Mark Oren, M.D., FACP
Corticosteroids are a type of anti-inflammatory medication used to treat many medical conditions, including cancer. These drugs are synthetic versions of the natural steroid cortisol. In cancer patients, they can be used as a form of chemotherapy to help kill cancer cells. They also may have additional benefits, such as improving appetite, relieving pain and reducing swelling associated with cancers.
Corticosteroids are used to treat a number of cancers, including:
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Multiple myeloma
- Brain tumors
There are many potential side effects associated with the use of corticosteroids during cancer treatment, including muscle and bone weakness, bloating and fluid retention. Patients should closely monitor such side effects and report them to their physician if they become especially severe. In most cases, side effects disappear after corticosteroid treatment is ended.
Corticosteroids are medications chemically related to the natural hormones produced by the body’s adrenal glands (located at the top of each kidney). They are synthetic versions of the natural steroid cortisol and should not be confused with the anabolic steroids sometimes abused by bodybuilders and athletes. These hormone-like drugs mimic cortisol’s role of protecting the body against illness and are used to treat many disorders, including cancers such as:
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Multiple myeloma
Corticosteroids are considered chemotherapy drugs when they are used to kill cancer cells or to arrest their growth. They also have additional benefits for cancer patients. For example, corticosteroids are sometimes prescribed to help reduce swelling around a cancer that pressures the nerves and causes pain. The corticosteroid dexamethasone is sometimes prescribed to reduce swelling around cancer deposits in the brain. This can help prevent headaches caused by brain tumors.
Corticosteroids also have a role in hormone therapy. For example, they have been used to hinder the adrenal glands’ production of androgens (male hormones) in certain treatments for prostate cancer.
Other potential benefits of corticosteroids in cancer patients include:
- Reducing nausea for patients treated with chemotherapy and radiation therapy
- Easing pain from bone cancer, spinal tumors, liver cancer and other conditions
- Stimulating appetite for patients with suppressed desire to eat
- Reducing potential for some allergic reactions before platelet transfusions
- Improving patients’ mood
Corticosteroids come with a number of potential side effects that must be closely monitored by patients and reported to their physicians. The National Cancer Institute (NCI) warns against long-term use of corticosteroids to avoid complications.
Corticosteroids used to treat cancer are taken orally as pills or as injections. Corticosteroids most often used for this purpose include dexamethasone, prednisolone, hydrocortisone and methylprednisolone. Corticosteroid pills or creams may be used when cancer patients experience radiation recall. This skin reaction may appear at the site of radiation treatment when certain chemotherapy drugs are used or when unprotected sun exposure takes place.
Corticosteroids are also used to treat various noncancerous conditions that may cause inflammation, such as arthritis and allergies.
Potential side effects of corticosteroids
Although short-term use of corticosteroids offers benefits for cancer patients, long-term use involves many possible complications and should be avoided, according to the National Cancer Institute (NCI). When used for long periods of time, corticosteroids can cause:
- Suppression of the immune system.
- Osteoporosis. A decrease in bone calcium that increases the risk of fractures.
- Hyperglycemia (high blood sugar) or diabetes.
- Necrosis (death) of bone tissue.
- Anxiety, mood changes or psychosis.
Corticosteroids can cause a number of temporary side effects. These include:
- Fluid retention.
- Increased facial hair.
- Increased urination.
- Appetite stimulation that can cause rapid weight gain.
- Bone and muscle weakness.
- Fat in the cheeks, abdomen and back of the neck.
Patients should call their physician if they experiencing any of the following potentially more serious symptoms:
- Emotional mood swings that disturb the patient or others
- Sleeping difficulties
- Shortness of breath
- Chronic thirst that may indicate dehydration or blood sugar problems
- Increased acid indigestion in stomach with ulcers
- Black, tarry stools or blood in stool
- Abnormal vaginal bleeding (between periods, or in postmenopausal women)
Patients who adhere to the following guidelines may reduce the incidence of some side effects:
- Limit salt intake by substituting spices and avoiding processed foods with high salt content.
- Maintain appropriate levels of calorie intake to help prevent excessive weight gain.
- Take drugs as directed.
- Do not stop taking medications unless under a physician’s supervision.
Drug or other interactions with corticosteroids
Patients should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Of particular concern to individuals taking corticosteroid drugs are:
- Anticonvulsants (used to treat seizures), such as carbamazepine, primidone and phenytoin. Can decrease the effectiveness of some corticosteroids.
- Diuretics (water pills). Can cause the diuretic to be less effective and may increase the loss of potassium.
- Heart medications. Can increase the risk of having an irregular heartbeat or other problems by decreasing the amount of potassium in the blood.
- Phenylbutazone (used to treat fever, pain and inflammation). Can reduce the effectiveness of corticosteroids.
- Cyclosporine (used to prevent transplanted organ rejection). Can cause seizures when taken with some corticosteroids.
- Aminoglutethimide (used to treat some kinds of tumors). Can reduce the effectiveness of corticosteroids.
- Griseofulvin (used to treat skin infections). Can reduce the effectiveness of corticosteroids.
- Ritodrine (used to stop premature labor). Could cause serious side effects when taken with corticosteroids.
- Barbiturates (group of drugs used as sedatives), including phenobarbital. Can decrease the effectiveness of some corticosteroids.
- Mitotane (used to treat cancers that affect the adrenal cortex). Can decrease the effectiveness of some corticosteroids.
- Amphotericin B by injection (used to treat fungal infections). Can decrease the amount of potassium in the blood.
- Antidiabetic agents or insulin (used to treat diabetes). Can increase blood glucose levels when taken with corticosteroids.
- Medicines containing potassium (used to treat high blood pressure). Can interfere with potassium levels in the blood.
- Medicines containing sodium. Can cause the body to retain excess sodium and water, which can cause high blood sodium, high blood pressure and excess body water.
- Licorice (candy made from the licorice plant’s root). Can increase the effects of corticosteroid medications.
A recent Canadian study noted potential drug interactions among cancer patients using corticosteroids. The interactions were cited between corticosteroids and aspirin and corticosteroids and warfarin, a common anticoagulant medication.
Symptoms of corticosteroid overdose
Symptoms of overdose can be similar to the side effects found with normal doses but are usually more severe. Patients exhibiting severe or extended symptoms should contact their physicians immediately. The side effects associated with corticosteroids include:
- Blurred vision
- Bone fractures
- Fullness in the face, neck or trunk
- High blood pressure
- Increased urination or thirst
- White patches in throat
- Impotence (males)
- Excessive hair growth (females)
- Menstrual changes
Pregnancy use issues with corticosteroids
Physicians agree that the rewards of using corticosteroids for some types of conditions often outweigh the risks. However, pregnant women should always discuss the use of corticosteroids with their physicians before using the medication.
Animal studies have demonstrated that oral and intravenous use of corticosteroids during pregnancy can cause birth defects. Using a higher dosage of corticosteroids has also been shown to cause unwanted effects during a pregnancy, including slower infant growth and adrenal gland problems. These problems were more likely to occur if the higher dosage was taken in the first trimester.
Women should exercise caution when breastfeeding. Though most types of corticosteroids do pass into breast milk, they are generally present at such low levels that it does not affect the infant. However, the corticosteroid dexamethasone has been linked to slow growth in nursing infants when used by the mother. Breastfeeding mothers should consult their physicians before taking corticosteroids.
Child use issues with corticosteroids
Corticosteroids are commonly used to treat cancer in children. Their range of side effects tends to be more pronounced in children than in adults. In addition, a child may not understand the cause of the side effects, such as increased appetite and thirst. Children may gain weight or retain fluids as a result. The side effects tend to lessen when the medication is discontinued, to the point that a loss of appetite may occur. A child should never take any type of corticosteroid treatment without first seeing a physician.
Children who are using corticosteroid drugs and contract certain infections (e.g., measles, chickenpox) may experience more severe infections. To avoid this, a physician may recommend vaccinations for some types of infection or suggest an alternative treatment, if appropriate.
Children and teenagers who take corticosteroids can experience slowed growth, particularly if the medication has been taken for a long period of time. This is due to the medication’s interference with the function of the adrenal gland.
An injection of corticosteroids is often given to young children who have a hard time swallowing the foul-tasting liquid form of the medication. Some children vomit after taking the liquid form. The effectiveness of a corticosteroid injection is comparable to the liquid form.
Elderly use issues with corticosteroids
Some older individuals will experience side effects that are more pronounced. Older adults have an increased risk of developing high blood pressure or osteoporosis (bone disease) when taking corticosteroid drugs. Women, in particular, are at risk for this condition.
Questions for your doctor about corticosteroids
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to corticosteroids:
- How can corticosteroids help my condition?
- Which corticosteroid is best for me?
- In what form will I receive the medication?
- Will I be taking corticosteroids along with other cancer treatments?
- How long will I be on this medication?
- What side effects can I expect from the drug I am prescribed?
- What are the long-term consequences with the corticosteroid I am using?
- What medications can I take if I am having side effects from this drug?
- Will you try different types of corticosteroids for my condition?
- What are my restrictions with breastfeeding while I am on corticosteroids?