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Steroids: Wonder drugs, but not without risks: steroid drugs relieve inflammation, but they should be used judiciously to minimize harmful side effects.

The first steroid medication, cortisone, earned the reputation of a "wonder drug" more than 60 years ago when it was found to be effective in treating rheumatoid arthritis. Since then, the number of diseases and disorders treated with steroids has grown exponentially, to include asthma, colitis and other intestinal disorders, psoriasis, lupus, breathing disorders, and allergic conditions.

Unfortunately, the list of possible side effects also has grown. A patient needs to be aware of these effects when weighing the costs and benefits of steroid use, and. that, in some cases, there are nonsteroidal alternatives.

Steroids 101

"Basically, steroid drugs reduce inflammation in the body, whether in the form of rheumatoid arthritis (inflammation of the joints), colitis (the bowel), asthma (lungs), or psoriasis (the skin)," explains Linda Russell, MD, assistant professor at Weill Cornell Medical College. Commonly used steroid drugs include cortisone, prednisone, and hydrocortisone (see "What You Should Know" for a list of steroid drugs).

Steroid drugs come in several forms. They may be applied topically, as a cream, spray, or lotion on the skin, or taken in pill form. They can be injected into the knee or administered epidurally into the spine. Generally speaking, the lowest dose is best, and local administration (a knee or elbow injection, for example), is preferable to systemic delivery via pills or epidural injection. Ultimatdy, however, it is the type and location of the disease that dictates the method of administration that is chosen.

Risky side effects for some

* Side effects are the Achilles' heel of steroids. Side effects may include:

* Fluid retention (typically in the form of swollen ankles)


* Nausea and/or vomiting

* Dizziness

* Glaucoma

* Cataracts

* Hypertension

* Mood changes, depression, anxiety

* Type 2 diabetes

* Bone thinning, sometimes resulting in osteoporosis (rare)

* Avascular necrosis (insufficient blood supply to the bones that can cause bone collapse), which can necessitate a joint replacement (very rare)

"The longer you're taking steroids, and the higher the dose, the worse the side effects are," said Dr. Russell. "Not everyone experiences side effects, but they can occur."

But, how long is "long"? If you take a steroid once a year, the side effects will probably be minimal, according to Dr. Russell. However, if you start taking them once a month, you may see side effects fairly soon. The same is true if you take them daily for more than two weeks.

Dr. Russell cautions against panicking, however. "If you had poison ivy and took steroids for five days and then stopped, you probably wouldn't have any side effects. Also, the effects are different in different people."

Topical steroids are much less risky than oral steroids. Using a low-dose, over-the-counter topical cream for bug bites and minor rashes is essentially safe, says Dr. Russell. However, concerns about side effects rise with a systemic disease such as rheumatoid arthritis, which may require frequent dosing with high-potency steroids.

Consider nonsteroidal options

Any use of high-dose steroids should be preceded by multiple conversations between a woman and her physician that include a discussion of alternative options. When treating rheumatoid arthritis, for example, Dr. Russell says that physicians now try to use steroids infrequently, and then only if the patient is having what is known as a "flare." Or, steroids are used temporarily, until the patient can be put on an effective course of nonsteroidal medication.

"We use far less cortisone than we did 20 years ago for rheumatoid arthritis," notes Dr. Russell. "There are now many good nonsteroidal medications that control inflammation."

Similarly, in treating asthma, physicians often first try nonsteroidal medications. If the patient requires steroids, they will start with steroid inhalers, which are safer than taking oral prednisone.

"For all conditions, you always want to explore what other medications are available that are safer than prednisone or cortisone," advises Dr. Russell.


Steroid drugs include the following:

* Becloemthasone

* Betamethasone

* Budesonide

* Ciclesonide

* Cortisone

* Dexamethasone

* Ethamethasoneb

* Flunisonide

* Fluticasone

* Hydrocortisone

* Methylprednisolone

* Mometasone

* Prednisolone

* Prednisone

* Triamcinolone
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Title Annotation:MEDICATIONS
Publication:Women's Health Advisor
Date:Dec 1, 2014
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