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Prednisone and other corticosteroids: Balance the risks and benefits
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Corticosteroid medications, such as cortisone, hydrocortisone and prednisone, have great potential in the treatment of a variety of conditions, from rashes to lupus to asthma. But corticosteroids also carry a risk of side effects. Working with your doctor, you can take steps to reduce the medications' side effects so that the benefits of treatment outweigh the risks. Find out more about corticosteroids to help you decide whether this type of medication is right for you.

How do corticosteroids work?

Corticosteroids mimic the effects of cortisone and hydrocortisone — hormones your body produces naturally in your adrenal glands, which sit atop your kidneys. Corticosteroids help control:

  • Stress of illness and injury
  • Immune function
  • Inflammation

Corticosteroid medications are chemically similar to your body's natural steroids and duplicate their actions. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation, which can reduce the symptoms of inflammatory conditions such as arthritis and asthma.

Researchers don't fully understand how corticosteroids suppress inflammation. One theory is that they deactivate a protein associated with inflammation. Another is that they alter the function of cell membranes.

How are corticosteroids used?

Dozens of corticosteroid medications are available today. The drugs are front-line treatments for rheumatoid arthritis, lupus, asthma, allergies and many other conditions. They also treat life-threatening conditions such as Addison's disease, in which the adrenal glands don't produce enough steroids, and help prevent organ rejection in transplant recipients.

You can take corticosteroids:

  • Orally. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions such as arthritis and lupus.
  • By inhaler and intranasal spray. These forms help control inflammation associated with allergy and asthma.
  • Topically. Creams, ointments and roll-ons can help heal many skin conditions.
  • By injection. This form is used to treat such signs and symptoms as the pain and inflammation of tendinitis, severe musculoskeletal pain or serious rashes from poison ivy.

What side effects can corticosteroids cause?

Like all medications, corticosteroids carry a risk of side effects. Some side effects can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact on your health.

Side effects of oral corticosteroids
Because oral corticosteroids affect your entire body instead of a particular area, this form is the most likely to cause significant side effects. Within days or weeks of starting oral therapy, you have an increased risk of:

  • Elevated pressure in the eyes (glaucoma)
  • Fluid retention, causing swelling in your lower legs
  • Increased blood pressure
  • Mood swings
  • Weight gain, with fat deposits in your abdomen, face and the back of your neck

When taking oral corticosteroids longer term, you may experience:

  • Cataracts
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections
  • Loss of calcium from bones, which can lead to osteoporosis and fractures
  • Menstrual irregularities
  • Suppressed adrenal gland hormone production
  • Thin skin, easy bruising and slower wound healing

Side effects of inhaled corticosteroids
When using inhaled corticosteroids, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause coughing, hoarseness, dry mouth and sore throat. Gargling and rinsing your mouth with water and spitting it out after each use may reduce such effects. Although some researchers have speculated that these drugs slow growth rates in children who use them for asthma, studies show that they don't affect final adult height.

Side effects of topical corticosteroids
Topical corticosteroids can lead to thin skin, red lesions and acne.

Side effects of injected corticosteroids
Injected corticosteroids can cause side effects near the site of the injection. Side effects may include pain, infection, shrinking of soft tissue and loss of color in the skin. Doctors usually limit corticosteroid injections to no more than three or four a year.

Reduce your risk of corticosteroid side effects

Despite their side effects, corticosteroid drugs remain an important medical treatment. To get the most benefit with the least amount of risk:

  • Ask about low-dose medications and intermittent dosing. Newer forms of corticosteroids come in varying strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
  • Ask about switching to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body's exposure to them and leading to fewer side effects.
  • Make healthy choices during therapy. When you're on corticosteroid medications for a prolonged period, talk to your doctor about ways to minimize side effects. You may need to reduce the number of calories you eat or increase your physical activity to prevent weight gain. Exercise can help reduce muscle weakness and osteoporosis risks. And taking calcium and vitamin D supplements and prescription bisphosphonates, such as alendronate (Fosamax) or risedronate (Actonel), can minimize bone thinning due to corticosteroids.
  • Take care when discontinuing therapy. If you take oral corticosteroids for prolonged periods, your adrenal glands produce less of their natural steroid hormones. To give your adrenals time to recover this function, your doctor may advise you to reduce your dosage gradually over a period of weeks or even months. If the dosage is reduced too quickly, you may experience fatigue, body aches, lightheadedness and difficulty recovering from minor illnesses.

The greatest risk to your health during corticosteroid withdrawal is the inability of your body to respond to the acute physical stress of serious illness, injury, surgery or general anesthesia. This can lead to shock and even death. Because additional corticosteroids can be given to you in preparation for surgery, it's important that you tell all your doctors if you have taken corticosteroids during the preceding year.

Weigh the risks and benefits of corticosteroids

Remember that corticosteroids are neither as awful nor as miraculous as they've been portrayed. Although they may cause a range of side effects, they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. If you work with your doctor to make choices that minimize side effects, you may achieve significant benefits with a reduced risk of such problems.

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  • June 07, 2006

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