Prednisone and other corticosteroids

Corticosteroid medicines include cortisone, hydrocortisone and prednisone, among others. They help treat rashes, inflammatory bowel disease, asthma and several other conditions. But corticosteroids also may have serious side effects.

Corticosteroids help lessen swelling and irritation, called inflammation. The medicine can ease symptoms of inflammatory conditions, such as arthritis, asthma and skin rashes.

Corticosteroids also lower immune system response. This can help manage conditions in which the immune system becomes too active and attacks the body's own tissues by mistake. These are called autoimmune conditions.

Corticosteroid medicines treat rheumatoid arthritis, inflammatory bowel disease, asthma, allergies and many other conditions. They also help prevent organ rejection in people who have a donor organ. They do that by lowering immune system response.

Corticosteroids also treat Addison's disease. This is a rare condition that happens when the adrenal glands don't make enough natural corticosteroid.

You can take corticosteroids in several ways, depending on the condition being treated:

• By mouth. Tablets, capsules or syrups help treat swelling and irritation, called inflammation, and pain linked with certain long-term conditions. These include autoimmune conditions such as rheumatoid arthritis and lupus.
• By inhaler and intranasal spray. Breathing in corticosteroids or putting them into the nose helps manage swelling and irritation linked with asthma and nasal allergies.
• As eye drops. This form treats conditions linked to eye swelling and irritation, such as uveitis.
• On the skin, called topical. Creams and ointments can help heal many skin conditions.
• By shot, also called injection. This form often treats muscle and joint symptoms, such as the pain and inflammation of tendinitis or arthritis.
• Through a vein, called intravenous. This mainly is for people in a hospital who need fast treatment of swelling and irritation. For instance, someone with lupus whose kidneys are failing may get corticosteroids through a vein.

Corticosteroids carry a risk of side effects. Some side effects can cause serious health concerns.

Corticosteroids that you take by mouth affect your whole body. For this reason, they are the most likely type of corticosteroid to cause side effects. Side effects depend on the dose you take. They may include:

• A buildup of fluid, causing swelling in the lower legs.
• High blood pressure.
• Mood swings, issues with memory and how you act, and other effects, such as not thinking clearly.
• Trouble sleeping, called insomnia.
• Upset stomach.
• Weight gain in the belly, face and back of the neck.

When taking corticosteroids by mouth for a longer time, you may have:

• Issues with the eyes, such as glaucoma or cataracts.
• A round face, sometimes called moon face.
• High blood sugar, which can start diabetes or make it worse.
• Higher risk of infections.
• Thinning of the bones, called osteoporosis.
• Tiredness, not wanting to eat and muscle weakness.
• Thin skin, bruising, acne and slower wound healing.

When using a corticosteroid that you breathe in, some of the medicine may stay in your mouth and throat instead of making it to your lungs. This can cause:

• Fungal infection in the mouth, known as oral thrush.
• Hoarse voice.

You may be able to prevent mouth and throat irritation if you gargle and rinse your mouth with water after each puff on your corticosteroid inhaler. Be sure not to swallow the rinse water. Some researchers think that inhaled corticosteroid medicines for asthma may slow growth in children.

Topical corticosteroids can lead to thin skin, easy bruising and acne.

Corticosteroid shots can cause short-term side effects near the site of the shot. These effects may include skin thinning or loss of color in the skin. Rarely, shots into joints may make joint pain and swelling worse for a few days. This pain is known as postinjection flare.

Other symptoms may include facial flushing, not being able to sleep and high blood sugar. Healthcare professionals most often limit corticosteroid injections to 3 to 4 a year.

Intravenous corticosteroids can cause side effects during and shortly after treatment. Short-term effects may include:

• Blood pressure changes.
• Heart rate changes.
• High blood sugar.
• Skin flushing.
• Trouble sleeping.
• Mood swings.

When taking corticosteroids through a vein for a longer time, you may have some of the same side effects of taking corticosteroids by mouth for a longer time.

To get the most out of corticosteroid medicines with the least amount of risk:

• Ask your healthcare professional about trying lower doses or taking the medicine every other day, called intermittent dosing. Newer forms of corticosteroids vary in how strong they are and how long they last. Ask about using low-dose, short-term medicines or taking corticosteroids by mouth every other day instead of daily.
• Ask your healthcare professional whether you should take calcium and vitamin D supplements. Long-term corticosteroid therapy may cause thinning bones, called osteoporosis. Ask about taking calcium and vitamin D supplements to help protect your bones.
• Take care when stopping corticosteroids. If you take corticosteroids by mouth for a long time, your adrenal glands may make less of their steroid hormones. To give your adrenal glands time to start making more steroid hormones, your healthcare professional may lower your dose little by little. If you lower too quickly, you may feel tired, lightheaded and achy.
• Wear a medical alert bracelet. Wear this if you've been using corticosteroids for a long time.
• See your healthcare professional regularly. If you're taking long-term corticosteroid therapy, your healthcare professional can watch for side effects.

Corticosteroids may cause a range of side effects. But they also may relieve the swelling and irritation, called inflammation, and pain of many conditions. Talk with your healthcare professional to help you know what to expect if you take corticosteroids.