What are the side effects of corticosteroids (steroids)?

From the Guidelines

Corticosteroids can cause a wide range of side effects, including hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis, as well as impacting mental health, and patients should be closely monitored for these potential side effects while receiving corticosteroids 1.

Common Side Effects

• Hypertension
• Hyperglycemia
• Sleep and mood disturbances
• Gastric irritation or ulcer formation
• Glaucoma
• Myopathy
• Osteoporosis These side effects can occur regardless of the duration or type of corticosteroid selected, and it is essential for the treating physician to ensure that the patient is adequately monitored for these potential side effects 1.

Mental Health Impact

Given the potential impact of corticosteroids on mental health, the treating physician should assess health-related quality of life (HRQoL), including depression, fatigue, mental status, etc., while patients are receiving corticosteroids 1.

Additional Risks

Other potential side effects of corticosteroids include lipodystrophy, cardiovascular disease, cerebrovascular disease, impaired wound healing, cataracts, peptic ulcers, infection, mood disorder, ophthalmologic disorders, skin disorders and alopecia, menstrual disorders and hormonal changes, avascular necrosis, pancreatitis, and diabetogenesis 1.

Clinical Considerations

When prescribing corticosteroids, doctors should use the lowest effective dose for the shortest time possible to minimize these risks, and patients should be informed about the potential side effects and monitored closely for any adverse reactions 1.

From the FDA Drug Label

The following adverse reactions have been reported with prednisone or other corticosteroids: Allergic Reactions anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema Cardiovascular System bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, ECG changes caused by potassium deficiency, edema, fat embolism, hypertension or aggravation of hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, necrotizing angiitis, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis Dermatologic acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema, angioneurotic edema, atrophy and thinning of skin, dry scaly skin, ecchymoses and petechiae (bruising), erythema, facial edema, hirsutism, impaired wound healing, increased sweating, Karposi’s sarcoma, lupus erythematosus-like lesions, perineal irritation, purpura, rash, striae, subcutaneous fat atrophy, suppression of reactions to skin tests, striae, telangiectasis, thin fragile skin, thinning scalp hair, urticaria Endocrine amenorrhea, postmenopausal bleeding or other menstrual irregularities, decreased carbohydrate and glucose tolerance, development of cushingoid state, diabetes mellitus (new onset or manifestations of latent), glycosuria, hyperglycemia, hypertrichosis, hyperthyroidism, hypothyroidism, increased requirements for insulin or oral hypoglycemic agents in diabetics, lipids abnormal, moon face, negative nitrogen balance caused by protein catabolism, secondary adrenocortical and pituitary unresponsiveness Fluid and Electrolyte Disturbances congestive heart failure in susceptible patients, fluid retention, hypokalemia, hypokalemic alkalosis, metabolic alkalosis, hypotension or shock-like reaction, potassium loss, sodium retention with resulting edema Gastrointestinal abdominal distention, abdominal pain, anorexia which may result in weight loss, constipation, diarrhea, elevation in serum liver enzyme levels (usually reversible upon discontinuation), gastric irritation, hepatomegaly, increased appetite and weight gain, nausea, oropharyngeal candidiasis, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine, ulcerative esophagitis, vomiting Hematologic anemia, neutropenia (including febrile neutropenia) Metabolic negative nitrogen balance due to protein catabolism Musculoskeletal arthralgias, aseptic necrosis of femoral and humeral heads, increase risk of fracture, loss of muscle mass, muscle weakness, myalgias, osteopenia, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture (particularly of the Achilles tendon), vertebral compression fractures Neurologic convulsions, delirium, dementia, depression, dizziness, EEG abnormalities, emotional instability and irritability, euphoria, hallucinations, headache, impaired cognition, incidence of severe psychiatric symptoms, increased intracranial pressure with papilledema, increased motor activity, insomnia, ischemic neuropathy, long-term memory loss, mania, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychiatric disorders including steroid psychoses or aggravation of preexisting psychiatric conditions, restlessness, schizophrenia, verbal memory loss, vertigo, withdrawn behavior Ophthalmic blurred vision, cataracts (including posterior subcapsular cataracts), central serous chorioretinopathy, establishment of secondary bacterial, fungal and viral infections, exophthalmos, glaucoma, increased intraocular pressure, optic nerve damage, papilledema Other abnormal fat deposits, aggravation/masking of infections, decreased resistance to infection, hiccups, immunosuppression, increased or decreased motility and number of spermatozoa, malaise, moon face, pyrexia

The side effects of corticosteroids (steroids) include:

• Allergic reactions: anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema
• Cardiovascular effects: bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure
• Dermatologic effects: acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema
• Endocrine effects: amenorrhea, postmenopausal bleeding or other menstrual irregularities, decreased carbohydrate and glucose tolerance
• Fluid and electrolyte disturbances: congestive heart failure in susceptible patients, fluid retention, hypokalemia
• Gastrointestinal effects: abdominal distention, abdominal pain, anorexia, constipation, diarrhea
• Hematologic effects: anemia, neutropenia (including febrile neutropenia)
• Metabolic effects: negative nitrogen balance due to protein catabolism
• Musculoskeletal effects: arthralgias, aseptic necrosis of femoral and humeral heads, increase risk of fracture
• Neurologic effects: convulsions, delirium, dementia, depression, dizziness
• Ophthalmic effects: blurred vision, cataracts (including posterior subcapsular cataracts), central serous chorioretinopathy
• Other effects: abnormal fat deposits, aggravation/masking of infections, decreased resistance to infection, hiccups, immunosuppression 2

From the Research

Side Effects of Corticosteroids

The use of corticosteroids is associated with several side effects, including:

• Increased risk of osteoporosis and fragility fractures 3, 4, 5
• Increased susceptibility to infections, especially chickenpox 6
• Serious side effects, such as diabetes and psychiatric disorders 5
• Metabolic effects, as all cells use the same glucocorticoid receptor 6
• Errors of judgment on high doses 6

Minimizing Side Effects

To minimize the side effects of corticosteroids, the following suggestions can be made:

• Use the minimum dose necessary to control the disease 6
• Take a single morning dose 6
• Make early dietary modifications, such as a low-calorie, low-sodium, and high-potassium diet 6
• Be aware of possible errors of judgment on high doses 6
• Regularly review the patient to assess the response to treatment and adjust the dose as needed 6

Specific Side Effects

Specific side effects of corticosteroids include:

• Osteoporosis, which can be increased by the use of continuous systemic corticosteroids (SG) or long-term high-dose inhaled corticosteroids (ICS) 3, 4
• Infections, which can be increased by the use of corticosteroids, especially in patients with asthma 6, 5
• Diabetes, which can be increased by the use of long-term oral corticosteroids (OCS) 5
• Psychiatric disorders, which can be increased by the use of long-term oral corticosteroids (OCS) 5