Prednisone and other corticosteroids: Balance the risks and benefits

[Guest guest]

Prednisone and other corticosteroids: Balance the risks and benefits

Weigh the benefits and risks of corticosteroids, such as prednisone, when

choosing a medication.

http://www.mayoclinic.com/health/steroids/HQ01431

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

'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.

For more information on the systemic effects of Corticosteroids, see:

http://www.mayoclinic.com/health/drug-information/DR202018