Patient education: Oral steroid medicines (The Basics)

What are oral steroids? — Oral steroids, also known as "glucocorticoids," are medicines taken by mouth to treat a wide range of medical conditions. These include autoimmune conditions (such as rheumatoid arthritis), allergic reactions, and flares of asthma or chronic obstructive pulmonary disease ("COPD"). Steroid medicines can also be given through an "IV" if you cannot swallow pills or if you are in the hospital. An IV is a thin tube that goes into a vein.

This article is for people who need to take oral steroids for a short time. Some people need to take oral steroids for their whole life for a condition called Addison disease. In this condition, the body does not make enough of a hormone called cortisol.

Other steroid medicines come as inhalers, nose sprays, or creams or ointments that go on the skin. These are sometimes called "corticosteroids." This article is only about oral steroids.

What are the names of common oral steroids? — Commonly used oral steroids include:

●Prednisone (sample brand name: Deltasone)

●Prednisolone (sample brand name: Orapred)

●Dexamethasone (sample brand name: Decadron)

●Methylprednisolone (sample brand name: Medrol)

These medicines come as pills and liquids.

What are oral steroids used for? — Oral steroids treat a wide variety of medical conditions. They include:

●Autoimmune conditions, such as rheumatoid arthritis, Crohn disease, or lupus – Some medical conditions happen when the body's infection-fighting system, called the "immune system," attacks healthy tissues and organs. This is called an "autoimmune response." Oral steroid medicines can help reduce or prevent this attack.

●Asthma, COPD, or gout flare – Oral steroids are used to reduce swelling and improve breathing for people who are having a severe flare, or "attack," of asthma or COPD. (COPD is a lung disease that makes it hard to breathe.) Oral steroids can also reduce pain and swelling in people with attacks of gout.

●Some allergic reactions – Oral steroids can be used for a short time to help with some kinds of allergic reactions, like blistering rashes due to poison ivy. You might take a smaller dose each day for several days, and then stop.

●Nausea and vomiting from chemotherapy – Oral steroids are sometimes used with other medicines to prevent nausea and vomiting due to chemotherapy.

●Preventing organ rejection – Oral steroids are also used with other medicines to keep your immune system from attacking a transplanted kidney or other transplanted organ.

There are separate patient education articles in UpToDate that discuss the range of medical conditions treated with oral steroids. Several are listed at the end of this article. Ask your doctor or nurse for the UpToDate patient education article about your disease or condition.

How do I take oral steroids? — Follow your doctor's instructions. People usually take oral steroids with breakfast or another meal. This is to prevent the medicine from causing upset stomach.

What are the side effects of oral steroids? — Taking oral steroids for less than 3 weeks is not likely to cause any serious side effects. Mild side effects that can happen with short-term use include upset stomach, increased appetite, mood changes, and trouble sleeping. Talk to your doctor if you have any of these side effects and they bother you.

More serious effects can happen if you need to take oral steroids for a long time or at high doses. These can include:

●Changes in appearance – Your face might start to look round, and you might gain some weight. Your skin might become thinner and bruise easily.

●Eye problems – Steroids can increase the pressure in the eye. This is called "glaucoma." They can also cause cloudiness of the lens in the eye, called "cataracts."

●Heart problems or high blood pressure

●High blood sugar – Taking oral steroids increases blood sugar levels. Most of the time, your blood sugar goes back to normal after you stop taking the steroid. But in some people, blood sugar remains high. If this happens, your doctor will monitor you more closely to see if you develop diabetes.

●Bone problems – Steroids can cause weakening of the bones, called "osteopenia" or "osteoporosis." They can also cause a problem with blood flow to bones, called "avascular necrosis."

●Growth problems in children and teens

●Immune system problems – Steroids affect your body's immune system, or infection-fighting system. This makes you more likely to get infections. It is also harder for your body to respond normally to vaccines.

Your doctor will give you the lowest dose for the shortest possible time. This lowers the risk of side effects. If you take steroid medicines for a long time, you will need regular exams and tests.

What else should I know about oral steroids? — Always take your steroid medicine exactly the way that your doctor tells you to.

If you need to take oral steroids for more than 3 weeks, carry a card that lists the name and dose of the steroid that you take. Show this card to anyone who treats you. You should also talk to your doctor or nurse to make sure that you get all of the vaccines you need. That's because taking steroid medicines for a long time can increase your chance of getting certain infections.

Your doctor might adjust your dose of steroids over time. Gradually decreasing the dose over time is called "tapering." If you take steroids for more than 3 weeks and get sick or need surgery, your doctor might need to temporarily increase your dose.

For more detailed information about your medicines, ask your doctor or nurse for information from Lexicomp available through UpToDate. The Lexicomp handouts explain how to use and store your medicines. They also list possible side effects and warn you if your medicines should not be taken with certain other medicines or foods.

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