Steroid-Induced Complications
Side effects of corticosteroid medicines like prednisone
Quick Facts
- Type: Medication-related complications
- Common drugs: Prednisone, dexamethasone, hydrocortisone
- Main risks: High blood sugar, bone loss, infections
- Key rule: Never stop long-term steroids suddenly
Overview
Corticosteroids such as prednisone, dexamethasone, and hydrocortisone are powerful anti-inflammatory medicines used for asthma, autoimmune diseases, allergies, and many other conditions. They can be life-changing and sometimes life-saving, but they mimic the body's stress hormone cortisol, and using them in higher doses or over a long time can cause a wide range of side effects.
These steroid-induced complications affect many body systems, from blood sugar and bones to mood, skin, and the immune system. The risk depends mainly on the dose and how long the medicine is taken. Many problems can be reduced by using the lowest effective dose for the shortest necessary time and by monitoring for known side effects. This page covers oral and injected (systemic) steroids rather than short courses of inhaled or topical steroids, which carry lower risks.
Signs and Complications
Steroid complications can be wide-ranging. Common ones include:
- Metabolic: Higher blood sugar (steroid-induced diabetes), increased appetite, and weight gain
- Bone and muscle: Thinning bones (osteoporosis) and muscle weakness
- Appearance: Rounded face, fat over the upper back, thin skin, easy bruising, and stretch marks (features of Cushing syndrome)
- Infection: Greater risk of infections because the immune response is dampened
- Eyes: Cataracts and raised eye pressure (glaucoma)
- Mood and sleep: Mood swings, irritability, anxiety, or trouble sleeping
- Stomach: Higher risk of ulcers, especially with anti-inflammatory painkillers
Causes
Complications arise because corticosteroids act like a continuous high level of the body's own cortisol. This affects nearly every system:
- They raise blood sugar and change how the body stores fat.
- They reduce calcium absorption and bone building, weakening bones.
- They suppress the immune system, lowering defenses against infection.
- They signal the adrenal glands to slow their own cortisol production, so the body becomes reliant on the medicine.
Because of this last effect, stopping long-term steroids suddenly can leave the body without enough cortisol, causing an adrenal crisis if not present. This is why long-term steroids are tapered down slowly rather than stopped at once.
Risk Factors
- Higher steroid doses
- Long duration of treatment
- Older age
- Pre-existing diabetes, osteoporosis, or high blood pressure
- Smoking or low physical activity (for bone loss)
- Combining steroids with anti-inflammatory painkillers (for ulcers)
- Frequent repeated courses rather than a single short course
Monitoring and Diagnosis
Steroid complications are mainly detected through monitoring during treatment:
- Blood sugar: Checks for steroid-induced diabetes, especially with higher doses.
- Blood pressure and weight: Tracked at visits.
- Bone density scans: For people on long-term steroids to assess bone loss.
- Eye exams: To screen for cataracts and glaucoma.
- Infection awareness: Watching for signs of infection that may be masked by steroids.
Treatment and Prevention
The goals are to use steroids safely, manage side effects, and protect against the most serious risks:
- Lowest effective dose: Using the smallest dose for the shortest time, and tapering rather than stopping abruptly.
- Protecting bones: Adequate calcium and vitamin D, weight-bearing exercise, and bone-protecting medicines when needed.
- Managing blood sugar: Diet changes and, if needed, medicines for steroid-induced diabetes.
- Preventing ulcers: Acid-reducing medicine when steroids are combined with anti-inflammatory painkillers.
- Reducing infection risk: Up-to-date vaccinations and prompt attention to infections.
- Sick-day and stress dosing: Extra steroid cover during illness or surgery for those on long-term treatment, to prevent adrenal crisis.
Using Steroids Safely
- Never stop a long-term steroid suddenly; follow a tapering plan
- Carry a steroid card or medical alert if on long-term treatment
- Take steroids with food and as directed
- Keep up with blood sugar, blood pressure, bone, and eye checks
- Report fever or signs of infection promptly, as steroids can hide them
- Ask before adding anti-inflammatory painkillers
When to See a Doctor
Contact your doctor if you develop high blood sugar symptoms (excess thirst and urination), new mood changes, signs of infection, or severe stomach pain while on steroids. Seek emergency care for:
- Severe weakness, dizziness, vomiting, or collapse, especially if a long-term steroid was recently stopped or missed (possible adrenal crisis)
- Black or bloody stools or vomiting blood (possible bleeding ulcer)
- High fever or rapidly worsening infection
Do not stop long-term steroids on your own, even if you feel side effects, without medical guidance.
Frequently Asked Questions
What are the most common side effects of steroids like prednisone?
Common effects include increased appetite and weight gain, higher blood sugar, mood changes, trouble sleeping, easy bruising, and, with long-term use, bone thinning and a higher risk of infection. Most are dose- and duration-related.
Why can't I stop steroids suddenly?
Long-term steroids signal the adrenal glands to slow their own cortisol production. Stopping abruptly can leave the body short of cortisol, which can cause a dangerous adrenal crisis. Long-term steroids are tapered down slowly instead.
Do steroids weaken bones?
Long-term steroid use can reduce bone density and raise the risk of fractures. Adequate calcium and vitamin D, weight-bearing exercise, and sometimes bone-protecting medicines help reduce this risk during treatment.
Can steroids cause diabetes?
Steroids can raise blood sugar and trigger steroid-induced diabetes, especially at higher doses or in people already at risk. Blood sugar is monitored during treatment, and it often improves when the steroid is reduced or stopped.
How can steroid side effects be reduced?
Using the lowest effective dose for the shortest time, taking the medicine with food, keeping up with recommended blood sugar, bone, and eye checks, staying up to date on vaccines, and never stopping long-term steroids abruptly all help.
References
- Mayo Clinic. Prednisone and other corticosteroids.
- MedlinePlus, U.S. National Library of Medicine. Steroids.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Corticosteroids.
- Hormone Health Network, Endocrine Society. Glucocorticoids.