Corticosteroids are anti-inflammatory medications that are prescribed to treat various conditions. They are available in a variety of forms.
- Treat inflammation relating to a number of conditions.
- Are not the same as anabolic steroids.
- Sometimes referred to as steroids.
If you have any concerns about inflammation, you can speak with one of our GPhC- registered clinicians via our online video consultation service, from 9.30am-4.30pm, Monday to Friday.
What are corticosteroids?
Corticosteroids are anti-inflammatory drugs that come in various forms, including topical creams, tablets and inhalers. While they are often referred to as “steroids”, they are not the same as anabolic steroids, which mimic the male hormone, testosterone. Corticosteroids can be prescribed to treat a range of conditions where inflammation is present, including asthma, atopic eczema and Crohn’s disease.
What is asthma?
Asthma is a fairly common condition in the UK and can present at any age, although it usually presents in childhood. The main symptoms include wheezing, difficulty breathing, coughing and tightness in the chest. Severe combinations of these symptoms are known as asthma attacks, which can be life threatening if they’re not treated quickly.
The condition can be triggered by a number of things, including allergic reactions to substances such as dust, pollen, smoke and pollution, as well as exercise and cold and flu strains. Asthma is a lifelong condition, and there is no cure for it, but there are a number of treatments that can help to manage or prevent symptoms.
How is asthma treated?
In most cases, treatment involves the use of inhalers, of which there are two types: reliever and preventer inhalers. Reliever inhalers should be used when an asthma attack or mild symptoms present, while preventer inhalers are used daily to prevent asthma attacks from happening in the first place. Inhalers that contain both types are also available. Some asthma medications are in tablet form, which tend to be prescribed if inhalers are not proving to be effective. Many of these types of corticosteroids can also be administered through an injection.
What is atopic eczema?
Atopic eczema is the most common form of eczema in the UK and is sometimes referred to as atopic dermatitis. It usually presents in the first year of life, although it can develop in adulthood. Symptoms of atopic eczema include cracked skin that appears red and can be itchy. It can flare up as often as a few times a month, but in most cases clears up almost entirely in between. It typically appears on the elbows and knees, as well as the face and scalp in children. For some people, symptoms are mild, and the skin may just be slightly irritated and itchy occasionally. In other instances however, eczema may appear all over the body, causing soreness and severe itchiness.
What causes eczema?
Eczema is caused by a combination of triggers, the most common of which include irritants (including certain soaps and detergents), allergens (including dust, fur and pollen), the environment (cold weather and damp), hormones (such as just before your period), food allergies (including wheat and dairy allergies), clothing (such as synthetic materials) and stress or anxiety.
There is no cure for eczema, but medications can be highly effective in managing symptoms. The main treatments are moisturisers (emollients) and corticosteroid creams. Should these prove to be ineffective, antihistamines and dermatological treatments may also be considered. In addition to medications, self-care can be highly effective, such as not scratching the affected area and avoiding triggers.
What is Crohn’s disease?
Crohn’s disease is a potentially serious condition that affects the digestive system. It’s a type of irritable bowel disease (IBD), which is not the same as irritable bowel syndrome (IBS). Symptoms of Crohn’s can either be chronic (constant) or present in flare ups (symptoms that come and go). They include diarrhoea, blood in the faeces, weight loss, severe fatigue, cramping, aches and pains, fever, nausea, vomiting, reddened eyes that can be sore, ulcers of the mouth, painful rashes and joint pain. It’s not entirely clear what causes Crohn’s, but there is almost certainly a genetic component, with the condition being passed down from parents to children. The immune system is also thought to play a part, with smoking, stomach infections and gut bacterial imbalance all thought to heighten the risks involved. Diet isn’t considered to be a factor in triggering the condition.
How is Crohn’s disease treated?
While there is no cure for Crohn’s disease, there are a number of medications and lifestyle choices that can help to manage symptoms and the risks involved. Corticosteroids are typically one of the first treatments to be offered, which reduce inflammation and many of the symptoms associated with Crohn’s. A liquid diet may also be recommended, which may be offered to children and young adults. This can help reduce the risk of slow growth, which can occur in young people.
Immunosuppressants have proven to provide some relief from Crohn’s if corticosteroids are not effective. They may need to be taken over a course of several years to take effect.
In some cases, a resection operation may be performed if symptoms are severe. This involves stitching healthy parts of the bowel together and removing the infected areas. An ileostomy may also be suggested, which requires a colostomy bag to be fitted, allowing your bowel to recover over the course of a few months.
If you would like to discuss corticosteroids or any related conditions with a registered clinician, you can make an appointment via our online video consultation service from 9.30am-4.30pm, five days a week. Our clinicians can also issue referrals to specialists for treatment or fit notes, where appropriate.
What side effects can corticosteroids cause?
Side effects to corticosteroids are possible, particularly when taken over a long period of time. Side effects may differ from one corticosteroid to the next, so it is important that you discuss any risks with your prescribing clinician. The patient information leaflet that comes with your medication will also detail any potential side effects.
The following information relates to the corticosteroid dexamethasone. You should stop taking this medication and seek immediate medical help if you experience: severe depression, suicidal thoughts, mania, mood swings, anxiety, insomnia, confusion, memory loss, hallucinations, strange and disturbing thoughts, allergic reactions, skin rashes, difficulty breathing, collapsing, swelling of the face, lips, tongue, throat and difficulty swallowing.
Other side effects of dexamethasone may include: gut problems, throat ulcers, stomach ulcers, indigestion, nausea, vomiting, swollen stomach, increased appetite, hiccups, diarrhoea, inflamed pancreas: pain in the back or tummy, low blood sodium, potassium or calcium, water retention, high blood pressure, blood clots, osteoporosis, bone disease, recurring infections, wounds that heal more slowly, bruising, acne, glaucoma, cataracts, eye infections, visual disturbances, loss of vision, irregular or missing periods, stunted growth in children and teenagers, swelling of the face (called ‘Cushingoid’ or ‘moon’ face), worsening of diabetes, abnormal responses to severe stress, growth of extra body hair, fits, worsening epilepsy, severe headaches, insomnia, feeling depressed, extreme mood swings, worsening schizophrenia and feeling generally unwell.
Is it safe to take corticosteroids alongside other treatments?
It is essential that you make your prescribing doctor aware of any medications you are currently or have recently taken before starting a course of treatment with corticosteroids.
Dexamethasone may not be suitable for you if you are using any of the following treatments: Warfarin, hypertension medicine, diuretics, rifampicin, rifabutin, phenytoin, carbamazepine, phenobarbitone, primidone, antacids, carbenoxolone, aspirin, ibuprofen, NSAIDs, diabetes medications, treatments that lower potassium levels, treatments for myasthenia, indinavir, saquinavir, ritonavir, cobicistat, oral contraceptives aminoglutethimide, methotrexate, ephedrine and acetazolamide.
Warnings and precautions when using corticosteroids
In order for your prescribing clinician to ensure that any treatment is right for you, they will need to know about any conditions that you are currently experiencing or are prone to.
In the case of dexamethasone, this includes: severe depression and bipolar disorder (including if these conditions have occurred in family members), cancer of the blood, muscle cramping, muscle weakness, confusion, visual disturbances, shortness of breath, haematological malignancy, kidney or liver problems, high blood pressure, heart disease, osteoporosis, muscle weakness, glaucoma, peptic ulcers, mental illnesses, epilepsy, migraines, underactive thyroid gland, parasitical infections, tuberculosis (TB) and stunted growth.
Whilst taking corticosteroids, you should avoid contact with anyone presenting with symptoms of viral infections, including chicken pox, measles and shingles. If you think you have been in contact with anyone experiencing these conditions, you should contact your doctor immediately as you may need a specialist treatment.
Is it safe to take corticosteroids if you are pregnant or breastfeeding?
It depends on the corticosteroid that you’re using. You should inform your prescribing doctor if you are pregnant, planning on becoming pregnant or are currently breastfeeding before starting treatment with any corticosteroids.
What types of corticosteroids are available?
Corticosteroids are available in various forms, including tablets, syrups, liquids, nasal sprays, inhalers, injections, gels, lotions and creams.
Can corticosteroids affect my ability to drive?
In most cases, corticosteroids should not affect your ability to drive, but this may depend on your reaction to the medication itself. If you are uncertain, you should speak to your prescribing clinician, or wait to see how you react to the treatment before driving.
Can corticosteroids trigger allergic reactions?
If you have any allergies, particularly severe ones, you should make sure your prescribing clinician is made aware of them before starting treatment with corticosteroids. It’s possible for anyone to be allergic to any medication, as well as intolerant to ingredients (such as lactose).
If you are unsure, you can refer to the patient information leaflet that comes with your medication, which lists the ingredients of your treatment in full. You can also discuss any potential allergic responses with your prescribing doctor prior to use of the medication.
Is it safe to consume alcohol with corticosteroids?
It’s usually safe to consume alcohol whilst taking corticosteroids, although excessive drinking may cause irritation of the stomach. If you plan on consuming alcohol during treatment, you should ask your prescribing clinician for advice on this before starting to take the medication.
Can I buy corticosteroids over the counter?
In some cases, yes. Many topical creams, for example, are available to buy at your local pharmacy or supermarket. Stronger corticosteroids may require a prescription, however.
Can I buy corticosteroids online?
You can speak with one of our GMC-registered clinicians about corticosteroids and any related conditions via our online video consultation service. Our clinicians are available for appointments between 9.30am-4.30pm, Monday to Friday. They can also provide referrals to specialists for treatment and fit notes, where suitable.
Please note that if we are able to issue treatment for any of the above conditions, our prescriber or pharmacist will need to access your summary care record to make sure that you’re already taking it. We can only provide a prescription for corticosteroids if you are already using this treatment.