Steroid Side Effects: How to Reduce Corticosteroid Side Effects

How to reduce drug side effects

Any suggestion here which is not clear or which you think may not apply to you, should be discussed with the your physician. Note also that the side effects of steroids very much depend on the dose and how long they are taken. If your dose is low, your risk of serious side effect is quite small, especially if precautions, as discussed below, are taken. Reading about these side effects may make you uncomfortable about taking steroids. You should be well aware of the risks before starting these medications. However, please be reassured that many people take steroids with minor or no side effects. Please also remember that steroids are often extremely effective and can be life-saving.

Note: The term “steroids” refers to anti-inflammatory steroids (corticosteroids) such as prednisone and methylprednisolone (Medrol®) and dexamethasone (Decadron®). The information below does not refer to muscle-building or “androgenic” steroids (such as testosterone), which share some chemical similarities but function quite differently than anti-inflammatory steroids).

Understanding corticosteroid side effects

Steroids are often extremely effective in relieving the pain and other symptoms of inflammatory arthritis and other forms of rheumatic disease. In some cases, they may be life-saving.

However, like all drugs, corticosteroids can have negative side effects. The degree to which they occur is usually dose-dependent: the higher the daily dose and the longer the period of time you take the drug, the greater your risk of side effects. If your dose is low, your risk of serious side effects is quite small, especially if you take the precautions below and any others your physician recommends. Sometimes your physician will arrange for you to take steroids on alternate days, which can decrease side effects.

Reading about these side effects may make you uncomfortable about taking steroids. While you should be fully aware of the risks before starting these medications, please be reassured that many people take steroids with minor or no side effects. If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician.

With long-term use, corticosteroids can result in the following side effects. But taking care of yourself as discussed below may reduce the risks.

Increased doses needed for physical stress

Steroid use for over two weeks can decrease the ability of your body to respond to physical stress. A higher dose of steroid may be needed at times of major stress, such as surgery or very extensive dental work or serious infection. This could be needed for as long as a year after you have stopped steroids.

Self-care tips:

  • Discuss this possibility with the surgeon or dentist, etc. who is taking care of you at the time. Your physician or surgeon may not feel you need to take the extra steroid at the time of surgery, but if they know you have been on corticosteroids they can watch you more carefully after surgery

Steroid withdrawal syndrome

Rapid withdrawal of steroids may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever. These symptoms could be hard to separate from those of your underlying disease.

Self-care tips:

  • If you get symptoms like these when you taper your steroids, discuss them with the doctor. Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease, depending on how you are doing. On each visit, discuss with the physician whether it is possible to decrease your steroid dose.
  • Note that even if you are having a steroid side effect, however, steroids still must be tapered slowly.
  • When used for less than two weeks, more rapid tapering is generally possible..

Infection

Long-term steroids can suppress the protective role of your immune system and increase your risk of infection.

Self-care-tips:

  • Since steroids can decrease your immunity to infection, you should have a yearly flu shot as long as you are on steroids. If you are on steroids for a prolonged period of time, you should also discuss with your doctor the possibility of getting “Pneumovax,” a vaccination against a certain type of pneumonia as well as “Prevnar 13,” another pneumonia vaccine. Shingles vaccination (Shingrix®) may also be considered. Your physician will take your age and risk factors into account when deciding which vaccinations you need.
  • Signs of possible infection, such as high fever, productive cough, pain while passing urine, or large “boils” on the skin should have prompt medical attention. If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor.

Gastrointestinal symptoms

Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin.

Self-care tips:

  • Report to your physician any severe, persisting abdominal pain or black, tarry stools.
  • Take the steroid mediation after a full meal or with antacids, as this may help reduce irritation of the stomach. Steroids can increase your appetite.
  • Watch calories to try to prevent excessive weight gain.

Osteoporosis

Thinning of the bones, with increase in fracture risk, can be a result of steroid therapy. At the beginning or before your steroid therapy, many patients will be asked to have a bone density test, especially if the steroid dose is high. If density is low, the bone density study It will be repeated in the future to assess the effectiveness of measures you will be using to prevent bone loss. Preventative strategies are important: a person can lose 10% to 20% bone mass within the first six months of corticosteroid therapy.

Self-care tips:

  • Most people taking corticosteroids will need to take a calcium supplement. See this reference from the National Institutes of Health about how much calcium you need for your sex and age, and how to get as much as possible from diet.
  • The minimal daily requirement of vitamin D is 800 international units (UI) daily, and most people on corticosteroids should take this amount. Your physician may check your vitamin D level and see if you actually need a higher dose.
  • Smoking and alcohol increase the risk of osteoporosis, so limiting these is helpful.
  • Weightbearing exercise (walking, running, dancing, etc) is helpful in stabilizing bone mass.
  • People on corticosteroids who have low bone density may be put on medications such as alendronate (Fosamax®) or Prolia®, and there are a number of others
  • Assess risk of falls. Make a thorough examination of your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night lights.

Weight gain

Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen.

Self-care tips:

Watch your calories and exercise regularly to try to prevent excessive weight gain. But don't let weight gain damage your self-esteem. Know that the weight will come off - and your stomach return to its normal size - relatively easily in the six months to a year after you discontinue steroids.

Insomnia

Steroids may impair your ability to fall asleep, especially when they are taken in the evening.

Self-care tips:

  • If possible, the physician will try to have you take your entire daily dose in the morning. This may help you sleep better at night (evening doses sometimes make it difficult to fall asleep).

Mood changes

Steroids, especially in doses over 30 milligrams per day, can affect your mood. Some people can feel depressed, some extremely “up” without any apparent reason. Just being aware that steroids can do this sometimes makes it less of a problem. Sometimes, this side effect requires that the steroid dosage be decreased. When the steroids are absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family knows about this possible side effect.

Self-care tips:

  • Simply being aware that steroids can have an affect on your mood can sometimes make it less of a problem. But, at times, this side will require that the steroid dosage be decreased. If maintaining the same steroid dosage is absolutely necessary, sometimes another medication can be added to help with the mood problem.
  • Make sure your family and friends know about this possible side effect so they will know what's going on if you respond to them in unexpected ways. Ideally, tell your family and friends about this possible side effect as you start the medication, so that they can help you detect any changes in your behavior.

Fluid retention and elevated blood pressure

Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure.

Self-care tips:

  • Watch for swelling of your ankles, and report this to your doctor. Occasional patients benefit from diuretics (water pills). Low sodium diet helps reduce fluid accumulation and may help control blood pressure.
  • Have your blood pressure followed regularly while you are on steroids, especially if you have a history of high blood pressure. Steroids can raise blood pressure in some patients.

Elevated blood sugar

Since cortisone is involved in maintaining normal levels of glucose (sugar) in the blood, long-term use may lead to elevated blood sugar or even diabetes.

Self-care tips:

  • Your blood sugar should be followed while you are on steroids, especially if you are a diabetic, since corticosteroids can raise blood sugar.

Eye problems

Steroids can sometimes cause cataracts or glaucoma (increased pressure in the eye).

Self-care tips:

  • If you have a history of glaucoma or cataract follow up closely with the ophthalmologist while on steroids. If you develop any visual problems while on steroids, you will need to see the ophthalmologist. Temporarily blurred vision when you start corticosteroids is often not a serious problem, but ophthalmology evaluation should always be arranged if you experience other, new visual symptoms while taking steroids.

Atherosclerosis (hardening of the arteries)

It is possible that steroids may increase the rate of "hardening of the arteries," which could increase the risk of heart disease. This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose.

Self-care tips:

  • Low cholesterol diet may help. If you develop signs suggesting heart problem, such as chest pain, get medical attention quickly.

Aseptic necrosis

  • Steroids, particularly at higher doses, can sometimes lead to damage to bones, called “aseptic necrosis.”

Self-care tips:

  • Hip pain, especially if you have no hip arthritis, could be an early sign of this damage. Report this to your doctor.

Authors

Headshot of Theodore R. Fields, MD, FACP
Theodore R. Fields, MD, FACP
Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College
 

Need Help Finding a Physician?

Related Content

Departments and Services