Also called: Steroids, Glucocorticosteroids, Inhaled Corticosteroids, Corticosteroid Drugs, Oral Corticosteroids
Marc J. Sicklick, M.D., FAAAAI, FACAAI
Corticosteroids are a group of anti–inflammatory drugs similar to hormones produced by the body. They are used to treat a variety of allergic conditions, including asthma, hay fever and eczema. They work by reducing inflammation in the airways, opening the breathing tubes and allowing normal respiration.
Corticosteroids can be taken in several forms, with each of the different forms used to treat different conditions.
These forms include:
- Inhaled methods. Used long–term to preventatively treat allergies and asthma.
- Nasal sprays. Used to treat inflammation in the nose and sinuses.
- Topical creams. Used to treat inflammation of the skin (e.g., eczema, rash).
- Oral methods (e.g., pills, liquids). Used to quickly treat allergy and asthma episodes (e.g., allergic reaction, asthma attack).
- Intravenous methods. Used to quickly treat allergy and asthma episodes, and usually administered by a physician.
Most corticosteroids are available only with a physician’s prescription. However, some topical creams are available over–the–counter.
Corticosteroids can have a wide range of serious side effects – particularly when oral forms of the drugs are taken for long periods of time. Inhaled corticosteroids are more localized and do not cause as many side effects. Many types of other medications can interfere with corticosteroids, and the medication should be used only after talking with a physician.
Corticosteroids are a type of anti–inflammatory medication that is effective in the treatment and prevention of allergic reactions and asthma attacks. While there are several types of corticosteroids, all work on the same principal – reducing or preventing inflammation. Most corticosteroids used to treat allergies and asthma reduce or prevent inflammation in the respiratory tract to relieve or avoid airway blockages.
Corticosteroids are considered the most effective medication currently available for the treatment of inflammation in the bronchial tubes. This drug type can be administered through several different methods. These include:
- Inhaled methods (e.g., inhalers, nebulizers). Medication is breathed deep into the lungs where it comes into contact with the mucous membranes of the lungs.
- Nasal sprays. Medication is inhaled into the nose and sinuses where it comes into contact with the walls of the sinuses. With this form of treatment the medication does not reach the lungs.
- Topical creams. Medication is applied directly to the skin to treat that skin area.
- Oral methods (e.g., pills, liquids). Medication is swallowed and absorbed into the bloodstream where it spreads throughout the body.
- Intravenous methods. Medication is injected under the skin through a needle and syringe. It enters the bloodstream and spreads throughout the body.
Inhaled corticosteroids are usually prescribed for the prevention of asthma or allergy symptoms. While most types of this medication have many side effects associated with them, inhaled and nasal spray corticosteroids usually affect only the inside of the lungs and sinuses, with very little of the medication penetrating into the bloodstream. This targeted delivery method is able to prevent many of the side effects experienced with more systemic forms of corticosteroids.
Oral and injectable forms of corticosteroids must travel throughout the entire body to reach problem areas. This allows the drug to come into contact with multiple organs and tissues in the body, making side effects more pronounced. As a result, this form of corticosteroid is most suitable as a short–term or occasional therapy. However, some conditions (e.g., lung disease, severe chronic asthma) may warrant long–term corticosteroid use.
Corticosteroids work by mimicking the hormone cortisol, which the adrenal gland naturally produces to protect against illness. It is unclear how exactly corticosteroids are able to so effectively reduce inflammation, but studies have shown that the medications lower the amount of chemicals released by some inflammatory cells. This leads to decreased swelling in inflamed areas.
When used to treat allergies and asthma, corticosteroids decrease inflammation in the airways and reduce mucus production. This opens the airways, permitting more airflow and treating or preventing symptoms such as shortness of breath and difficulty breathing. Corticosteroids also keep the cells from responding to additional stimuli that may cause further inflammation. This reduction in hyperreactivity (excessive sensitivity) makes the medication useful as a preventative treatment.
Individuals should never stop taking a corticosteroid treatment abruptly as serious side effects can result. However, some physicians have recently begun to recommend corticosteroid treatments taken as–needed for the treatment of mild asthma. A physician can provide a schedule for safely discontinuing the use of corticosteroids.
Types and differences of corticosteroids
The different forms of corticosteroids are useful at treating different allergy and asthma conditions:
- Inhaled forms of corticosteroid are considered by physicians to be the best form of treatment for long–term control of persistent asthma and allergy symptoms. They are taken regularly whether symptoms are present or not to prevent attacks. These may need to be taken for weeks or months before symptoms are completely under control.
- Corticosteroids by mouth and injection are used to quickly get control over allergy and asthma episodes (e.g., allergic reaction, asthma attack). It is often recommended when high doses of inhaled corticosteroids fail to control symptoms. This type of treatment is usually not suitable for long–term use due to the increased risk of side effects.
- Nasal and topical corticosteroids are used short–term to relieve minor allergy symptoms. Nasal sprays are useful for treating sinus inflammation, while topical creams can effectively treat rashes on the skin.
- Some oral corticosteroids are designed to be used for several days to control the recurrence of allergy or asthma episodes. They are discontinued once the individual has recovered or has begun taking another type of regular treatment (e.g., inhaled corticosteroids)
|Generic Name||Brand Name(s)|
|beclomethasone||Beclovent, Qvar, Vanceril|
|budesonide||Pulmicort Respules, Pulmicort Turbohaler|
|dexamethasone||Aeroseb–Dex, Decaderm, Decadron, Decaspray|
|hydrocortisone||Acticort, Aeroseb–HC, Ala–Cort, Ala–Scalp HP, Allercort, Alphaderm, Bactine, Beta–HC, Cetacort, Cort–Dome, Cortifair, Cortril, Delacort, Dermacort, Dermarest DriCort, DermiCort, Dermtex HC, Gly–Cort, Hi–Cor 1.0, Hydro–Tex, Hytone, LactiCare–HC, Lemoderm, MS Cortaid, MyCort, Nutracort, Penecort, Pentacort, Rederm, S–T Cort, Synacort, Texacort|
|prednisone||Deltasone, Liquid Pred, Meticorten, Orasone, Prednicen–M, Sterapred, Sterapred DS|
|prednisolone||Orapred, Pediapred, Prelone|
Conditions treated with corticosteroids
Corticosteroid drugs are prescribed for a variety of conditions, including:
- Allergies (e.g., hay fever, allergic sinusitis). Exaggerated or inappropriate reaction of the immune system to any substance that, in most people, causes no symptoms. Applying corticosteroids directly to the mucous membranes (using inhalers or nasal sprays) can reduce or prevent inflammation due to contact with an allergen.
- Asthma. Condition in which the airways become blocked or narrowed, causing shortness of breath and difficulty breathing. Corticosteroids are used to reduce or prevent inflammation and narrowing in the bronchial tubes.
- Chronic obstructive pulmonary disease (COPD). A chronic, progressive disease of the lungs that reduces airflow over time, causing coughing, wheezing and shortness of breath. Corticosteroids may be recommended in patients who are not benefitting from other therapy.
- Atopic dermatitis. Skin condition usually characterized by itching and a red, raised rash. Topical corticosteroid creams are used to treat the rashes experienced with this condition.
- Contact dermatitis. Any inflammation that occurs on the skin’s surface after coming in contact with an allergen or irritant. Topical corticosteroids may be prescribed to treat inflammation in a confined area.
- Urticaria (hives). Smooth, raised, red, pink or white bumps of varying sizes that can appear suddenly anywhere on the body and can cause discomfort and itching. Corticosteroids may be recommended when antihistamines fail to relieve symptoms. They relieve inflammation and swelling and lessen the chance of the rash recurring.
- Angioedema. A condition in which the skin swells and welts form on the skin, usually near the eyes, mouth, hands, feet and genitals. Corticosteroids may be prescribed to lessen swelling, redness and itching in moderate to severe cases of angioedema.
- Lupus. An autoimmune, inflammatory disease. Corticosteroids are able to treat inflammation and control many of this condition’s moderate to severe symptoms.
- Cystic fibrosis. Genetic disease characterized by respiratory problems due to poor salt absorption. Corticosteroids are used to treat the inflamed tissues in the respiratory tract often associated with cystic fibrosis.
- Irritated bowel conditions (e.g., ulcerative colitis, Crohn’s disease). Conditions often characterized by an inflamed or irritated intestine. Corticosteroids treat these conditions by reducing inflammation in the intestines.
- Multiple sclerosis (MS). Chronic neurological disease of the central nervous system. Corticosteroids reduce MS attacks by reducing spinal cord and brain inflammation.
- Cancer pain. Some types of cancerous growths cause swelling and pain. Corticosteroids are able to relieve swelling and reduce the amount of pain associated with this condition.
- Rheumatoid arthritis. Condition characterized by pain and swelling in the joints. Corticosteroids reduce painful joint inflammation associated with this condition.
- Carpal tunnel syndrome. Condition caused by an inflammation in the wrist that puts pressure on a nerve, causing pain. Corticosteroids are capable of providing pain relief by reducing inflammation and pressure in the wrist.
- Nephrotic syndrome. Kidney disorder characterized by low levels of protein in the blood. Corticosteroids help restore normal function to the kidneys by reducing inflammation.
Conditions of concern with corticosteroids
Patients should not take corticosteroid drugs if they have been diagnosed with any of the following conditions:
- Diabetes mellitus (sugar diabetes). A disease in which the body cannot adequately process glucose (blood sugar) for energy. Some types of corticosteroids affect blood glucose control.
- Cirrhosis. Disease of the liver. Inhaled corticosteroids may have a stronger effect on individuals with this condition.
- Liver disease. Corticosteroids may not be eliminated from the body at the usual rate when used with this condition.
- Glaucoma. A group of eye diseases that affect the optic nerve, which connects the eye to the brain. It typically involves gradually increased pressure inside the eye. Corticosteroids can cause the pressure in the eye to further increase.
- Hypothyroidism. Decreased production of thyroid hormone. Inhaled corticosteroids may have a stronger effect in individuals with this condition.
- Myasthenia gravis. A chronic autoimmune neuromuscular disease. Muscle weakness caused by this condition could be exacerbated by corticosteroids.
- Infections. When left untreated, corticosteroids can cause infections to worsen. Patients taking corticosteroids should contact their physician if fever or any other signs or symptoms of infection develop.
- Osteoporosis. A disorder in which the bones lose mass and density. High doses of inhaled corticosteroids can cause this condition to worsen in women who are past menopause and not receiving estrogen treatments.
- Chickenpox or measles. Contagious skin diseases that can spread to other parts of the body. Using corticosteroids can cause unusually severe infections in those exposed to these diseases. It can also lead to a fatal course. As a result, patients should inform their physician immediately if they suspect an infection with these diseases while on corticosteroids of any kind.
- Tuberculosis. Infectious bacterial disease. Corticosteroid use can cause infections to return in individuals with a history of tuberculosis.
- Strongyloides. Worm infestation. Corticosteroids can cause the condition to heal slower or worsen the existing infection.
- Amebiasis. Infection from an amoeba (one–celled organism). Some types of nasal corticosteroids worsen this condition.
- Psychosis. A mental condition that causes people to lose touch with reality. This disorder can be made worse by using corticosteroids.
- Weak heart (weakened heart muscle) or heart disease. Some types of corticosteroids can worsen these conditions.
- Kidney disease or kidney stones. Treatment of these conditions (particularly dialysis) can be disrupted by the excess water retention common when using corticosteroids.
- High blood pressure. Corticosteroids can exacerbate this condition by causing the body to retain extra water.
- AIDS (Acquired Immunodeficiency Syndrome). Viral disease that weakens the immune system. Corticosteroids can interfere with the treatment of this condition.
- Stomach ulcer, ulcerative colitis or intestinal problem. Corticosteroids can mask the symptoms of a serious stomach or intestinal condition.
- High cholesterol. Corticosteroids can increase blood cholesterol levels.
Potential side effects of corticosteroids
Common side effects of corticosteroids include:
- Inhaled corticosteroids:
- Sore mouth or throat, hoarseness
- Thrush (fungus infection in the mouth)
- Decrease in bone thickness
- High blood pressure in the eye or fluid buildup in the eye
- Nasal spray corticosteroids:
- Increased chance of bruising
- Skin or muscle wasting
- Weight gain or fluid retention
- Decrease in bone density
- Damage to bones and bone cells (avascular osteonecrosis)
- Increased blood pressure
- Increased risk of ulcer
- Increased risk of eye complications (e.g., glaucoma, cataracts)
- Topical corticosteroids:
- Skin blisters filled with blood
- Itching or burning skin
- Increased skin sensitivity
- Numbness in the fingers
- Increased chance of bruising
- Raised red spots on the skin
- Oral and intravenous:
- “Puffy” face
- Blurred vision
- Frequent urination
- Increased thirst
- Increased appetite and weight gain
- Stomach irritation
- Flushing of face or cheeks
Some side effects of corticosteroid drugs are considered more dangerous, though rare. An individual should immediately contact a physician if they experience any of the following side effects:
- Unusual confusion or excitement
- Mental depression
- Eye pain
- Irregular heartbeat
- Bloody stool
- Unusual increase in hair growth
- Delayed growth (in children)
Use of corticosteroids can also lower a person’s resistance to infection. Corticosteroids can also cause existing infections to worsen. Therefore, patients taking corticosteroids should contact their physician if fever or any other signs or symptoms of infection develop.
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:
- Antacids (counteracts stomach acidity). Can decrease the effectiveness of some corticosteroids.
- Anticonvulsants (used to treat seizures). 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.
- Ephedrine (used as a bronchodilator). May decrease the effectiveness of nasal corticosteroids.
- Ritodrine (used to stop premature labor). Could cause serious side effects when taken with corticosteroids.
- Rifampin (antibacterial drug used to treat tuberculosis). May decrease the effectiveness of nasal corticosteroids.
- Barbiturates (group of drugs used as sedatives). 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.
- Ketoconazole (used to treat fungal infections). Can increase the risk for side effects from corticosteroids.
- Antidiabetic agents or insulin (used to treat diabetes). Can increase glucose (blood sugar) 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.
- Synthetic growth hormones. Corticosteroids can interfere with the effectiveness of these medications.
- Antibiotics (used to treat bacterial infections). Some antibiotics can increase the amount of corticosteroid removed from the body.
In addition, licorice (candy made from the licorice plant’s root) can increase the effects of corticosteroid medications.
Symptoms of corticosteroid overdose
Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients exhibiting any of these symptoms should contact their physicians immediately:
- 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
Studies have show that daily use of almost all types of inhaled corticosteroid drugs while pregnant (at normal dosage) do not cause birth defects or other problems. However, 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.
Nasal corticosteroids are generally considered to be safer than intravenous or oral corticosteroids. Using a nasal corticosteroid in place of an oral or intravenous corticosteroid during pregnancy is often recommended by a physician, when possible.
Most physicians agree that the rewards of using corticosteroids on some types of conditions (e.g., asthma) often outweigh the risks. However, pregnant women should always discuss the use of corticosteroids with their physicians before using the medication.
Breastfeeding women should exercise caution when nursing. While 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 have a range of side effects that tend to be more pronounced in children than in adults. 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 medications interference with the function of the adrenal gland. Because of the side effects, some physicians have begun to recommend that children with mild asthma use corticosteroids on an as–needed basis.
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.
Corticosteroid treatments may be less effective for young infants less than 1 year old.
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 (a disorder in which the bones lose mass and density) when taking corticosteroid drugs. Women, in particular, are at risk for this condition. However, recent research has suggested that the risk of non vertebral fracture in older adults is not higher in the short term when inhaled corticosteroid treatments are used.
Depending on the patient’s individual situation, older adults may be advised to undergo bone density screening, a test that can help detect osteoporosis. Patients at risk may also benefit from taking calcium supplements, undergoing hormone replacement therapy and exercising regularly.
Patients over the age of 50 also risk the development of cataracts (clouding of the lens of the eye) and glaucoma (a group of diseases that can damage the optic nerve, resulting in vision loss). For this reason, older adults taking high doses of corticosteroids may be advised to undergo eye examinations.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians. Patients may wish to ask their doctor the following questions related to corticosteroids:
- Are corticosteroids safe for me to take?
- How and when should I take this drug?
- What should I do if I miss a dose?
- How long will it take for the drug to take effect?
- How will I know if the drug is working?
- How long will I have to take this drug? Is it safe for me to stop taking the drug on my own if I am feeling well?
- What side effects may I develop?
- For what side effects should I seek medical attention?
- Is it safe for me to stop taking the drug if unpleasant side effects develop or should I contact you first?
- Are there medications, nutritional supplements or herbal medications I should avoid while taking this drug?
- What are other possible treatments if the drug does not work?