Prednisone and other corticosteroids

Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication.

By Mayo Clinic Staff

Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, lupus and asthma. But these drugs also carry a risk of serious side effects. Working with your doctor, you can take steps to reduce these side effects so that the benefits of corticosteroid treatment outweigh the risks.

How do corticosteroids work?

Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which are small glands that sit on top of your kidneys. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis and asthma.

Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues.

How are corticosteroids used?

Corticosteroid drugs are used to treat rheumatoid arthritis, lupus, asthma, allergies and many other conditions. They also treat Addison's disease, a condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs. And these drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients.

You can take corticosteroids:

  • By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as rheumatoid arthritis and lupus.
  • By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies.
  • Topically. Creams and ointments can help heal many skin conditions.
  • By injection. This form is often used to treat muscle and joint signs and symptoms, such as the pain and inflammation of tendinitis.

What side effects can corticosteroids cause?

Corticosteroids carry a risk of side effects, some of which can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact.

Side effects of oral corticosteroids

Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive and may include:

  • Elevated pressure in the eyes (glaucoma)
  • Fluid retention, causing swelling in your lower legs
  • High blood pressure
  • Problems with mood swings, memory and behavior and other psychological effects, such as confusion or delirium
  • Weight gain, with fat deposits in your abdomen, face and the back of your neck

When taking oral corticosteroids longer term, you may experience:

  • Clouding of the lens in one or both eyes (cataracts)
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
  • Thinning bones (osteoporosis) and fractures
  • Suppressed adrenal gland hormone production, which may result in a variety of signs and symptoms, including severe fatigue, loss of appetite, nausea and muscle weakness
  • Thin skin, bruising and slower wound healing

Side effects of inhaled corticosteroids

When using inhaled corticosteroids, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

  • Fungal infection in the mouth (oral thrush)
  • Hoarseness

If you gargle and rinse your mouth with water — don't swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Some researchers have speculated that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma.

Side effects of topical corticosteroids

Topical corticosteroids can lead to thin skin, red skin lesions and acne.

Side effects of injected corticosteroids

Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient's situation.

Reduce your risk of corticosteroid side effects

To get the most benefit from corticosteroid medications with the least amount of risk:

  • Try lower doses or intermittent dosing. Newer forms of corticosteroids come in various strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
  • Switch to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body's exposure to them and leading to fewer side effects.
  • Make healthy choices during therapy. When you're taking corticosteroid medications for a long time, talk with your doctor about ways to minimize side effects. Eat a healthy diet and participate in activities that help you maintain a healthy weight and strengthen bones and muscles.
  • Consider taking calcium and vitamin D supplements. Long-term corticosteroid therapy may cause thinning bones (osteoporosis). Talk with your doctor about taking calcium and vitamin D supplements to help protect your bones.
  • Take care when discontinuing therapy. If you take oral corticosteroids for a long time, your adrenal glands may produce less of their natural steroid hormones. To give your adrenal glands time to recover this function, your doctor may reduce your dosage gradually. If the dosage is reduced too quickly, your adrenal glands may not have time to recover and you may experience fatigue, body aches and lightheadedness.
  • Wear a medical alert bracelet. This or similar identification is recommended if you've been using corticosteroids for a long time.
  • Get regular checkups. If you're taking long-term corticosteroid therapy, see your doctor regularly to check for side effects.

Weigh the risks and benefits of corticosteroids

Corticosteroids may cause a range of side effects. But they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. If you work with your doctor to make choices that minimize side effects, you may achieve significant benefits with a reduced risk of such problems.

Oct. 09, 2019

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