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).

Conditions treated with corticosteroids

Corticosteroid drugs are prescribed for a variety of conditions, including:

Corticosteroid Contraindications

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. Corticosteroid drugs 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 corticosteroid medications 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. Corticosteroid medications 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:

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:

• Blindness
• Unusual confusion or excitement
• Hallucinations
• Mental depression
• Eye pain
• Irregular heartbeat
• Bloody stool
• Unusual increase in hair growth
• Vomiting
• 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

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.

Pregnancy use issues

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 corticosteroid drugs 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

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

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.