Glucocorticoids are medications that are prescribed to treat inflammation in the body that relates to various conditions.
- Treat inflammation.
- Not related to anabolic steroids
- Available in many different forms.
If you are concerned about any health condition relating to inflammation, you can speak with one of our GMC-registered clinicians via our online video consultation service. They are available for appointments between 9.30am-4.30pm, Monday to Friday.
What are Glucocorticoids?
Glucocorticoids are part of the corticosteroid family. They are sometimes referred to as steroids, but are not the same as anabolic steroids, which are sometimes used without medical consultation to improve muscle mass and boost athleticism. They are typically prescribed to treat asthma, Crohn’s disease and rheumatoid arthritis.
What is asthma?
Asthma is a common condition in the UK that affects the lungs. It can first present at any age, but is usually triggered in childhood. Symptoms of asthma include difficulty breathing, wheezing, coughing and tightness in the chest. Some of the more serious cases of asthma result in asthma attacks, which may also cause a rapid heartbeat, drowsiness, fainting, confusion, dizziness, fatigue and the lips and fingers turning blue.
What causes asthma?
It’s not clear what causes asthma, but inflammation of the airways, which triggers a build-up of mucus, is thought to include a genetic component. Pollution may also play a part for many people, as well as environmental factors, such as allergies, mould, smoke and changes in the weather. Exercise and certain medications may worsen symptoms in some cases.
How is asthma treated?
While there is no cure for asthma, medication, lifestyle changes and avoidance of triggers can all help people to manage the condition. Inhalers, of which there are two types, are used to tackle symptoms, whether to prevent them from occurring in the first place (preventer inhalers) or to relieve symptoms that are already present (reliever inhalers). Some inhalers may contain both types of treatment (combination inhalers).
Reliever inhalers are typically blue in colour, contain a bronchodilator (which relaxes the airways) and work within a few minutes. If you are using your reliever inhaler more than a few times a week, a preventer inhaler will likely be prescribed. Preventer inhalers are often brown in colour and contain a steroid based active ingredient, which reduces inflammation. These inhalers should be used even when you are not presenting with symptoms.
Other treatments include leukotriene receptor antagonists (LTRAs), which prevent asthma attacks from occurring. They are available in tablet form or as a syrup.
Theophylline is a medication that is prescribed when other treatments have proved ineffective. It should be taken daily to prevent attacks from occurring. Steroids may also be issued in tablet form to relieve or prevent attacks. Due to the side effects associated with long term use of steroids, however, this will likely be a last resort that is prescribed when other treatments haven’t been successful.
What is Crohn’s disease?
Crohn’s disease is a condition that affects the digestive system. It’s an inflammatory bowel disease (IBD) which should not be confused with irritable bowel syndrome (IBS). Symptoms of the condition can be ever present or come and go in “flare ups” that occur every few weeks or months. They include fatigue, diarrhoea, stomach cramps and stomach aches, blood in your stools and weight loss. Less common symptoms may include ulcers of the mouth, pain in the joints, sore eyes, nausea, vomiting and patches of irritated skin.
What causes Crohn’s disease is unclear, but there is thought to be a strong genetic factor as the risk of it developing is significantly increased if a family member has it. Smoking is also thought to be a risk factor, as well as previous gut infections and an imbalance of gut flora (bacteria in the intestines). There is currently no evidence to suggest that diet plays any role in triggering the condition, or making it more severe.
How is Crohn’s disease treated?
While there is no cure for Crohn’s disease, symptoms can be managed well with the right treatment. It should be noted that it may take some time to determine the best form of treatment from one person to the next, as no two people are the same. The most common medication prescribed is steroids, which reduces inflammation when taken daily. Steroids may start providing relief within a matter of a few days, but can take as long as a few months to become fully effective.
In children, use of steroids can result in slow growth, but this can be tackled by consuming nutrient dense drinks rather than eating normal solid foods for a few weeks. In some cases, immunosuppressants may be recommended, to prevent the immune system from impacting on the condition. These should be taken orally and daily over the course of several years to help manage symptoms.
Surgery will only be considered in the most severe cases, and when other treatments have proven ineffective. This may include a resection, which involves removing the diseased part of the bowel and reattaching the healthy parts. An ileostomy is another option, where the area affected is bypassed with use of a colostomy bag, where faeces is collected, allowing the gut to heal. While these treatment methods will provide some relief, symptoms will likely return after some time.
What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic and long-term condition that affects the body’s joints. The main symptoms include pain and swelling of the joints, which gets worse over the course of a few weeks when flare-ups occur. The pain is often worse in the morning or after prolonged periods of rest. Joints may also feel stiff, often leaving you unable to fully bend your fingers, knees or ankles, which are typically the first areas to present with symptoms.
Joints may also radiate heat when they become swollen, with small lumps, called nodules, appearing under the skin. Less common symptoms include fatigue, sweating, loss of appetite, fever, dry eyes, chest pain and weight loss.
Rheumatoid arthritis is caused by a reaction of the immune system, which attacks the lining of the joints rather than invading substances, bacteria or viruses. It’s not clear why the immune system reacts in this way, but genetics are thought to increase the risk of the condition developing. Hormones may also play a role, with women more likely to have rheumatoid arthritis than men.
How is rheumatoid arthritis treated?
There is no cure for rheumatoid arthritis, but it can be managed using a variety of treatment methods when flare ups occur, including medications, surgery and lifestyle changes.
Disease-modifying anti-rheumatic drugs (DMARDs) are the most common treatments for the condition. They work by blocking chemicals that cause the immune-reaction, and slow the progress of the disease. Newer forms of drugs, known as biological treatments, may be prescribed alongside these treatments, which are administered via injection.
In more severe cases, JAK inhibitors may be prescribed. These are typically only provided when other treatments haven’t been effective.
Painkilling medications are often prescribed alongside the treatments listed above to help manage symptoms. There are many different types of painkillers available, but non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, such as glucocorticoids, are the most common. Steroids are however not particularly suitable for long-term use due to the side effects associated with them.
If you would like to speak to a registered clinician about glucocorticoids, or any related conditions, our online video consultation service is available from 9.30am to 4.30pm, five days a week. Our clinicians can also issue fit notes and referral to specialists for treatment, where suitable.
What side effects can glucocorticoids have?
Like all medications, glucocorticoids can cause some side effects, and it is important to be aware of these before you start using this treatment. You can discuss any potential side effects with your prescribing clinician, and refer to the patient information leaflet that comes with your medication for a list of specific side effects for your medication.
Because there are different types of glucocorticoids available, the risk of side effects may vary according to your specific treatment, as well as the strength of the medication. The following information relates to the glucocorticoid prednisone only.
You should stop taking prednisone and seek medical attention if you notice any of the following symptoms, as they can indicate that you are experiencing an allergic reaction: swollen face, tongue or body, shortness of breath, shock and collapsing.
Other serious side effects that require immediate medical attention include severe abdominal pain and skin ulcers.
Steroids can cause mental health difficulties in around 5% of people. You should speak to your prescribing clinician if you notice any of the following: depression, suicidal thoughts, mania, mood swings, anxiety, insomnia, memory loss, confusion, hallucinations and strange and frightening thoughts.
Other possible side effects include tiredness, an increased number of white blood cells, blood clotting, nausea, vomiting, heart problems, shortness of breath, convulsions, dizziness, vertigo, headaches, pressure in the brain, sleeplessness, thinning of the skin, bruising, stretch marks, patches of skin reddening, itching, rash, hives, acne, extra hair growth, slow healing of wounds, increased sweating, reactions to skin tests, reduction of growth in babies, children and adolescents, irregular menstrual periods, weight gain, increased blood sugar, carbohydrate imbalance in diabetes, euphoria, dependency on treatment, general unwell feeling, vision problems, worsening of schizophrenia, worsening of epilepsy, stroke risk increased, blurred vision, glaucoma, cataracts, pressure on the nerve to the eye, thinning of eye tissue, bulging eyes, worsening of viral or fungal infections, risk of contracting infection is increased, existing infections worsening, signs of infection masked, previous infections reactivated, muscle wasting of the upper arms and legs and muscle pain.
Can glucocorticoids cause interactions with other medicines?
Because all medications can interact with other substances, it’s essential that you tell your prescribing clinician about any medications you are currently or have recently taken before starting treatment. A full list of possible interactions can be found on the patient information leaflet that comes with your medication. The following information relates to the glucocorticoid prednisone.
Prednisone may not be suitable if you are taking any of the following: antifungals, antibiotics, antiepileptic drugs, oestrogens, contraceptive pills, HRT, thiazide diuretics hypertension medications, anticoagulants, carbenoxolone, asthma medications, antimuscarinics, anticholinergics, immunosuppressants, antacids, diabetes treatments, ciclosporin, cardiac glycosides, NSAIDs, mifepristone, cytotoxic drugs, vaccinations, somatropin, acetazolamide, loop diuretics, theophylline, antithyroids and isoniazid.
Some treatments, such as HIV medications, may increase the effects of glucocorticoids and require careful monitoring from your prescribing doctor.
Warnings and precautions when taking glucocorticoids
If you are experiencing or are prone to any other health conditions, you should inform your doctor so that they will be able to safely prescribe the right treatment for you. You should avoid use of prednisone entirely if you have any of the following: an allergy to prednisolone, cold sores that affect the eyes, an untreated infection, galactose or lactose intolerance or glucose-galactose malabsorption.
Your prescribing clinician may recommend an alternative treatment if any of the following apply to you: Tuberculosis (TB); high blood pressure; a heart condition; liver or kidney problems; scleroderma; diabetes; osteoporosis; epilepsy; stomach ulcers; taken steroids before and had muscular problems; are receiving treatment for myasthenia gravis; have ever had blood clots; you are planning to have a vaccination; Cushing’s disease; hypothyroidism; Duchenne’s muscular dystrophy; inflammatory bowel disease; eye disease; you are undergoing immunosuppression therapy.
Are glucocorticoids a suitable treatment for children and adolescents?
Treatment with glucocorticoids in children and adolescents can result in slow growth rate. Therefore, your prescribing clinician may need to adjust the dosage of the medication to minimise this risk. You should speak with your prescribing clinician if you have any concerns, including whether another treatment may be more suitable.
Are glucocorticoids safe to take if you are pregnant or breastfeeding?
If you are pregnant, think you may be pregnant or are planning on becoming pregnant, it’s important that you should speak to your prescribing doctor before starting treatment with glucocorticoids.
What types of glucocorticoids are available?
Glucocorticoids are available in various forms, including oral (syrups and tablets), inhalers, nasal sprays, topical (creams and gels) and injections.
Can glucocorticoids interact with food, drink or alcohol?
It depends on the specific treatment. You should avoid eating liquorice whilst taking steroid tablets. If you are unsure, consult your prescribing clinician or refer to the patient information leaflet that comes with your medication.
Can glucocorticoids affect my ability to drive?
Some treatments may cause dizziness, and so you should determine how your specific treatment affects you before operating any form of heavy machinery.
Am I allergic to any of their ingredients?
This may depend on the type of glucocorticoid that you are using. You should speak with your doctor before starting treatment about any allergies you have. You can also refer to the patient information leaflet that comes with your medication, which lists all of its ingredients. Some tablets contain may lactose.
Can I buy glucocorticoids over the counter?
Some forms of glucocorticoids are available to buy over the counter, such as certain topical treatments, but most are available on prescription only.
How do I buy glucocorticoids online?
You can discuss glucocorticoids with a GPhC-registered clinician via our online video consultation service. Our registered clinicians are available for appointments between 9.30am-4.30pm, Monday to Friday. They can also issue referral to specialists for treatment and fit notes, where appropriate.
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 glucocorticoids if you are already using this treatment.