• The complications of corticosteroid therapy in children are protean. Perhaps the most important of these are adrenal insufficiency after withdrawal of steroids, immunosuppression, and growth failure. The physician who is caring for a child receiving corticosteroids must be aware of these common complications as well as the many less frequent side effects, such as cataracts, pseudotumor cerebri, pancreatitis, and steroid myopathy, to name a few. In all children, the risk of using corticosteroids should be weighed carefully before therapy with these agents is begun. Show
(Am J Dis Child 132:806-810, 1978) IntroductionCorticosteroids, often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions. They're a man-made version of hormones normally produced by the adrenal glands (two small glands that sit on top of the kidneys). Corticosteroids are available in different forms, including:
What are corticosteroids used for?Corticosteroids are mainly used to reduce inflammation and suppress the immune system. They are used to treat conditions such as:
Corticosteroids can also be used to replace certain hormones that are not being produced by the body naturally – for example, in people with Addison's disease. Possible side effectsCorticosteroids will only be prescribed if the potential benefits of treatment outweigh the risks. They will also be prescribed at the lowest effective dose for the shortest possible time. There aren't usually any severe side effects if you take steroid injections, a steroid inhaler, or a short course of steroid tablets. However, prolonged treatment at high doses – particularly with steroid tablets – can cause problems in some people. Potential side effects of long-term treatment include:
If you have troublesome side effects after taking corticosteroids, don't stop taking your medication until your doctor says it's safe to do so, because of the possibility of these unpleasant withdrawal effects. Your dose may need to be reduced slowly over a few weeks or months, and you may have to have tests to ensure that your adrenal glands are still working properly before stopping corticosteroids altogether, if you have been taking them for a long time. Read more about the side effects of corticosteroids. Cautions and interactionsFor most people, including pregnant or breastfeeding women, steroid inhalers and injections are safe. However, they will still only be used if a doctor thinks the potential benefits outweigh the risks. As steroid tablets are more likely to cause side effects, there are some circumstances when they shouldn't be used or should only be used with caution. These circumstances include:
Corticosteroids can often be taken while you’re pregnant or breastfeeding, although your doctor will only prescribe them if the risks of not being treated outweigh the risks associated with the medication. Read more about who can use corticosteroids and interactions of corticosteroids. Who can use themFor most people, steroid inhalers and steroid injections should not cause any troublesome side effects. Steroid tablets are generally prescribed with more caution, as these can potentially cause more problems. Steroid tabletsCorticosteroid tablets are the most powerful type of steroid medication, because they can affect the whole body. They shouldn't be used if you have an ongoing widespread infection, because they could make it more severe. However, you should continue to take corticosteroids if you develop an infection while already being treated, unless advised otherwise. Steroid tablets should be used with caution in people with:
They should also be used with caution in people with a health condition that could be made worse by taking oral corticosteroids, including:
In these situations, you will only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks. Steroid injectionsMost people can safely have corticosteroid injections, but they should be avoided or used with caution if you have an ongoing infection or a blood clotting disorder (such as haemophilia). Steroid inhalers and spraysThere is generally no reason why someone shouldn't be able to use a steroid inhaler or steroid spray, but these should be used with caution in people with ongoing infections, such as tuberculosis (TB). PregnancyCorticosteroids are generally safe to use during pregnancy. However, they're not usually recommended unless the potential benefits outweigh the risks. For example, steroid tablets may be recommended if you're pregnant and have severe asthma, because the risk to your baby from uncontrolled asthma is higher than from the medication. There is no evidence that using a steroid inhaler during pregnancy increases the risk of problems such as birth defects, so you can usually continue to use this as normal while you're pregnant. BreastfeedingIf a woman needs to take steroid tablets while she is breastfeeding, a type called prednisolone is usually recommended, because it is thought to have the least chance of causing the baby any adverse effects. As a precaution, it's usually recommended that a breastfeeding mother waits three to four hours after taking a tablet before feeding her baby. Steroid injections, inhalers and sprays are not thought to pose a risk to babies being breastfed. Medicines that interact with themCorticosteroids can interact with other medicines, and the effects of either medicine can be altered as a result. There is less chance of this happening with steroid injections or sprays, although it can occasionally happen if they're used at high doses and for a long time. Some of the more common interactions are listed below, but this is not a complete list. If you want to check your medicines are safe to take with corticosteroids, ask your GP or pharmacist, or read the patient information leaflet that comes with your medicine. Anticoagulant medicinesAnticoagulant medicines are medications that make the blood less sticky. They are often prescribed to people with a history of blood clots or an increased risk of developing them. Combining corticosteroids with anticoagulant medicines can sometimes make anticoagulants less effective. Alternatively, it can increase their blood-thinning effect, which can cause bleeding inside the digestive system. AnticonvulsantsAnticonvulsants are medicines used to prevent seizures (fits) and are often used to treat epilepsy, but they can reduce the effectiveness of corticosteroids. Depending on how frequent and severe your seizures are and the condition the steroids are being used to treat, you may be advised to temporarily stop taking anticonvulsants. Diabetes medicationCorticosteroids can decrease the effectiveness of medications used to treat diabetes. If you need to take both of these medications, your blood glucose levels will usually be checked more regularly and your dose of diabetes medication may need to be adjusted. HIV medicationCorticosteroids, including steroid inhalers, can sometimes interact with a type of medication known as protease inhibitors (such as ritonavir) used to treat HIV. The HIV medication may increase the level of corticosteroid in your body, which might increase your risk of experiencing side effects. Live vaccinesSome vaccinations contain a weakened form of the infection they are designed to protect against. These are known as live vaccines. Examples of live vaccines include:
As corticosteroids can weaken your immune system and make you more vulnerable to infection, you should avoid any live vaccine until at least three months after your course of corticosteroids has finished. Non-steroidal anti-inflammatory drugsNon-steroidal anti-inflammatory drugs (NSAIDs) are a group of commonly used painkillers, such as ibuprofen, that are available over the counter at pharmacists. Combining NSAIDs and corticosteroids can increase your risk of developing stomach ulcers and internal bleeding. If you need to take both medications, you may be given an additional medication called a proton pump inhibitor (PPI) to reduce the risk of stomach ulcers. Side effectsCorticosteroids are powerful medications that can sometimes have a wide range of side effects. They will only be used if the potential benefits are thought to outweigh this risk. The risk of experiencing side effects largely depends on:
Some of the main side effects are listed below, but this is not a complete list. To learn about all the possible side effects of your medication, read the patient information leaflet that comes with it. Steroid inhalersInhaled steroids usually have few or no side effects if used at normal doses. However, they can sometimes cause:
Rinsing your mouth out with water after using your medication can help to prevent oral thrush, and using a device called a spacer with your medication can help to prevent many of the other problems. There is also some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease (COPD) can increase the risk of chest infections such as pneumonia. Discuss this with your health professional if you’re concerned. Inhaled steroids at high doses can sometimes cause some of the more serious side effects that are more often linked with steroid tablets (see below), but this is rare. Steroid injectionsSteroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days. Steroid injections can also cause muscle or tendon weakness, so you may be advised to rest the treated area for a few days after the injection. Other possible side effects can include infections, blushing, and thinning and lightening of the skin in the area where the injection is given. Because of the risk of side effects, steroid injections are often only given at intervals of at least 6 weeks and a maximum of 3 injections into one area is usually recommended. Steroids that are injected into a blood vessel (intravenous steroids) may sometimes cause some of the more widespread side effects described below. Steroid tabletsShort, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects. It’s sometimes necessary, however, for them to be taken for longer periods. In these cases, you’re more likely to develop troublesome side effects, although this is not inevitable. Steroid tablets taken for longer than 3 weeks can potentially cause:
Most side effects should improve if you're able to reduce your dosage or eventually stop taking the medication. You may have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take steroid tablets on a long-term basis. Last updated: What are some side effects of cortisone?Common side effects of cortisone may include:. high blood pressure;. muscle pain or weakness;. sleep problems (insomnia), mood changes;. thinning skin, bruising or discoloration;. increased sweating;. headache, dizziness, spinning sensation;. stomach pain, bloating; or.. slow wound healing.. What are the most common adverse effects of corticosteroid drugs?Potential side effects of long-term treatment include:. increased appetite – potentially leading to weight gain.. thinned skin that bruises easily.. increased risk of infections.. mood changes, mood swings and depression.. diabetes.. high blood pressure.. osteoporosis (weak and brittle bones). Which of the following are toxic effects of cortisone therapy?[1] The most common adverse effects of corticosteroids include osteoporosis and fractures, suppression of the hypothalamic-pituitary-adrenal (HPA) axis, Cushingoid features, diabetes and hyperglycemia, myopathy, glaucoma and cataracts, psychiatric disturbances, immunosuppression, cardiovascular disease, ...
What is a most common complication from longWhile corticosteroids have many uses, they also come with several long-term side effects. These medications are known to lead to problems like osteoporosis (thin bones), a weakened immune system, cataracts, thin skin with topical products, and fungal infections of the mouth or throat with inhalers.
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