Why are steroid tablets used?

Steroid tablets (cortisone or corticosteroids) work mainly by reducing inflammation. They are used to treat various conditions where inflammation occurs. For example: some auto-immune diseases; some types of muscle, skin, and joint diseases; asthma; etc. Steroids are also used to treat some cancers. Prednisolone is the common steroid tablet. The outlook (prognosis) for a number of diseases has improved, sometimes dramatically, since steroids became available.

Some general points about steroid tablets

• A short course of steroids usually causes no side-effects. For example, a 1-2 week course is often prescribed to ease a severe attack of asthma. This is usually taken without any problems.
• Side-effects are more likely to occur if you take a long course of steroids (more than 2-3 months), or if you take short courses repeatedly.
• The higher the dose, the greater the risk of side-effects. This is why the lowest possible dose which controls symptoms is aimed for if you need steroids long-term. Some diseases need a higher dose to control symptoms than others. Even for the same disease, the dose needed often varies from person to person.
• A common treatment plan is to start with a high dose to control symptoms. Often the dose is then slowly reduced to a lower daily dose that keeps symptoms away. The length of treatment can vary, depending on the disease. Sometimes the steroid treatment is gradually stopped if the condition improves. However, steroids are needed for life for some conditions as symptoms return if the steroids are stopped.
• The type of steroids used to treat disease are called corticosteroids. They are different to the 'anabolic' steroids which some athletes and bodybuilders use. Anabolic steroids have very different effects.

What are the possible side-effects of steroids?

For many diseases, the benefit of taking steroids usually outweigh the side-effects. However, side effects can sometimes be troublesome. You should read the information leaflet that comes with your medicine packet for a full list of possible side-effects. The main possible side-effects include the following:

• Osteoporosis ('thinning of the bones'). However, treatment can help to protect against this if the risk is high. For example, you can take a medicine to help prevent bone loss.
• Weight gain. You may also develop a 'puffiness' around the face.
• Increased chance of infections as steroids may suppress the immune system. In particular, you are at risk of having a severe form of chickenpox if you have not had chickenpox in the past (and so are not immune). Most people have chickenpox as a child and are immune to it. If you have not had chickenpox in the past:
  • Keep away from people with chickenpox or shingles.
  • Tell a doctor if you come in contact with people with these conditions.
  Also, tuberculosis (TB) may flare up again if you had it in the past, even many years ago.
• Increase in blood pressure. So have your blood pressure checked regularly. It can be treated if it becomes high.
• High blood sugar which may mean extra treatment if you have diabetes. Steroids may occasionally cause diabetes to develop. If you take long-term steroids, your doctor may arrange a yearly blood sugar test to check for diabetes. In particular, if you have a family history of diabetes.
• Skin problems such as poor healing after injuries, thinning skin, and easy bruising. Stretch marks sometimes develop.
• Muscle weakness.
• Mood and behaviour changes. Some people actually feel better in themselves when they take steroids. However, steroids may aggravate depression and other mental health problems, and may occassionally cause mental health problems. If this side effect occurs it tends to happen within a few weeks of starting treatment and is more likely with higher doses. Some people even become confused, irritable and suffer from delusion and suicidal thoughts. These mental health effects can also occur when steroid treatment is being withdrawn. Seek medical advice if worrying mood or behaviour changes occur.
• An increased risk of developing cataracts.
• An increased risk of duodenal and stomach ulcers. Tell your doctor if you develop indigestion or abdominal (stomach) pains.

The above are only the main possible side-effects which may affect some people who take steroids. There is often a balance between the risk of side-effects against the symptoms and damage that may result from some diseases if they are not treated. Some of the less common side effects are not listed above but will be included on the leaflet that comes with your medicine.

Stopping steroid tablets

Do not stop steroid tablets suddenly if you have been taking them for more than three weeks.

It probably does no harm to forget the odd tablet. However, you may get serious withdrawal effects once your body is used to the steroids. These may develop within a few days if you stop steroid tablets suddenly. Any change in dose should be supervised by a doctor. Any reductions in dose are done slowly, over a number of weeks.

Why is it necessary to gradually reduce the dose before stopping steroid tablets?

Your body normally makes steroid chemicals by itself which are necessary to be healthy. When you take steroid tablets for a few weeks or more, your body may reduce or stop making its own steroid chemicals. If you then stop taking steroid tablets suddenly, your body does not have any steroids. This can cause various 'withdrawal' symptoms until your body resumes making natural steroids over a few weeks. The withdrawal symptoms can be serious, even life-threatening and include: weakness, tiredness, feeling sick, vomiting, diarrhoea, abdominal pain, low blood sugar, and low blood pressure which can cause dizziness, fainting or collapse.

If the dose is reduced gradually, the body gradually resumes its natural production of steroids and the withdrawal symptoms do not occur.

Some other important points about steroid tablets

• Do not take anti-inflammatory painkillers (such as ibuprofen, etc) whilst taking steroids (unless advised by a doctor). The two together increase the risk of a stomach or duodenal ulcer developing.
• Most people who take regular steroids carry a 'steroid card' and/or a MedicAlert® bracelet (see below), or similar. This gives details of your dose, your condition, etc, in case of emergencies. For example, if you were knocked unconscious in an accident, it is important that the doctors know that you take steroids and need to take them regularly.
• The dose of steroid may need to be increased for a short time if you are ill with other conditions. For example, if you have a serious infection, or have an operation. This is because you need more steroid during physical stress.
• See a doctor if you have any concerns about your steroid treatment.

MedicAlert® Foundation

Some people who take long-term steroids like to wear a MedicAlert® emblem. You wear it as a bracelet or necklet. It is engraved on the back with the member's main medical condition, personal identification number, and 24-hour emergency number. For further details contact:

MedicAlert® Foundation
1 Bridge Wharf, 156 Caledonian Road, London, N1 9UU.
Tel: 0800 581420 Web www.medicalert.org.uk