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Corticosteroids: Side Effects and Solutions

Recognize and manage the common side effects of corticosteroids.

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If you have inflammation, there is no quicker or more efficient way to control it than with corticosteroids (also called glucocorticoids). But while these powerful anti-inflammatory drugs can be lifesavers, they can also cause some pretty nasty side effects. To reduce the risk of corticosteroids’ side effects, doctors often recommend taking the lowest dose for the shortest period of time. But in some cases, doctors may recommend that you stay on long-term, low-dose treatment.

Most side effects are related to the amount of medicine you take. Some side effects occur in almost anyone who takes corticosteroids, whereas others are less common.

If you need to take steroids for more than a week or two, don’t stop taking them abruptly. Withdrawal symptoms can be severe, so you must take them – and stop taking them –  safely. Your doctor will give you instructions for tapering off of the drug.

The following recommendations will help minimize the risk of some of corticosteroids’ most troublesome side effects:

Weight Gain

Steroids affect your metabolism and the way your body stores fat. At first, much of your weight gain will be due to water retention. But over time, your body fat may increase as well. Corticosteroids tend to increase your appetite, prompting you to eat more than you need. You may notice fat accumulation in your face, on the back of your neck, and around your abdomen.

Solution: Watch your calories and exercise regularly to prevent excessive weight gain. Particularly watch your salt intake, which can increase fluid build-up. If you do gain weight, it won’t likely linger forever. Most people start to lose it relatively easily once they taper off the steroids.

Mood Swings

Corticosteroids make some people feel positive and uplifted but others feel sad, anxious, nervous, or depressed.

Solution: Generally, positive or negative effects on your mood will subside after the first few weeks of treatment. Nervousness and accompanying sleep difficulties can be alleviated by taking your medicine early in the day. Classic stress-relievers like exercise, yoga or meditation may help stabilize your mood while your body adjusts to the medicine. But be sure to call your doctor if you notice drastic mood or behavior changes.

Susceptibility to Infection

Corticosteroids suppress the body’s autoimmune response, alleviating inflammation. However, they can also suppress your response to infection, allowing even minor infections to become serious.

Solution: Be sure to get an annual flu shot and ask your doctor about the pneumonia vaccine. Don’t get live vaccines – including the measles, mumps, rubella (MMR) and chickenpox vaccines – which can cause you to become sick. Prevent infection by washing your hands frequently, avoiding crowds and avoiding people you know are sick. If you notice any signs of infection – a dry cough, fever or painful urination, for example – call your doctor immediately.

Thinning Skin

Corticosteroids inhibit the production of collagen, a chief component of skin. This results in thinning and weakening of the skin. This may show up as stretch marks, easy bruising and the appearance of small blood vessels beneath the skin.

Solution: There is little, if anything, you can do to stop your skin from thinning while applying topical corticosteroids or taking them orally. But there are a number of products – including collagen hydrolysate or vitamin E creams – you can use to reduce the appearance of stretch marks. Cosmetics can camouflage tiny blood vessels or bruises on the face.

Cataracts and Glaucoma

Using corticosteroids can worsen or increase your risk of two eye problems: cataracts (the clouding of the eye’s lens) and glaucoma (the buildup of pressure in the eye).

Solution: To reduce your risk of cataracts, avoid other causes such as direct sunlight and cigarette smoking. Although cataracts cannot be reversed, regular eye exams will alert your doctor to a possible problem. Your doctor may need to change your medication or lower the dose. Regular eye exams are also important to check for glaucoma, which can be treated and often reversed if detected early. 

Bone Loss

One of the most common and potentially destructive side effects of corticosteroid use is osteoporosis. Thinning of the bones can lead to painful and debilitating fractures.

Solutions: While taking corticosteroids it’s more important than ever to stop smoking and take in enough calcium (1500 mg daily) and vitamin D (800 mg daily). It’s also important to get regular weight-bearing exercise, such as walking, dancing or weight lifting. If you are going to be on corticosteroids more than 3 months, consider getting bone density scans and taking an osteoporosis medication called a bisphosphonate.

Blood Sugar Changes

Corticosteroids are also called "glucocorticoids" because of their effects on glucose metabolism. Increases in blood glucose levels are common among people taking steroids. Some people may even develop steroid-induced diabetes.

Solutions: People with diabetes will have to be extra-diligent and work with their doctors closely to monitor blood sugar levels and make medication adjustments. Blood sugar spikes usually resolve when the steroids are decreased or discontinued.

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