If
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Corticosteroids
Complete list of drugs used to
treat arthritis.
Medicines that are similar to the natural hormone cortisone and belong to the family of
drugs called steroids.
Purpose of Corticosteroids
Corticosteroids are used in several forms, to treat many different conditions. Because
they reduce itching, swelling, redness, and allergic reactions, they are often used in
treating skin problems, severe allergies, asthma, and arthritis. These drugs also suppress
the body's immune response, so they are used in patients who have received organ
transplants, to reduce the chance of rejection. In people whose bodies do not produce
enough natural corticosteroids, the drugs can raise the levels of those hormones.
Corticosteroids also are used to treat certain cancers (along with other drugs), and to
reduce inflammation in other medical conditions.
Description of Corticosteroids
Corticosteroids are medicines that are similar to the natural hormone cortisone. They
affect many body processes, including the breakdown of protein, fat, and carbohydrate; the
activity of the nervous system; the balance of salt and water; and the regulation of blood
pressure. Because of their widespread effects, these drugs are useful in treating many
medical conditions, but they can also have undesirable side effects.
These medicines come in a variety of forms, suitable for treating different conditions.
For example, inhalant corticosteroids are used to prevent asthma attacks, while
corticosteroid ointments, creams and gels are used to treat skin problems. Some examples
of corticosteroids are beclomethasone (Beconase, Vancenase, Vanceril), betamethasone
(Diprolene, Lotrisone), hydrocortisone, mometasone (Elocon), prednisone (Deltasone,
Orasone), and triamcinolone (Azmacort, Nasacort).
Recommended dosage of Corticosteroids
Recommended dosage depends on the patient, the type and strength of the drug, and the
form in which it is used. Also, the physician may change the dose during the course of
treatment. Check with the physician who prescribed the drug or the pharmacist who filled
the prescription for the correct dosage.
Always use corticosteroids exactly as the physician directs. Never take larger or more
frequent doses, and do not take the drug for longer than directed. Do not use the medicine
for any conditions other than those for which it was prescribed.
People who take some oral forms of corticosteroids may be told to take the medicine
only every other day. This keeps the body from losing the ability to produce its own
natural corticosteroids. More medicine may be needed before, during, and after stressful
situations, but dosages should only be increased according to a physician's directions.
Precautions of Corticosteroids
Corticosteroids are powerful drugs that may cause serious side effects. Anyone taking
them should be sure they fully understand the benefits and risks of these drugs.
Inhalant forms of these drugs will reduce the frequency and severity of asthma attacks
when taken every day, but will not relieve an asthma attack once it has started. To
relieve asthma symptoms, patients must use airway-opening medications (brochodilators).
When using inhalant forms of both a bronchodilator and a corticosteroid, use the
bronchodilator first and then wait several minutes before using the corticosteroid.
Gargling and rinsing the mouth with water after using inhalant corticosteroids helps
prevent hoarseness and throat irritation.
In children and teenagers, these medicines can stop or slow growth and affect the
function of the adrenal glands (small glands located above each kidney, which secrete
natural corticosteroids). Another possible problem for children is that corticosteroids
may make infections such as chickenpox and measles more serious. The benefits and risks of
giving corticosteroids to children and teenagers should be thoroughly discussed with the
child's physician. By adjusting the doses and forms in which corticosteroids are given,
the physician may be able to lower the chance of unwanted side effects.
In older people, corticosteroids may increase the risk of high blood pressure and bone
disease. Bone problems from corticosteroids are especially likely in older women.
Patients who take corticosteroids regularly should not stop taking them suddenly, even
if their symptoms improve. Gradually tapering the dose before stopping the drug completely
can allow the body time to adjust. If directed by a physician to reduce the dose, follow
directions exactly and see the physician as often as directed.
Corticosteroid ointments, creams and gels can be absorbed through the skin and travel
into the bloodstream. This is not a problem unless large amounts are absorbed. Then,
unwanted side effects in other parts of the body are possible. To reduce the chance of
that happening, do not spread the medicine over too large an area and do not cover it with
plastic wrap, adhesive bandage, or any other type of airtight covering unless told to by
your physician.
Patients taking corticosteroids over long periods may need to follow special diets,
reducing the amount of sodium or increasing the amount of protein they eat, for example.
Their health care providers can tell them if any diet changes are necessary.
Some patients may need to carry or wear medical identification indicating that they use
this medicine and may need more of it in times of emergency, such as a severe asthma
attack. The patient's physician can advise the patient whether such identification is
necessary.
Before having skin tests, emergency treatment, or surgery (including dental surgery),
anyone using corticosteroids should let the physician or dentist in charge know that they
use this type of medicine.
Corticosteroids can lower a person's resistance to infection and can make infections
harder to treat. Anyone who has a serious infection or injury while taking corticosteroids
should get prompt medical attention and should make sure the physician in charge knows
about the medicine. Avoid contact with people who have infections, especially chickenpox
and measles. People who are taking or have been taking corticosteroids should not have
immunizations, such as live vaccinations for polio without checking with their physicians.
They should also avoid contact with anyone who has taken the oral polio vaccine, as there
is a chance the virus could be passed on to them. Other people living in their home should
not take the oral polio vaccine. The injectable form of the polio vaccine should be used
instead because the virus used to form the vaccine is inactive.
Special conditions concerning Corticosteroids
People with certain medical conditions or who are taking certain other medicines can
have problems if they take corticosteroids. Corticosteroids can also cover up the symptoms
of some medical problems. If the condition gets worse, the patient has no way of knowing
it. Before taking these drugs, be sure to let the physician know about any of these
conditions:
Allergies
Anyone who has had unusual reactions to corticosteroids in the past should let his or
her physician know before taking the drugs again. The physician should also be told about
any allergies to foods, dyes, preservatives, or other substances.
Pregnancy
Too much use of corticosteroids during pregnancy may cause problems in the baby after
it is born, such as slower growth. Nasal and inhalant forms of the drugs are considered
safer to use in pregnancy than are corticosteroids taken by mouth or injection. When used
properly, corticosteroid ointments, creams, and gels -- used to treat skin conditions --
are not known to cause any problems if used during pregnancy.
Breastfeeding
The safety of using corticosteroids while breastfeeding depends on the type of
corticosteroid and the form in which it is being used. When taken by mouth or injection,
for example, the drugs pass into breast milk and may cause growth problems in nursing
babies. Creams, gels, and other forms that are applied to the skin are not known to cause
problems in nursing babies whose mothers use them. However, these medicines should not be
applied to the breasts just before breastfeeding. In general, women who are breastfeeding
should ask their physicians before using any type of corticosteroid.
Diabetes
Corticosteroids may affect blood sugar levels. Any person with diabetes who notices
changes in blood or urine test results while taking corticosteroids should check with a
physician.
Other medical conditions
Before using corticosteroids, people with any of these medical problems should make
sure their physicians are aware of their conditions:
- Osteoporosis or any other bone disease
- Current or past tuberculosis
- Glaucoma or cataracts
- Infections of any type (virus, bacteria, fungus, amoeba)
- Sores in the nose or recent nose surgery (if using nasal spray forms of corticosteroids)
- Underactive or overactive thyroid
- Liver disease
- Stomach or intestine problems
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Kidney disease or kidney stones
- Myasthenia gravis
- Systemic lupus erythematosus (SLE)
- Emotional problems
- Skin conditions that cause the skin to be thinner to bruise more easily.
Use of certain medicines
Taking corticosteroids with certain other drugs may affect the way the drugs work or
may increase the chance of side effects.
Side effects of Corticosteroids
Side effects generally are rare when corticosteroids are used for a short time.
However, when they are used over time, they may lower the body's ability to fight off
infections or may make infections harder to treat. Other common side effects include
changes in appetite (increase or decrease), nervousness, restlessness, sleep problems, and
indigestion. These problems usually go away as the body adjusts to the drug and do not
require medical treatment. Less common side effects may occur with some forms of
corticosteroids. Inhalants may cause dry throat, headache, nausea, skin bruising or
thinning, and an unpleasant taste. Nasal spray forms may irritate the nose or throat, and
ointments, gels, or creams may irritate the skin. Again, these side effects do not need
medical attention unless they don't go away or they interfere with normal activities
More serious side effects are not common, but may occur. If breathing problems,
wheezing, or tightness in the chest occur, call a physician immediately. Additional side
effects do not need emergency care, but should have prompt medical attention. Anyone who
is taking corticosteroids and has any of the symptoms listed below should check with the
physician who prescribed the medicine as soon as possible:
- White, curd-like patches in the mouth or throat
- Pain when swallowing or eating
- White patches or sores inside nose or in the anal area
- Eye pain or vision problems
- Loss of sense of taste or smell
- Stomach or abdominal pains, nausea, or vomiting
- Rash, acne, or other skin problems
- Swelling of face, eyelids, or lips
- Unusual tiredness or weakness
- Stuffy, dry, or runny nose (continuing over time)
- Watery eyes (continuing over time)
- Black, tarry stools
- Irregular heartbeat
- Menstrual problems
- Muscle cramps, weakness, or pain
- Rapid weight gain
- Unusual marks or bruises; wounds that won't heal
- Confusion, excitement, restlessness, mood swings, or unusual or disturbing thoughts or
feelings
- Hallucinations.
Other rare side effects are possible. Anyone who has unusual or bothersome symptoms
after taking corticosteroids should get in touch with his or her physician.
Interactions with Corticosteroids
Corticosteroids may interact with a variety of other medicines. When this happens, the
effects of one or both of the drugs may change or the risk of side effects may be greater.
Anyone who takes corticosteroids should let the physician know all other medicines he or
she is taking. Among the drugs that may interact with corticosteroids are:
- Insulin and diabetes medicines
- Heart medicine such as digitalis
- Diuretics (water pills)
- Medicine containing potassium or sodium
- Immunizations (vaccinations)
- Cyclosporine (Sandimmune)
- Blood thinners, such as warfarin (Coumadin)
- Estrogen drugs, such as conjugated estrogens (Premarin) or oral contraceptives
- Antacids (if taken frequently).
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