Corticosteroids. Uses and Precutions

 

Corticosteroids By Pharmacytimess.com

Corticosteroids

Introduction

Corticosteroids, often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions.

They're a man-made version of hormones normally produced by the adrenal glands (two small glands that sit on top of the kidneys).

Corticosteroids are available in different forms, including:

• tablets (oral steroids)
• injections – which can be into blood vessels, joints or muscles
• inhalers – such as mouth or nasal sprays
• lotions, gels or creams (topical steroids)

 

Commonly referred to as steroids, corticosteroids are a type of anti-inflammatory drug. They are typically used to treat rheumatologic diseases, like rheumatoid arthritis, lupus or vasculitis (inflammation of the blood vessels). Specific corticosteroids include the medications cortisone and 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.

 

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 (like rheumatoid arthritis or lupus).

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 to reduce the risk of side effects.

How steroids works?

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. Signs of inflammation include:

• Redness.
• Warmth.
• Swelling.
• Pain.

Steroids reduce the production of chemicals that cause inflammation. This helps keep tissue damage as low as possible. Steroids also reduce the activity of the immune system by affecting the way white blood cells work.

Corticosteroids Indications

Corticosteroids are mainly used to reduce inflammation and suppress the immune system.

They are used to treat conditions such as:

• asthma
• allergic rhinitis and hay fever
• urticaria (hives)
• atopic eczema
• chronic obstructive pulmonary disease (COPD)
• painful and inflamed joints, muscles and tendons
• lupus
• inflammatory bowel disease (IBD) – including Crohn's disease and ulcerative colitis
• giant cell arteritis and polymyalgia rheumatica
• multiple sclerosis (MS)

 

Corticosteroids can also be used to replace certain hormones that are not being produced by the body naturally – for example, in people with Addison's disease.

 

When are steroids given?

Steroids are used to treat many conditions in which the body’s defense system doesn’t work properly and causes tissue damage. Steroids may be 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 in the treatment for certain rheumatologic inflammatory conditions, such as:

• Systemic vasculitis (inflammation of blood vessels).
• Myositis (inflammation of muscle).
• Rheumatoid arthritis (chronic inflammatory arthritis).
• Systemic lupus erythematosus (a generalized disease caused by abnormal immune system function).

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 worsening 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. Short-term use of higher doses of steroids might help a person recover from a severe flare-up of arthritis.

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

The decision to prescribe steroids is always made on an individual basis. Your healthcare provider will consider your age, physical activity, and other medicines you are taking. Your provider 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 chance 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.
• Changes in mood.
• Muscle weakness.
• Blurred vision.
• Increased growth of body hair.
• Easy bruising.
• Lower resistance to infection.
• Swollen, "puffy" face.
• Acne.
• Osteoporosis (bone weakening disease).
• Onset of, or worsening of, diabetes.
• Onset of, or worsening of, high blood pressure.
• Stomach irritation.
• Nervousness, restlessness.
• Difficulty sleeping.
• Cataracts or glaucoma.
• Water retention, swelling.

If you have troublesome side effects after taking corticosteroids, don't stop taking your medication until your doctor says it's safe to do so, because of the possibility of these unpleasant withdrawal effects.

Your dose may need to be reduced slowly over a few weeks or months, and you may have to have tests to ensure that your adrenal glands are still working properly before stopping corticosteroids altogether, if you have been taking them for a long time.

 

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.

Side effects of Corticosteroids:

Corticosteroids are powerful medications that can sometimes have a wide range of side effects.

They will only be used if the potential benefits are thought to outweigh this risk.

The risk of experiencing side effects largely depends on:

• the type of steroid you're taking – steroid tablets (oral corticosteroids) are more likely to cause side effects than inhalers or injections
• the dose – the higher the dose, the greater the risk of developing side effects
• the length of treatment – for example, you're more likely to develop side effects if you take steroid tablets for more than three weeks
• your age – young children and the elderly are more likely to experience side effects

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.

Steroid inhalers

Inhaled steroids usually have few or no side effects if used at normal doses. However, they can sometimes cause:

• a sore mouth or throat
• minor nosebleeds
• difficulty speaking or a hoarse or croaky voice
• a cough
• oral thrush

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. Discuss this with your health professional if you’re concerned.

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.

Steroid injections

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.

Steroid tablets

Short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects.

It’s sometimes necessary, however, for them to be taken for longer periods. In these cases, you’re more likely to develop troublesome side effects, although this is not inevitable.

Steroid tablets taken for longer than 3 weeks can potentially cause:

• increased appetite – which can potentially lead to weight gain if you find it difficult to control what you eat
• acne
• rapid mood swings and mood changes – such as becoming aggressive, irritable and short-tempered with people
• thin skin that bruises easily
• muscle weakness
• delayed wound healing
• a combination of fatty deposits that develop in the face, stretch marks across the body and acne – known as Cushing’s syndrome
• weakening of the bones (osteoporosis)
• diabetes (or they may worsen existing diabetes)
• high blood pressure
• glaucoma and cataracts (eye conditions)
• stomach ulcers – you may be prescribed an additional medication called a proton pump inhibitor (PPI) to reduce this risk
• mental health problems, such as depression, suicidal thoughts, anxiety, confusion and hallucinations – see your GP if you experience any of these problems
• increased risk of infections, particularly chickenpox, shingles and measles – avoid close contact with anyone who has an infection and seek medical advice immediately if you think you may have been exposed
• reduced growth in children

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.

 

Does the side effects are common?

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

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, healthcare providers follow several guidelines:

• Use steroids only when necessary.
• Watch the patient closely to detect early signs of serious side effects.
• If possible, use local steroids for local problems.
• Use the smallest dose needed to control the disease.
• Reduce the dose gradually as long as the disease remains under control.
• Monitor blood pressure and blood sugar often and treat if necessary.
• Monitor bone density and prescribe medications and supplements to help bone health.

There are other ways to prevent certain side effects, and these need to be discussed individually with your healthcare provider.

Cautions and interactions

For most people, including pregnant or breastfeeding women, steroid inhalers and injections are safe. 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:

• having an ongoing widespread infection
• having mental health or behavioural problems – such as depression or alcohol dependence
• having certain underlying physical conditions – such as liver problems, heart failure, high blood pressure or diabetes
• taking another medication that may interact with corticosteroids

Corticosteroids can often be taken while you’re pregnant or breastfeeding, although your doctor will only prescribe them if the risks of not being treated outweigh the risks associated with the medication.

Who can use them

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.

Steroid tablets

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.

Steroid tablets should be used with caution in people with:

• liver problems, such as liver disease – corticosteroids may not be broken down by the liver at a normal rate, leading to increased levels of the medication in the blood
• mental health or behavioural problems, such as depression or alcohol dependence – corticosteroids can have unpredictable effects on behaviour and mood
• wounds – oral corticosteroids can delay wound healing  

They should also be used with caution in people with a health condition that could be made worse by taking oral corticosteroids, including:

• heart failure
• a recent heart attack
• high blood pressure
• diabetes
• epilepsy
• glaucoma
• underactive thyroid gland
• osteoporosis
• obesity
• psychosis
• stomach ulcers

In these situations, you will only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks.

Steroid injections

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).

Steroid inhalers and sprays

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).

Pregnancy

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. 

Breastfeeding

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.

Interactions of Corticosteroids

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

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

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.

Diabetes medication

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.

HIV medication

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.

Live vaccines

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:

• the measles, mumps and rubella (MMR) vaccine
• the BCG vaccine for tuberculosis (TB)

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

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 develocping 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.

 Read also: 

1. Dengue awareness
2. How To Treat Low Blood Sugar (Hypoglycemia) 
3. Eye Disorders and Diseases
4. Heart Attack Symptoms, Risk, and Recovery
5. Heart Failure
6. ANTIRHEUMATIC DRUGS
7. Diabetes and types of Diabetes
8. High Blood Pressure Symptoms and Causes

References:

NHS Inform

Cleveland Clinic