To coincide with an article in the September 2007 issue of Drug Safety Update about the early psychiatric side-effects associated with corticosteroids, we have prepared a series of questions and answers for patients:

Different pills

1. What are steroid medicines used for?
2. What are the different types of steroid medicines?
3. Are there any important side effects that I should look out for when taking steroids? See also question 5 for longer term side effects?
4. Why might I need to look out for infections?
5. What about longer term side effects?
6. How do I report a suspected side effect?
7. Is it safe to take other medicines when taking steroids?
8. What do I need to know about stopping steroid tablets?
9. Why have I been given a steroid ‘blue card’?
10. Where can I get more information on steroids and other medicines?


1. What are steroid medicines used for?
Most steroid medicines (sometimes called ‘corticosteroids’) are important treatments for a variety of illnesses that involve inflammation in the body. Examples include allergic conditions in the lung that cause wheezing (asthma), other serious allergic reactions, inflammation in parts of the body such as the joints (e.g. rheumatoid arthritis), the bowel (eg ‘Crohn’s disease’ and ‘ulcerative colitis’), and various other types of inflammation that affects muscles, blood vessels, skin (eg eczema) and the eyes. In addition, steroids are sometimes used to treat blood conditions (including leukaemia) and swelling of the brain.

The information below refers to steroid medicines (corticosteroids). Sex hormones (such as those included in the Oral Contraceptive Pill, and Hormone Replacement Therapy for women), are also steroids, but they are quite different from corticosteroids. If you take sex hormones for contraception, menopausal symptoms or other reasons, you can find out more about these medicines by reading the Patient Information Leaflet, or speaking to your doctor or pharmacist.


2. What are the different types of steroid medicines?

  • Steroids can be given in several different ways. Whenever possible, steroids are given directly to the part of the body that needs treating (e.g. by inhalation into the lungs for wheezing, as eye drops for eye inflammation, or as an injection directly into a joint). Some steroids are taken by mouth (eg as tablets) or are given as injections into muscles or (occasionally) veins. These medicines have beneficial effects around the body and are very important treatments for potentially serious illnesses, but they can also cause side effects in some people (see below).
  • The risk of side effects is very much lower when steroids are given directly to the part of the body that needs treating (eg by inhalation - most people have not problems at all with inhaled steroids). However, it is important to stick to the dose prescribed for you. Taking very high doses of inhaled steroids increases the risk of side effects.
  • Steroids that are put on the skin are generally much safer and cause very few problems when used correctly. Your doctor or nurse will tell you exactly where to apply the medicine and how much to use. Only use steroid creams or ointments on these areas of skin, and do not use the medicine for any longer than you have been advised.

Examples of steroid medicines are:

Tablets or injections: Dexamethasone, prednisolone, methylprednisolone, hydrocortisone
Inhalers (‘puffers’): Beclomethasone, budesonide, fluticasone, mometasone, ciclesonide
Creams and ointments for the skin: Hydrocortisone, mometasone, betamethasone, triamcinolone

Many of these medicines are also available for use in very small doses as eye or nose drops, or for treatment of mouth conditions. Some steroids can also be given by a number of other routes such as an ‘enema’ (to treat bowel conditions).

This is not a complete list of steroid medicines - check your Patient Information Leaflet (which comes with the medicine), or with your doctor, nurse or pharmacist if you are unsure if your medicine is a steroid.


3. Are there any important side effects that I should look out for when taking steroids? See also question 5 for longer term side effects
Steroids are very effective (and sometimes life-saving) medicines. The benefit of your steroid medicine is expected to be greater than the risk of unwanted effects. However, like other medicines, steroids can cause problems. Your Patient Information Leaflet lists all the possible side effects.

  • Remember: Most people don’t get serious side effects.
  • The side effects below relate mainly to steroids taken as tablets or by regular injection.

Here are some particular signs to look out for

  • Mood changes, depression, suicidal thoughts, or feeling ‘high’ (sometimes causing unusual behaviour) – these conditions affect children as well as adults, and can happen within days of starting treatment Difficulty sleeping, confusion, agitation (nervousness)
  • Skin rashes or any signs of infection - see question 4
  • Stomach/intestine problems (nausea, diarrhoea, pain, rarely ulcers or bleeding)
  • Worsening of diabetes (i.e. higher blood sugar)
  • Worsening of epilepsy (i.e. more frequent fits)
  • Headaches
  • Changes in your menstrual periods

If you feel unwell in any way, or are concerned about any of these possible side effects, keep taking your medicine but seek medical advice as soon as possible.


4. Why might I need to look out for infections?
Steroids can reduce your body’s ability to fight infections (by making your immune system less active), so you may be more likely to catch an infection, and you may be more unwell than normal if this happens. Chicken pox is a particular concern if you are taking steroid tablets: if you have not had chicken pox, avoid close contact with anyone who has chicken pox or shingles.


5. What about longer term side effects?
As with most medicines, the risk of steroid side effects increases with higher doses and with longer treatment. You will be prescribed long-term steroids (i.e. for months or years) only if your doctor thinks it’s important for your health. Here are the more important long-term side effects, which you should look out for. Not everyone gets these side effects.

  • Eye problems: poor vision due to problems with the eye lens (cataract) or increased pressure in the eye (glaucoma)
  • Muscle weakness
  • Thinning of the bones and increased risk of fractures
  • Reduced growth in children (your doctor and nurse will check carefully for this)
  • High blood pressure
  • Change in appearance, and skin changes: bruising, ‘stretch marks’, acne, sweating, weight gain, developing a rounder face (which disappears after stopping treatment).

If you feel unwell in any way, or are concerned about any of these possible side effects, keep taking your medicine but seek medical advice as soon as possible.


6. How do I report a suspected side effect?
As well as talking to your doctor, you can report suspected side effects using ‘Yellow Card forms’. These are available from pharmacies and other outlets across the NHS or from the Yellow Card hotline on freephone 0808 100 3352. Reports can also be completed on the web at www.yellowcard.gov.uk. The Government carefully checks these reports to see if new information or advice can be offered to healthcare professionals and patients.


7. Is it safe to take other medicines when taking steroids?
Some medicines should not be taken together, and sometimes doses may need to be changed if they are given together. Before taking a new medicine it is very important to tell your doctor, nurse or pharmacist about any other medicines that you are taking. Don’t forget to tell him/her about herbal remedies or any non-prescription medicines you might have bought in a pharmacy or supermarket (eg painkillers or cold remedies) because these may affect your treatment.

Your Patient Information Leaflet that comes with your medicine lists the medicines that you need to be particularly careful about when taking steroids.

If you take steroids that are taken regularly as tablets or by injection you may need to be particularly careful of the following:

Some medicines can affect how much steroid gets into your body or how quickly your body breaks down or eliminates steroids (meaning that the dose you take may need to be adjusted). These include:

  • Some antibiotics (e.g. rifampicin, erythromycin), antifungal treatments (e.g. itraconazole, ketoconazole) and antivirals including HIV treatments (e.g. ritonavir, saquinavir, indinavir)
  • Some treatments for epilepsy (e.g. carbamazepine, phenytoin, phenobarbitone, primidone)
  • Ciclosporin (a treatment used after organ transplant, and sometimes for rheumatoid arthritis or severe psoriasis)
  • Antacids for indigestion (especially if they contain magnesium trisilicate)
  • Cold remedies, treatments for a blocked nose (i.e. those that contain  the active ingredient ephedrine)
  • Some hormones (including sex hormones and the contraceptive pill)

Some medicines may increase the risk of some side effects, if given with steroids, including:

  • Aspirin and anti-inflammatory medicines (e.g. ibuprofen, diclofenac, naproxen and ‘-coxib’ medicines) are often used in combination with steroids for pain and arthritis. Stomach or intestinal problems may occur more frequently when these medicines are used together - report any symptoms (e.g. stomach pains, indigestion, vomiting or change in bowel motions) to your doctor.
  • Methotrexate (sometimes used to treat cancer and commonly to treat rheumatoid arthritis) - your doctor will arrange for blood tests to check for side effects
  • Some vaccines should be avoided (check with your doctor or nurse before you have any vaccination)

Some medicines may not work as well if taken at the same time as steroids - doses of these medicines may need to be adjusted:

  • Medicines used to treat diabetes
  • Some medicines used to treat high blood pressure, including water tablets (diuretics)
  • Medicines for myasthenia gravis (a condition that causes muscle weakness)
  • Growth hormone
  • Some muscle-relaxing treatments used during surgery (make sure your surgeon and anaesthetist knows you are taking steroids)

Some treatments may need to be carefully monitored (eg by blood tests) while you take steroids:

  • Medicines for thinning the blood (eg warfarin, phenindione)
  • Some medicines, including digoxin (for heart problems), acetazolomide (for glaucoma and epilepsy), some treatments for wheezing/breathing problems (eg salmeterol, salbutamol, terbutaline) and water tablets (diuretics) make may reduce the amount of potassium in your body, especially when taken with steroids. This may cause thirst, weakness, dizziness, confusion, or (if severe) collapse.

Check you Patient Information Leaflet for full details of any other medicines that may be important for your particular steroid, and tell your doctor, nurse or pharmacist if you use, or intend to use, any of these medicines


8. What do I need to know about stopping steroid tablets?
If you are taking steroids tablets (or high-dose inhaled steroids) for more than three weeks, your doctor will advise you to reduce the dose gradually - it is very important that you follow this advice. When steroids get into your body for more than three weeks (particularly if given regularly by mouth as tablets), your body gradually stops making its own (natural) steroids needed to keep you well. Stopping your medicine gradually (for example by taking fewer tablets over several days or weeks) gives your body time to get back to normal. If you feel unwell in any way while you are reducing your steroids you should see your doctor as soon as possible.

If you are taking steroids for a short period (ie less than three weeks) your doctor may advise you that there is no need to reduce the dose gradually.


9. Why have I been given a steroid ‘blue card’?
You may have received a steroid ‘blue card’ because you are taking steroid tablets (or high doses of inhaled steroids) for more than three weeks. Keep this card with you everywhere: it is an important reminder for you and your health advisers - always show it to doctors, nurses, dentists and pharmacists, especially if you are due to have any surgery or other procedure that involves an anaesthetic, or if you are unwell in any way.

The blue card:

  • includes information on type and dose of steroids you are taking
  • reminds you not to stop taking your steroid suddenly
  • warns about the dangers of chicken pox (for those who have not had it before)
  • advises you to see a doctor if you feel unwell
  • refers you to the Patient Information Leaflet for further information.

10. Where can I get more information on steroids and other medicines?

  • Always read the leaflet that comes with your medicine. It contains important information about safe use, what to look out for and what to do in the event of problems.
  • If you have been given a blue ‘steroid card’ read it carefully; keep it with you at all times and show it to any doctor or nurse who treats you (see question 9).
  • If you have other questions about your steroid medicine, talk to your doctor, nurse or pharmacist.
  • You can also get information from NHS Direct and NHS Direct Wales/Galw lechyd Cymru on 0845 46 47 (text phone 0845 606 4647) or NHS 24 (Scotland) on 08454 24 24 (textphone 18001 08454 24 24).


Page last modified: 21 July 2007