STEROIDS: WHEN AND WHY THEY ARE PRESCRIBED
The most well-known form of steroids is the anabolic steroids often used by athletes and bodybuilders. But did you know steroids are much more commonly used for medical purposes?
Steroids are anti-inflammatory drugs that are prescribed for inflammatory diseases like eczema, arthritis, asthma, and autoimmune diseases. Various types of steroids help control your swelling and immune response.
Corticosteroids are available in many forms, some you can even get over-the-counter. However, they require frequent medical guidance to prevent potential side effects, especially when discontinuing steroid therapy.
Read on to learn why you might be prescribed steroids, how they work, and how you can safely stop using them.
What Are Steroids?
Steroids, or corticosteroids, are anti-inflammatory drugs that mimic the function of cortisol, a hormone produced naturally in the body by the adrenal glands.
Cortisol is an essential hormone in your body that regulates various metabolic processes and immune responses.
Medical steroid preparations come in many forms:
- Oral Steroids: You can take steroids as tablets or syrup. It’s commonly used to treat asthma, infections, blood disorders, allergies, and certain cancers. Prednisolone is an oral corticosteroid that prevents organ rejection in transplant patients.
- Steroid Injections: Steroid injections locally reduce inflammation and pain in muscles, blood vessels, or joints. Your doctor may give steroid injections in cases of arthritis, sciatica, and joint pain. Steroid shots your doctor may prescribe are methylprednisolone and hydrocortisone - injected directly into diseased and painful areas.
- Steroid Inhalers: Steroid inhalers allow you to breathe in the drug. These treat conditions like asthma or chronic obstructive pulmonary disease (COPD), to reduce inflammation in the lungs and airways and improve breathing. Steroid inhalers you may find in your local pharmacy include beclomethasone and fluticasone.
- Steroid Nasal Sprays: Steroid nasal sprays reduce the swelling and mucus in your nose. They are often used for hay fever, sinusitis, non-allergic rhinitis, stuffy nose, and nasal polyps. Beclomethasone and fluticasone are some of the common nasal sprays.
- Topical Steroids: Steroids can be prescribed as a cream or ointment if you have skin conditions like eczema, dermatitis, and psoriasis. Topical corticosteroids can also come as eye drops to reduce inflammation on the eye surface. Hydrocortisone cream is a common topical steroid you can get over-the-counter.
Keep in mind that all these steroids differ from anabolic steroids, or what we commonly call Appearance and Performance-Enhancing Drugs (APEDs). Professional athletes and bodybuilders may take anabolic steroids to build body mass. These steroids imitate the function of the male hormone testosterone and are rarely used for medical purposes.
What Are The Effects Of Steroids?
Corticosteroids are an artificial version of cortisol, which your adrenal glands normally produce. When you take corticosteroids in doses higher than what your body typically produces, it stimulates physiological reactions in your body:
- Anti-inflammation: Steroids are primarily anti-inflammatory. They inhibit inflammatory pathways and minimize the production of inflammatory chemical mediators. Steroids effectively reduce inflammation and further tissue damage.
- Reduces immune response: An active immune system is vital as your natural defense against illness and infection. But in cases of autoimmune conditions, it can be a cause of disease. Autoimmune diseases occur when your immune system mistakenly attacks your healthy cells. The immune-suppressive effect of steroids is one of the main mechanisms by which it helps treat immune-mediated diseases, like psoriasis, rheumatoid arthritis, and others.
Why Would I Be Prescribed Steroids?
Your healthcare provider may prescribe steroids in several health conditions, but they must consider important factors before deciding if steroids are the proper treatment for you.
- Age
- Physical Activity
- Medications you are currently taking
- The nature and extent of your condition
- Alternative treatment options
- Other significant medical conditions
- Your ability to take the prescribed dosage
These are factors that allow your healthcare provider to weigh the potential benefits of steroids against the risks. They will probably help you understand this before you take the drug.
Corticosteroids can be the primary treatment in various inflammatory diseases. Other times, you might only use it moderately or when other treatment methods don’t work.
These are a few common medical conditions that are treated with steroids:
- Auto-Immune Diseases: Autoimmune diseases cause your body’s immune system to target and damage its cells and tissues. Corticosteroids can suppress the activity of the immune system and reduce inflammation to prevent further damage.
- Organ Transplant: After an organ transplant, your immune system may see the transplanted organ as a harmful, foreign body that it needs to attack. The suppression of your immune system by steroids decreases the risk of organ rejection. These steroids are called immunosuppressive or anti-rejection medicines.
- Musculoskeletal Pain: Steroids reduce inflammation and soothe injured nerves. They are widely used in the management of musculoskeletal conditions, like arthritis or carpal tunnel syndrome.
- Allergies: Steroids reduce symptoms of congestion that occur in allergic reactions. It can treat a stuffy nose, watery eyes, and sneezing. They are most often used for conditions like hay fever, asthma, and common allergies.
- Lung Disorders: Steroids aid in reducing the inflammation in the lungs and airways, especially when taken in as inhaled preparations of steroids. These are prescribed for severe lung conditions, such as chronic obstructive pulmonary disease (COPD) and asthma.
- COVID-19: Patients with severe COVID-19 may develop a systemic inflammatory response that results in lung injury and organ failure. The anti-inflammatory and immunosuppressive properties of steroids can prevent adverse effects in critically ill patients with COVID-19.
What Are The Side Effects Of Steroids?
Like any other medication, steroids may have some side effects. These side effects depend on the type of steroid, the dosage, and the treatment duration.
Some of these steroid risks are more prevalent than others and are only experienced with a systemic or long-term use of steroids. That is why your healthcare provider will only prescribe corticosteroids if the potential benefits are greater than the risks.
These are a few side effects that can arise with long-term use of steroids:
- Muscular weakness
- Osteoporosis (weakening of bones)
- Easy bruising
- Hair growth on the body
- Acne
- Reduced resistance to infections
- Increased appetite
- Weight gain
- Blurred vision
- Mood swings
- Restlessness
- Anxiety
- Stomach Irritation
- Difficulty sleeping
- Higher risk of diabetes
- Higher risk of high blood pressure
- Cataracts
- Water retention
- Depression
Consult your doctor and discuss the potential side effects of your treatment before starting steroids.
How Are Steroids Stopped?
Stopping your steroid medication is something that should be thoroughly discussed with your doctor. Your doctor will likely tell you that you cannot stop taking steroids suddenly.
Sudden cessation of steroid therapy may interfere with the normal hormonal balance in your body. When you’re on long-term oral or intravenous steroid therapy, your adrenal glands will not produce much cortisol themselves, since your blood cortisol levels are artificially high from steroid therapy. So, the adrenal glands become lazy over time. They become used to not producing much cortisol.
This is why doctors taper down steroids at the end of therapy. Tapering means that your dose is slowly reduced over a few days before you can stop therapy completely. This gives your adrenal glands time to re-adjust and slowly increase endogenous steroid production back to the normal levels.
During the tapering-off process, your doctor will monitor you for potential adverse effects.
Oral Steroids
Oral steroids are usually tapered over 3-6 weeks.
Let’s say, for example, you’re taking prednisolone 40 mg. You will be instructed to reduce your dose by 10 mg every 3 days until your dose is 10 mg per day. Afterwards, you should reduce your dose to 5 mg for 5 more days and then stop.
There’s usually no standard way to taper down steroids, and each doctor will provide a cessation plan depending on how long you’ve been taking steroids, their type, and other factors.
Intravenous (IV) Steroid
The tapering-off period for intravenous steroids is at least 6 weeks.
If you’re taking IV methylprednisolone at the hospital, you might be switched to oral steroids before you leave. You will then be instructed on how you can slowly reduce the dose over the next few days/weeks of your recovery.
Your tapering-off period is an essential measure to prevent serious complications. Your doctor frequently monitors your condition throughout the process.
What Happens If You Stop Steroids Suddenly?
If you have been taking steroids for over 3 weeks, it is not advisable that you suddenly stop taking them or miss a dose.
Cutting off steroids suddenly results in an abrupt decline in your steroid levels. This negatively affects the various vital functions.
If you suddenly stop taking steroids or taper off too quickly, you’ll likely experience these common withdrawal symptoms:
- Very low blood pressure
- Lightheadedness
- Fatigue
- Insomnia
- Weakness
- Body aches
- Joint pains
- Nausea
- Loss of appetite
- Increased risk of infection
- Osteoporosis (weak, brittle bones)
- Hyperglycemia (increased blood sugar levels)
Adrenal insufficiency is a medical emergency and usually requires immediate medical care. You should not delay seeking medical attention if you experience any adverse effects after stopping steroids.
Frequently Asked Questions (FAQs)
Why have I been prescribed steroids?
Steroids are anti-inflammatory drugs and are prescribed for a range of conditions associated with inflammatory and immune diseases. Your doctor may prescribe steroids for allergies, asthma, eczema, lung disorders, muscular and joint pains, and autoimmune disease.
When should steroids be taken?
In taking steroids, it’s crucial that you follow the instructions and dosage that your doctor or pharmacist prescribes. Unless there are no explicit instructions, you can take steroids as a single dose after breakfast.
What does a steroid prescription do?
Steroids reduce inflammation and suppress the activity of your immune system. They may be prescribed to relieve various conditions, ranging from allergies to autoimmune disease and even COVID-19.
What are the main types of steroids?
You can take corticosteroids as oral steroids, steroid injections, steroid inhalers, steroid nasal sprays, and topical steroids.
Do steroids give you energy?
Steroids can make you feel energetic and euphoric. If taken late in the day, they can keep you awake at night and disturb your sleep/wake cycle. Because of this, steroids have been associated with many cognitive changes.
What are the common side effects of steroids?
Although rare with moderate use, steroids can have side effects like abnormal hair growth, acne, increased appetite, susceptibility to infection, weight gain, mood swings, anxiety, and restlessness.
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References
- Steroids: Pharmacology, Complications, and Practice Delivery Issues
- Pulmonary Diseases And Corticosteroids
- Corticosteroids
- Steroids As Pain Relief Adjuvants
- Use of Corticosteroids for Musculoskeletal Pain during the COVID-19 Pandemic - American Academy of Orthopaedic Surgeons
- NHS.UK: Steroids
- Cleveland Clinic: Corticosteroids
- WebMD
- THE CLATTERBRIDGE CANCER CENTRE: Steroid Tapering Guidance
- IBD clinic
- Mayoclinic
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