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STEROIDS (TABLET TREATMENT)

What are the types of Steroids?

In this leaflet we are talking about corticosteroids such as prednisolone, betamethasone, dexamethasone, budesonide, methylprednisolone and deflazacort. Anabolic steroids and the steroids used in replacement therapy are not included in this leaflet.

What are Steroids for ?

Your own body makes substances called steroids. The most important is cortisol, made by your adrenal glands (situated above each kidney). Separate leaflets will tell you about using cortisol if you have a disorder of the adrenal or pituitary gland (see below). Even if you are producing enough cortisol yourself, extra corticosteroid can be used to dampen down inflammation in some part of the body.. Steroids are only rarely used where inflammation is due to infection. The types of inflammation for which steroids are often used include asthma, rheumatoid arthritis, inflamed bowel and certain kidney disorders. They are also used to stop rejection of transplanted organs, and for some types of leukaemia.

How do Steroids work ?

The cortisol which you make yourself has several functions. It keeps the level of sugar in your blood normal. It reduces inflammation and helps you recover from injury and stress. It also keeps the balance of salts and water in your body normal. The type of corticosteroid tablet which you are being given can do these things. However, it is designed to have its main benefit by reducing inflammation. It calms down a part of your body called the immune system. Steroids have different strengths and work for different lengths of time. Your doctor will choose one which is appropriate for your condition.

How should Steroids be used ?

You should take careful note of the way your doctor told you to take your steroids. Often they need only be taken once a day, usually in the morning but the times may be important. Make sure you know how many to take, how often to take them, and what time of day you should take them. If you are not sure ask your doctor or pharmacist (check the label first). All steroid tablets should be taken with or straight after food, because otherwise they can irritate your stomach. Certain steroid tablets are coated to reduce this irritation (they are usually shiny): taking this type with food is not so important. Please keep taking your steroid tablets for as long as your doctor has told you to. Try not to miss doses.

During Treatment with Steroids

You will probably start to feel much better quite quickly after you have started taking your steroid tablets. They will give you a sense of wellbeing. Appetite is often increased. You can easily gain weight and so may need to reduce your food intake. Your face and tummy are most likely to be affected by the weight. If you are on small doses of steroids, or high doses in short courses, it is unlikely that you will experience side-effects. If you are on high doses for longer periods, you might experience several more serious problems. You may get water retention, causing swelling of your ankles and raised blood pressure . Your doctor will check this regularly. If you have heart trouble already, steroids may occasionally worsen this: let the doctor know if you get sudden ankle swelling or shortness of breath . The effect on your blood sugar may cause loss of control if you already have diabetes. It can also bring on diabetes . Your doctor will occasionally check your blood or urine for sugar. However, let your doctor know if you begin to pass more urine or get thirsty: these can be symptoms of diabetes. Osteoporosis (bone thinning) can occur with treatment lasting beyond 6 months or so. This can cause bony pains and increases the risk of fractures: additional drugs can be given to you to reduce this risk. If a child is taking steroid tablets, growth may be slowed down. Steroids cause the stomach to make more acid. This can cause indigestion : you should tell your doctor if this happens: a drug can be given to protect you from this effect if you are known to have acid or ulcer problems. As mentioned above, steroid tablets are given to quieten down your immune system. This is good for the disorder that is being treated, but it does mean that the body is less able to protect itself from certain infections . If you do get an infection, it may cause fewer symptoms and hide important warnings, such as fever. During, and for three months after treatment, avoid close personal contact with anyone who has a serious infection. This includes also measles, chickenpox or shingles. Other effects which you may notice include moodiness , acne spots on your face or trunk and some thinning of your hair. Cataracts are also more likely to occur in people taking steroids.

Drug Interference

Many painkillers and anti-inflammation drugs will increase the risk of stomach symptoms: nausea and indigestion. You could even get bleeding from an ulcer. Alcohol can have the same effect. Paracetamol (Panadol) and codeine are quite safe to take. Steroids make many blood pressure pills less effective. Be sure to have your blood pressure checked: the doses may need to be increased. Similarly, if you have diabetes, medication may need to be increased: check your blood or urine glucose tests daily, or more. You will not be given live vaccines if you are taking high doses of steroids. With your suppressed immune system, you won't respond to the vaccine as you should and it may make you ill. If you are taking water tablets (diuretics), or asthma medicines such as salbutamol, terbutaline or salmeterol, you might need to take extra potassium: your doctor may do a blood test for this. Anticonvulsants such as phenytoin, carbamazepine, phenobarbitone and primidone can reduce the effect of some steroids. Their dose may need to be increased.

What if Steroids are not taken ?

Your condition would not respond and you may become very ill indeed. Your adrenal gland does not make its own cortisol while you are on steroid tablets. If you have been on steroids for more than 3 weeks or so, stopping them suddenly can make you seriously ill. Your doctor will probably advise you how to stop them gradually, over a few days, weeks or even months. This also helps to stop the inflammation "rebounding".

General advice on Steroids

Always carry a steroid card or Medicalert bracelet with you. This is in case of accident: people will know that you are having this important drug. Show it to any doctor who treats you. You may also need to have more steroid if you become ill, since the normal body would make more cortisol under such conditions. It is wise to tell your doctor immediately if any of the above problems occur. If you have any questions not covered in this leaflet, please ask your pharmacist or doctor. Keep this leaflet handy in case you want to refer to it again.