Steroid Medications: What Every Patient Should Know Before Starting

What steroid medications do

Glucocorticoid medications, often called steroids in clinical practice, are synthetic versions of cortisol. They suppress inflammation throughout the body and modulate the immune system. They are extraordinarily effective for a wide range of inflammatory and immune mediated conditions, which is why they are used so widely.

Common oral steroids include prednisone, methylprednisolone (Medrol), and dexamethasone. Inhaled, topical, intranasal, and injected forms also exist and have somewhat different side effect profiles.

Common uses

• Severe allergic reactions and poison ivy.
• Asthma exacerbations and COPD flares.
• Many inflammatory conditions including rheumatoid arthritis, lupus, and inflammatory bowel disease.
• Some skin conditions including severe eczema and psoriasis flares.
• Some cancer treatment regimens.
• Adrenal insufficiency, in which case the steroid replaces what the body is not producing.
• Certain neurological conditions including some types of migraine and certain emergencies.

The short course vs long term distinction

Short courses (typically less than 2 weeks) carry meaningfully different risks than long term use. A 5 day course of prednisone for poison ivy is generally well tolerated and rarely causes lasting issues. Long term use carries cumulative effects that affect many body systems.

Common side effects

Short term effects

• Increased blood sugar. Particularly important for diabetic patients to monitor.
• Increased blood pressure.
• Difficulty sleeping. Often improved by taking the dose early in the day.
• Mood changes. Irritability, anxiety, sometimes mood elevation that can be uncomfortable.
• Increased appetite.
• Fluid retention.
• GI upset.
• Increased risk of infection.

Long term effects

• Bone loss and increased fracture risk.
• Weight gain and central fat distribution.
• Skin thinning and easy bruising.
• Increased risk of cataracts and glaucoma.
• Suppression of the adrenal glands, meaning the body’s own cortisol production decreases.
• Muscle weakness.
• Increased risk of infections.
• Worsening of diabetes or new onset diabetes.

Diabetes management during steroid courses

Steroids significantly raise blood sugar. Diabetic patients on prednisone often need temporary changes to their diabetes regimen. Blood sugar should be checked more frequently during a steroid course. Insulin doses may need to be increased. Oral diabetes medications may need to be intensified. As the steroid is tapered, the diabetes regimen needs to come back down to avoid hypoglycemia.

If you are diabetic and starting a steroid, this is a conversation worth having with both your prescriber and your pharmacist before the first dose.

Vaccines and infections during steroid treatment

Steroids suppress the immune system. Several considerations follow.

• Live vaccines (MMR, varicella, yellow fever, oral typhoid) should generally be avoided during steroid therapy and for some weeks after.
• Inactivated vaccines (flu, pneumococcal, Tdap) are generally appropriate but may produce a somewhat reduced immune response.
• Infections should be reported promptly because they can progress more rapidly during steroid therapy.
• Patients on chronic steroids may need additional prophylactic medications, including for opportunistic infections in some cases.

Bone protection on long term steroids

Patients on steroids for more than 3 months should have bone density assessed and may need to start a bone protective medication, including a bisphosphonate or other osteoporosis treatment. Calcium and vitamin D supplementation is generally recommended.

Drug interactions to know

• NSAIDs combined with steroids significantly increase GI bleeding risk.
• Anticoagulants may need closer monitoring during steroid therapy.
• Several anti seizure medications affect steroid metabolism.
• Rifampin reduces steroid effectiveness.
• Steroids can reduce the effectiveness of some vaccines and immunizations.

Where pharmacy fits

Free pharmacist counseling for every new steroid prescription. We walk through the taper schedule, the side effects to watch for, and any adjustments needed to your other medications. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You are starting a steroid for the first time, especially if for more than a short course.
• You are diabetic and have been prescribed prednisone.
• You take other medications and want to confirm there are no interactions.
• You are unsure about your taper schedule.
• You are experiencing significant side effects.
• You have a planned vaccine during steroid therapy.
• You are pregnant or breastfeeding and on a steroid.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.