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Oral steroids

What are oral steroids?

Oral steroids are man-made medicines that are very similar to a hormone called cortisol, which your body normally makes. "Oral" means you swallow them as tablets and liquids. They are commonly called steroids, and doctors and nurses often call them glucocorticoids. The most commonly used one is called prednisone.

Oral steroids are not the same as the steroids that athletes take to build more muscle – they have very different effects.

What do oral steroids do?

Oral steroids are anti-inflammatory drugs used to treat many different conditions, such as inflammatory bowel disease, rheumatoid arthritis, PMR (polymyalgia rheumatica), and asthma. They are also used to replace steroids in conditions where people have stopped making their own, such as Addison's disease.

What if I am taking long-term oral steroids?

Short courses of steroids (less than three weeks) are unlikely to cause any problems. However, if you are on steroids for more than three weeks there are some things you need to watch closely.

If you are taking 5 mg or less of prednisone daily, it is important that you increase your dose if you get sick: When people get sick or have an accident their body usually makes more cortisol to help them recover. If someone can't make this extra cortisol they might go into shock or collapse unless they get extra steroids.

See your doctor if you are taking more than 5 mg of prednisone daily and you get sick.

Other times you might need to increase your dose: You will need to take extra oral steroids if you have a serious accident of any kind (such as a broken bone or burn) or are having surgery. You don't usually have to increase your dose because of emotional stress, a head cold or increased exercise.

Going overseas: Make sure you have enough pills. Carry a summary of your medical history with you in case you need to see a doctor. Don't take any risks with hygiene, as tummy bugs can be very unpleasant.

Don't stop taking oral steroids suddenly: You may get serious side effects if you suddenly stop taking them. Missing an occasional dose probably won't do any harm, but a doctor should supervise any long-term change in dose, which will have to happen gradually.

Medical alert bracelet: If you are on long-term steroids, consider wearing a medical alert bracelet or pendant so medical staff know how to treat you in an emergency. Search online for medical bracelets NZ to find medical bracelet suppliers.

Remember!

What are the possible side effects?

A short course of steroids usually has few side effects. But side effects are more likely if you take longer-term steroids. These are the main things to look out for:

Osteoporosis, or thinning bones. Some medicines can help to prevent this – talk to your doctor if you are worried about it.

Weight gain. You might also get some puffiness around your face.

Increased chance of infections. This happens because oral steroids suppress your immune system. In particular, you are at risk of developing a severe form of chickenpox if you have not had it in the past (once you have had chickenpox, you are immune to it). Stay away from anyone with chickenpox or shingles. Tell your doctor if you do come in contact with anyone who has chickenpox or shingles. Also, if you have had tuberculosis (TB) at any time in the past, it might flare up again.

Increased blood pressure. Make sure you get your blood pressure checked regularly. If it does get high it can be treated.

High blood sugar. If you have diabetes, you might need to increase your diabetes medication. Even if you don't have diabetes, get your blood sugar checked occasionally, as long-term steroid use can sometimes cause diabetes.

Skin problems. Your skin might thin, bruise more easily and take longer to heal after injuries. You might develop stretch marks. Try to prevent unnecessary trauma to your skin.

Mood and behavioural changes. Some people generally feel in a better mood when taking oral steroids. However, oral steroids can sometimes make depression and other mental health issues worse (or even cause them). If this happens, it will happen within a few weeks of starting and usually only with higher doses. If you are worried about your moods or mental health, talk to your doctor.

Trouble sleeping (insomnia).

Increased risk of stomach and duodenal ulcers (duodenal ulcers happen in your intestine). Tell your doctor if you develop indigestion or stomach ache. This can happen if you take anti-inflammatory pills such as Nurofen of Voltaren while on steroids.

Important!

It is very important not to take anti-inflammatory medicine when you are on steroids.

Remember, these are the most common side effects. But if you are worried about anything that happens, talk to your doctor about it.

Written by the Department of Endocrinology, Christchurch Hospital. Endorsed by HealthInfo clinical advisers. Updated March 2017.

Page reference: 75997

Review key: HIORS-75997