What You Need to Know Before Starting Oral Steroids?

An oral steroid is a medication that duplicates hormones produced by the body. These hormones lower inflammation while decreasing the immune system’s reaction. Steroid drugs are artificial forms of these hormones that are also known as corticosteroids.

Types of oral steroids

The most common type of corticosteroid medicines are glucocorticoids, which include:

• Prednisolone
• Betamethasone
• Dexamethasone
• Hydrocortisone
• Methylprednisolone
• Deflazacort

Another group of corticosteroids is mineralocorticoids. These are used as substitutes for steroids that the body is not producing on its own. A used mineralocorticoid is fludrocortisone.

Use of oral steroids:

Oral steroids are prescribed for many conditions to reduce inflammation or weaken the immune system. Some examples include:

• Inflammatory gastrointestinal illnesses include Crohn’s disease and ulcerative colitis.
• Autoimmune diseases such as systemic lupus erythematosus (SLE) and autoimmune hepatitis.
• Relapses in many sclerosis.
• Rheumatoid arthritis and polymyalgia rheumatica are both joint and muscle disorders.
• Allergies.
• Asthma.
• Chronic obstructive pulmonary disease (COPD).
• Croup.

Oral steroids are also used to manage symptoms of certain cancers or to replace natural steroids when the body isn’t producing enough, as in Addison’s disease, congenital adrenal hyperplasia, and hypopituitarism.

Instructions for taking oral steroids

The way you take oral steroids can vary based on the specific medication and the condition being treated. For short-term use, a high dose may be prescribed daily for a few days or a week, then stopped. If the treatment is longer, the dosage is usually reduced before stopping. For long-term use, you might start with a high dose to control symptoms and then reduce it to the lowest effective dose. Treatment duration depends on the condition, and in some cases, steroids may be needed for life. Always follow the instructions given by your doctor or pharmacist, including when and how to take your medication, usually in the morning with food.

It’s important to take oral steroids exactly as your doctor directs. If you’re taking tablets, take them with a glass of water. For liquid forms, use a special measuring device to ensure the correct dose. Never stop taking steroids without consulting your doctor, as it could worsen your condition or cause withdrawal symptoms like weakness, nausea, or dizziness. Your doctor may reduce your dose to prevent these effects. Always report any new or worsening symptoms to your healthcare provider right away.

Is there a reason why I won’t be prescribed steroids?

You might not be able to take steroids if you have an infection or any wounds, as they can slow down healing or hide symptoms.

Steroids can affect certain health conditions like diabetes, heart issues, high blood pressure, or mental health problems. If you have any of these, your doctor will need to ensure that steroids won’t worsen your condition.

For those with systemic sclerosis, prednisolone might cause kidney problems at specific doses, so it may not be prescribed.

If you have an infection of the skin, steroid creams or gels may not be appropriate. Also, if you have skin conditions like rosacea, acne, or ulcers, steroid creams could make them worse.

Possible side effects of oral steroids

Short courses of oral steroids usually have no side effects. Yet, side effects become more likely if you take steroids for longer periods (over 2-3 months) or have repeated short courses. Higher doses increase the danger; so, doctors try to prescribe the lowest dose that still manages your symptoms. Certain conditions need greater doses, which might vary from person to person.

Despite potential side effects, the benefits of taking oral steroids often outweigh the risks for many conditions. Still, side effects can be troublesome. Always read the information leaflet with your medication for a complete list of possible side effects. Common side effects include:

• Bone Thinning (Osteoporosis): Long-term steroid use may need medications or supplements to strengthen bones and prevent osteoporosis.
• Weight Gain: You may notice weight gain and puffiness around the face and neck.
• Increased Risk of Infections: Steroids can suppress the immune system, making infections more likely and severe. Be cautious if you haven’t had chickenpox, shingles, or measles. Past infections like tuberculosis (TB) or herpes may also recur.
• High Blood Pressure: Steroids may raise blood pressure, so regular checks are important. It can be managed if detected.
• High Blood Sugar (Hyperglycemia): Steroids can increase blood sugar levels, leading to diabetes. Those with diabetes might need more medication. Yearly blood sugar tests may be necessary.
• Skin Issues: It is possible to have slower wound healing, thinner skin, simple bruises, and stretch marks.
• Muscle Weakness: This improves after stopping steroids, and physiotherapy might help.
• Mood and Behavioral Changes: While some feel more energetic, steroids can also worsen depression and mental health issues, sometimes causing confusion, irritability, or even delusional thoughts. These effects are more likely at higher doses and can also occur when tapering off steroids. Seek medical advice if these changes happen.
• Increased Risk of Cataracts: If you experience blurred vision or other eye issues, consult your doctor as cataracts might develop.
• Increased Risk of Stomach Ulcers: Steroids can lead to stomach or duodenal ulcers, so report any indigestion, acid reflux, or abdominal pain to your doctor. Medication may be given to lower this risk.

These are some of the main side effects, but your medication leaflet will list less common ones as well. Always weigh the benefits of steroid treatment against the potential risks.

Conclusion

In conclusion, oral steroids can be an effective treatment for a variety of conditions, helping to reduce inflammation and manage symptoms. Yet, they come with potential side effects, especially when used long-term. It’s important to follow your doctor’s instructions and be aware of any changes in your health while taking these medications. Always weigh the benefits against the risks and consult your healthcare provider with any concerns.