory, immunosuppressant , metabolic, and endocrine effects. Definition Corticosteroids : a class of steroid hormones that includes glucocorticoids and mineralocorticoids  Endogenous corticosteroids : hormones synthesized from cholesterol in the adrenal cortex  Endogenous glucocorticoids e.
Relative to hydrocortisone , systemic corticosteroids differ in potency of their glucocorticoid effects relative glucocorticoid potency and mineralocorticoid effects relative mineralocorticoid potency for a given dose. Relative potency of systemic corticosteroids   Duration of action Drug Common routes of administration Equivalent doses Relative glucocorticoid potency Relative mineralocorticoid potency Systemic glucocorticoids Short-acting 8—12 hours Hydrocortisone Oral Injectable Topical 20 mg 1 1 Cortisone Oral Injectable 25 mg 0.
Topical glucocorticoids Inhaled glucocorticoids Local effects Skin manifestations as in systemic glucocorticoids Allergic dermatitis Oral candidiasis can be prevented by using a spacer or by rinsing out the mouth after inhalation Lung infections Hoarseness Allergic dermatitis Eyes As in systemic glucocorticoids Ocular reactions Other - Growth inhibition Osteoporosis Adrenal suppression.
Alterations to lipid levels usually require at least 2 weeks of systemic therapy. Ocular disease   Glaucoma can result from several weeks of any form of steroid administration. Psychiatric complications   Typically within 2 weeks of starting systemic therapy, particularly with very high-dose therapy.
Measures to prevent complications of glucocorticoid therapy Complication to prevent Before therapy During therapy Adrenal suppression and adrenal insufficiency   Educate patients on sick day rules. Provide an emergency hydrocortisone kit for injection. Osteoporosis  Assess fracture risk. Promote patient education on modifiable risk factors. Consider PPIs , e. Diabetes and hyperglycemia  Obtain baseline HbA1c. Regularly monitor patients.
Routine recommended inactivated vaccines e. Cardiovascular disease  Obtain baseline blood pressure measurement and lipid panel. Regular blood pressure measurements to identify arterial hypertension Regular lipid panels to identify lipid disorders Ocular disease    Screen patients for a history of cataracts or glaucoma.
Regular eye examinations  Educate patients on the symptoms of glaucoma. Psychiatric disease   Screen patients for psychiatric comorbidities, e. Prevention and management of glucocorticoid-induced side effects: A comprehensive review. J Am Acad Dermatol.
Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. Steroids: pharmacology, complications, and practice delivery issues. Ochsner J. Arlt W et al. Society for Endocrinology Emergency Guidance: Emergency management of acute adrenal insufficiency adrenal crisis in adult patients. Endocrine Connections. How to avoid precipitating an acute adrenal crisis. British Medical Journal.
Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Short-term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population-based case-crossover study. Aliment Pharmacol Ther. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. Glucocorticoid-induced diabetes and adrenal suppression: How to detect and manage them.
Cleveland Clinic Journal of Medicine. Retrospective review of the incidence of monitoring blood glucose levels in patients receiving corticosteroids with systemic anticancer therapy. Ann Palliat Med. Infection Risk and Safety of Corticosteroid Use. Rheum Dis Clin North Am. Glucocorticoid-induced hypertension. Pediatr Nephrol. Prednisone increases very low density lipoprotein and high density lipoprotein in healthy men.
Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis. J Curr Glaucoma Pract. Review: Ocular side effects of anti-rheumatic medications: what a rheumatologist should know. Psychiatric Adverse Effects of Corticosteroids.
Mayo Clinic Proceedings. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Factors associated with the initiation of proton pump inhibitors in corticosteroid users. Pharmacoepidemiol Drug Saf. Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency.
Endocrinol Diabetes Metab. Hepatitis C virus HCV reactivation caused by steroid therapy for dermatomyositis.. Intern Med. Screening for Latent Tuberculosis Infection in Adults. Prevalence, screening and treatment of latent tuberculosis among oral corticosteroid recipients. European Respiratory Journal. However, they will still only be used if a doctor thinks the potential benefits outweigh the risks. As steroid tablets are more likely to cause side effects, there are some circumstances when they shouldn't be used or should only be used with caution.
These circumstances include:. Read more about who can use corticosteroids and interactions of corticosteroids. For most people, steroid inhalers and steroid injections should not cause any troublesome side effects. Steroid tablets are generally prescribed with more caution, as these can potentially cause more problems.
Corticosteroid tablets are the most powerful type of steroid medication, because they can affect the whole body. They shouldn't be used if you have an ongoing widespread infection, because they could make it more severe. However, you should continue to take corticosteroids if you develop an infection while already being treated, unless advised otherwise.
They should also be used with caution in people with a health condition that could be made worse by taking oral corticosteroids, including:. In these situations, you will only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks.
Most people can safely have corticosteroid injections, but they should be avoided or used with caution if you have an ongoing infection or a blood clotting disorder such as haemophilia. There is generally no reason why someone shouldn't be able to use a steroid inhaler or steroid spray, but these should be used with caution in people with ongoing infections, such as tuberculosis TB.
Corticosteroids are generally safe to use during pregnancy. However, they're not usually recommended unless the potential benefits outweigh the risks. For example, steroid tablets may be recommended if you're pregnant and have severe asthma , because the risk to your baby from uncontrolled asthma is higher than from the medication. There is no evidence that using a steroid inhaler during pregnancy increases the risk of problems such as birth defects, so you can usually continue to use this as normal while you're pregnant.
If a woman needs to take steroid tablets while she is breastfeeding, a type called prednisolone is usually recommended, because it is thought to have the least chance of causing the baby any adverse effects. As a precaution, it's usually recommended that a breastfeeding mother waits three to four hours after taking a tablet before feeding her baby. Steroid injections, inhalers and sprays are not thought to pose a risk to babies being breastfed.
Corticosteroids can interact with other medicines, and the effects of either medicine can be altered as a result. There is less chance of this happening with steroid injections or sprays, although it can occasionally happen if they're used at high doses and for a long time. Some of the more common interactions are listed below, but this is not a complete list.
If you want to check your medicines are safe to take with corticosteroids, ask your GP or pharmacist, or read the patient information leaflet that comes with your medicine. Anticoagulant medicines are medications that make the blood less sticky.
They are often prescribed to people with a history of blood clots or an increased risk of developing them. Combining corticosteroids with anticoagulant medicines can sometimes make anticoagulants less effective. Alternatively, it can increase their blood-thinning effect, which can cause bleeding inside the digestive system. Anticonvulsants are medicines used to prevent seizures fits and are often used to treat epilepsy , but they can reduce the effectiveness of corticosteroids.
Depending on how frequent and severe your seizures are and the condition the steroids are being used to treat, you may be advised to temporarily stop taking anticonvulsants. Corticosteroids can decrease the effectiveness of medications used to treat diabetes. If you need to take both of these medications, your blood glucose levels will usually be checked more regularly and your dose of diabetes medication may need to be adjusted. Corticosteroids, including steroid inhalers, can sometimes interact with a type of medication known as protease inhibitors such as ritonavir used to treat HIV.
The HIV medication may increase the level of corticosteroid in your body, which might increase your risk of experiencing side effects. Some vaccinations contain a weakened form of the infection they are designed to protect against. These are known as live vaccines.
Examples of live vaccines include:. As corticosteroids can weaken your immune system and make you more vulnerable to infection, you should avoid any live vaccine until at least three months after your course of corticosteroids has finished. Non-steroidal anti-inflammatory drugs NSAIDs are a group of commonly used painkillers, such as ibuprofen , that are available over the counter at pharmacists.
Combining NSAIDs and corticosteroids can increase your risk of developing stomach ulcers and internal bleeding. If you need to take both medications, you may be given an additional medication called a proton pump inhibitor PPI to reduce the risk of stomach ulcers. Some of the main side effects are listed below, but this is not a complete list. To learn about all the possible side effects of your medication, read the patient information leaflet that comes with it. Inhaled steroids usually have few or no side effects if used at normal doses.
However, they can sometimes cause:. Rinsing your mouth out with water after using your medication can help to prevent oral thrush, and using a device called a spacer with your medication can help to prevent many of the other problems. There is also some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease COPD can increase the risk of chest infections such as pneumonia.
Inhaled steroids at high doses can sometimes cause some of the more serious side effects that are more often linked with steroid tablets see below , but this is rare. Steroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days. Steroid injections can also cause muscle or tendon weakness, so you may be advised to rest the treated area for a few days after the injection.
Other possible side effects can include infections, blushing, and thinning and lightening of the skin in the area where the injection is given. Because of the risk of side effects, steroid injections are often only given at intervals of at least 6 weeks and a maximum of 3 injections into one area is usually recommended. Steroids that are injected into a blood vessel intravenous steroids may sometimes cause some of the more widespread side effects described below.
Short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects. Most side effects should improve if you're able to reduce your dosage or eventually stop taking the medication. You may have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take steroid tablets on a long-term basis.