Tips to Prevent and Manage the Side Effects of Oral Corticosteroids

Tips to Prevent and Manage the Side Effects of Oral Corticosteroids

Understand the side effects of corticosteroids and how to reduce or prevent them in treating IBD.

Corticosteroids, also called steroids, are anti-inflammatory synthetic versions of hormones, such as cortisol, produced by the adrenal glands. The adrenal glands are two small glands located on top of the kidneys. Cortisol, often called the stress hormone, is the main hormone required for staying healthy. It plays a key role in metabolism, stress and the immune response. It can also affect memory formulation and blood pressure control. Cortisol stimulates the production of glucose in the liver by breaking proteins and fats.

Corticosteroids are important in the treatment of many allergic, inflammatory, immunologic and malignant disorders. Corticosteroids act by suppressing inflammation and are used with autoimmune conditions (when the immune system attacks healthy cells in your body), such as Lupus, Rheumatoid Arthritis, Psoriasis, and Inflammatory Bowel Disease (IBD). They are also used in other conditions, such as hay fever, hives and Chronic Obstructive Lung Disease (COPD). Corticosteroid medications include Cortisone, Hydrocortisone, Prednisone, Prednisolone, Methylprednisolone and Budesonide

Corticosteroids are administered orally, using an inhaler or intranasal sprays, in eye drop form, topically, or through injection.

Oral steroids are used for autoimmune conditions (lupus, inflammatory bowel disease and rheumatoid arthritis), asthma or COPD flare, severe allergic reactions, and preventing an organ transplant rejection.

Corticosteroid Issues
Corticosteroid Issues

Side effects of oral corticosteroids

The severe side effects of corticosteroids are evident with prolonged treatment of high doses. Most times, doctors aim at prescribing steroids at the lowest effective dose for the shortest possible time for people with IBD.

Side effects, which depend on dosage, are:

  • Weight gain
  • Upset stomach
  • High blood pressure
  • Insomnia or lack of sleep
  • Fluid retention, causing swelling in the lower legs
  • Issues with memory, behavior and mood swings
  • Psychological effects, such as confusion and delirium

Longer-term side effects of oral corticosteroids include:

  • Round or moon face from fat deposition in the face
  • Weight gain, which can be due to fluid retention and higher calorie intake from increased appetite. Steroids cause redistribution and accumulation of fat in the back of the neck, abdomen and face
  • High blood sugar, which can trigger or worsen diabetes
  • Thinning and fragile bones, causing Osteoporosis and fractures
  • Severe fatigue and loss of appetite
  • Nausea
  • Muscle weakness
  • Increased risk of infections
  • Thin skin
  • Bruising and slower wound healing
  • Heart problems, including heart disease and failure
  • Eye problems, such as cataracts (lens of eyes become progressively opaque resulting in blurred vision) or glaucoma (abnormally high pressure in the eye)
  • Growth problems in children and adolescents
Eye Exam
Eye Exam

Tips to prevent or manage these side effects include:

  • Follow a low-salt and healthy heart diet, because of potential side effects with steroids of high blood pressure, fluid retention and weight gain.
  • Watch your calories. Work with your dietitian or doctor, who can guide you accordingly, while minding your conditions and the medications.
  • Avoid drinking alcoholic beverages while being treated with steroids. Alcohol can exacerbate stomach problems caused by steroids,
  • Insomnia or lack of sleep is a common side effect of steroids. Talk to your doctor regarding taking the whole dose in the morning.
  • If you are taking steroids for more than 3 weeks, carry a card listing the name and dose of the steroid you take. Show this card to anyone who treats you, including your dentist.
  • People usually take oral steroids with breakfast or another meal, to avoid an upset stomach. Please follow your doctor’s instructions.
  • Schedule periodic eye examinations with your doctor for early detection of cataracts (clouding of the eye’s lens) and glaucoma (increased pressure in the eye).
  • Talk to your doctor about getting a bone-density test done every 1-2 years to check for development of weak bones. Also, check for the need to take calcium and vitamin D supplements if you are not getting enough nutrients in your diet. Resistance training exercises such as walking and jogging are critical to keeping bones strong. Discuss with your doctor if these forms of physical activity are right for you.
  • One of the side effects of steroids is high blood sugar levels. If you have diabetes, you will need to watch your blood sugar closely. Talk to your doctor if you experience confusion, tiredness, more thirst or hunger than usual, pass urine more frequently, feel flushed, breathing faster, or your breath smells like fruit.
  • This medication may cause you to have more infections than usual. Avoid being near anyone with chickenpox or measles if you have not had these health problems before. For some people taking steroid drugs, chickenpox and measles can be difficult. If you have been exposed to chickenpox or measles, contact your doctor.
  • Always check with your doctor as soon as possible if you notice any signs of infection, such as sore throat, fever, sneezing or coughing. Also wash your hands often to prevent infections.
  • Please tell your doctor in charge that you are taking this medication:
    • Before having any kind of surgery or emergency treatment
    • If you have a major injury or infection
    • Before getting any skin test done
  • Please do not suddenly stop taking this medication without first checking with your doctor. If you are planning to stop, gradually reduce the amount taken over time as directed by your doctor. Your body becomes dependent on steroids. The longer you take them, the more dependent on them your body becomes. Suddenly stopping the medication can cause withdrawal symptoms such as weakness, fatigue, nausea and dizziness.
Steroid Pills
Pills Image

Steroids relieve inflammation fast, no matter what the route of administration is. However, the trade-off is serious side effects with long-term use. They are potent, fast-acting anti-inflammatories, and not to be confused with anabolic steroids, which some athletes take to improve their performance.

Steroids are potent, fast-acting anti-inflammatories that can be used while waiting for other treatments to start working. Your doctor and you will weigh the benefits and risks before you are prescribed steroids. Please observe any changes in symptoms or side effects that occur while taking steroids, and discuss these with your doctor.

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