From the Guidelines
Synthetic corticosteroids are known to cause a wide range of significant side effects, including weight gain, mood changes, insomnia, high blood pressure, and elevated blood sugar, among others, as reported in a 2020 narrative review on glucocorticoids used in rheumatic disease 1.
Main Side Effects
The main side effects of synthetic corticosteroids can be categorized into several groups, including:
- Metabolic effects: weight gain, increased appetite, elevated blood sugar
- Psychological effects: mood changes, insomnia, anxiety, irritability
- Cardiovascular effects: high blood pressure, increased risk of cardiovascular problems
- Musculoskeletal effects: muscle weakness, bone loss (osteoporosis)
- Dermatological effects: acne, thinning skin, easy bruising
- Ophthalmological effects: cataracts, glaucoma
- Immunological effects: decreased immune function, increased risk of infections
Severity of Side Effects
The severity of side effects typically depends on dosage, duration of use, and individual susceptibility, with higher doses and longer use generally causing more pronounced effects, as noted in a 2019 guideline on immune thrombocytopenia 1.
Monitoring and Management
It is essential to monitor patients for potential corticosteroid side effects and conduct regular follow-up assessments to maintain control of the underlying condition, as recommended in a 2007 guideline on asthma management 1.
Key Considerations
- The risk of adverse effects appears to rise exponentially with the daily GC dose, with doses above 5 mg prednisolone equivalent per day associated with a higher risk of significant side effects 1.
- Close monitoring for hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis is crucial when using corticosteroids, as emphasized in the 2019 guideline on immune thrombocytopenia 1.
From the FDA Drug Label
Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. Musculoskeletal Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation (i.e., decreasing absorption and increasing excretion) and inhibition of osteoblast function. Neuro-Psychiatric Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that they affect the ultimate outcome or natural history of the disease. Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Ophthalmic Intraocular pressure may become elevated in some individuals If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored. Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of the corticosteroid withdrawal syndrome including, myalgia, arthralgia, and malaise. Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens The adverse effects of corticosteroids in pediatric patients are similar to those in adults
The main side effects of synthetic corticosteroids (steroids) are:
- Musculoskeletal effects: decreased bone formation, increased bone resorption, and osteoporosis
- Neuro-Psychiatric effects: psychiatric derangements, mood swings, personality changes, and severe depression
- Ophthalmic effects: elevated intraocular pressure
- Immune system suppression: increased risk of infection with any pathogen
- Withdrawal syndrome: myalgia, arthralgia, and malaise after prolonged therapy
- Other effects: gastrointestinal perforation, anaphylactoid reactions, and growth effects in pediatric patients 2, 2, 2
From the Research
Side Effects of Synthetic Corticosteroids
The use of synthetic corticosteroids, commonly referred to as steroids, can lead to various side effects due to their anti-inflammatory and immune-modulating properties. Some of the key side effects include:
- Hypertension and atherosclerosis
- Blood clotting
- Jaundice
- Hepatic carcinoma
- Tendon damage
- Psychiatric and behavioral effects
- Reduced fertility and gynecomastia in males [ 3 ]
- Sexual dysfunction
- Alterations of the cardiovascular system
- Liver toxicity [ 4 ]
Factors Influencing Side Effects
The occurrence and severity of side effects can depend on several factors, including:
- Dose and duration of treatment [ 5, 6 ]
- Route of administration [ 5 ]
- Preexisting medical conditions [ 5 ]
- Individual patient characteristics [ 4 ]
Management of Side Effects
To minimize the risk of side effects, it is essential to: