STEROIDS
(dexamethasone, prednisolone)

What are steroids?

Steroids (corticosteroids) are hormones that occur naturally in the body.  Steroids suppress the body's immune system by blocking a chemical called histamine (released during an allergic reaction) and altering protein manufacture to decrease swelling and inflammation.  Steroids used to treat disease are man-made corticosteroids and are different to anabolic steroids sometimes used in sports.  Prednisolone is the most common steroid tablet, but dexamethasone is also used orally.  Oral steroids are used to treat many autoimmune conditions including allergies, asthma and neurological disorders such as CIDP, myasthenia gravis & NMO. 

How long do they take to work?

Dexamethasone and prednisolone work quickly, usually within a few days, but full benefits can take months in some cases.

What dose do I take?

Prednisolone is available in 1, 2.5 and 5 mg tablets either as a plain or enteric coated tablet.  Prednisolone is usually taken in the morning with food.  Often you will start on a high dose, e.g. 40-60 mg, and then slowly reduce to a lower daily (maintenance) dose to prevent disease relapse, but sometimes they may be withdrawn if the disease is judged to be ‘in remission’.  Dexamethasone may be given as high dose pulses of 40 mg daily for 4 days, every 4 weeks, for 6 months, and then stopped. 

Do not stop taking corticosteroids suddenly if you have been taking them for more than three weeks.  Your body normally makes its own steroid chemicals and when you take steroid tablets your body may reduce or stop making its own steroid chemicals.  If you suddenly stop steroid tablets you may experience withdrawal symptoms such as weakness, tiredness, feeling sick, vomiting, diarrhoea, abdominal pain, low blood sugar and low blood pressure which can cause dizziness, fainting or collapse.  These side effects can be serious or even life-threatening.  If the dose is reduced gradually, the body resumes its natural production of steroids and the symptoms do not occur, although some have to withdraw more slowly than others to avoid low energy and fatigue.

When taking steroid tablets you should carry a (blue) steroid treatment card which records how much steroid you are on and for how long you have been taking it, and a (red) steroid emergency card.  If you become unwell or are involved in an accident you may require extra steroids: ensure treating medics are aware that you take steroids regularly.

What do I do if I miss a dose?

If you miss 1 dose take the usual dose when it is next due.

What are the possible side effects?

The longer you are taking corticosteroids and the higher the dose, the more likely you are to have problems.  The most common side effects are:

Weight gain: usually around the middle and/or puffiness around the face;

Increased risk of duodenal and stomach ulcers: you are usually prescribed medication (lansoprazole, omeprazole) to reduce these effects; tell your doctor if you develop indigestion or abdominal (stomach) pains;

Osteoporosis: (thinning of the bones) you are usually prescribed calcium and vitamin D supplements, often with alendronic acid (taken weekly), to help prevent bone loss; aim do to at least 30 minutes of weight-bearing exercise each day and avoid smoking;

Sudden severe bone damage: rarely this occurs, usually affecting the hips, and may require surgical replacement;

Increased chance of infections: as steroids suppress the immune system you are more likely to develop infections (including COVID), and signs of infection can be disguised initially or the infection can become severe very quickly; if you come into contact with or develop chicken pox or shingles you should report to your doctor as soon as possible as you may need special treatment; other infections should be discussed with your GP as you may need early antibiotics;

Skin problems: acne, stretch marks, poor healing after injuries, thinning skin, and easy bruising;

Increased blood pressure: have your blood pressure checked regularly, it can be treated if it becomes high;

High blood sugar: your doctor may arrange a regular blood sugar test to check for diabetes, particularly if you have a family history of diabetes; cholesterol or potassium levels may also be affected;

Risk of blood clots: the risk of blood clots including heart attack, stroke and deep vein thrombosis or pulmonary embolism is increased on steroids;

Mood and behavioural changes: some people actually feel better in themselves when taking steroids, but they can aggravate mental health   problems such as depression, confusion or irritability, and some people may develop delusions or suicidal thoughts; seek medical advice if any worrying mood or behavioural changes occur;

Eye problems: steroids may exacerbate glaucoma or cataracts.

The above side-effects may affect some people who take steroids.  There is a balance between the risk of side-effects against the symptoms and damage that may result if not treated.  Side effects usually improve with a lower dose and/or stopping steroids.

Can I take other medicines along with steroids?

Dexamethasone or prednisolone may be prescribed along with other drugs in treating your condition.  You should not take anti-inflammatory painkillers e.g. ibuprofen (low dose aspirin is OK), as together they may increase the risk of a stomach ulcer developing.  Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, nurse or pharmacist.

Do I need any special checks while on Prednisolone?

Your doctor may check your general condition such as height, weight, blood pressure and sugar levels.  You may have a DEXA scan to assess bone density.  You should let your dentist know you are on steroids if you are having dental treatment.

Alcohol

It is safe to drink alcohol in moderation whilst on steroids, but it may aggravate indigestion and/or promote osteoporosis.

Vaccinations

Pneumovax and yearly flu vaccines are safe and recommended, but avoid 'live' vaccines such as that used against yellow fever.

What happens if I need an operation?

Let the doctor or nurse know so they can advise you what to do about your steroid therapy.  If you need an operation, you may need to increase the dose of corticosteroids for a short time.  This is because the body requires more steroids during physical stress (including if severe infections).

Are steroids OK if pregnant or breastfeeding?

Although it is best not to take steroids during pregnancy, it is safer than many drugs and the benefit of treatment may outweigh the risks.  Please discuss with your doctor.  Prednisolone appears in small amounts in breast milk but maternal doses of up to 40mg daily are unlikely to affect the infant.

3 Important things to remember whilst taking steroids

• Always carry steroid treatment (blue) and emergency (red) cards
• Never stop steroids abruptly or alter your dose without discussing with your doctor – if vomiting you may need replacement by injection
• If you have minor surgery or moderate illness (e.g. fever, antibiotics) while taking steroid tablets, the dose should be temporarily doubled

 

This information leaflet is designed to answer common questions patients ask about Prednisolone. Further information can be found in the information leaflet supplied by the manufacturer or from your specialist nurse, doctor or pharmacist.  If you have any concerns regarding your treatment, please contact your GP.