What are the main side effects of synthetic corticosteroids (steroids)?

From the Guidelines

Synthetic corticosteroids are associated with significant side effects, including weight gain, increased blood sugar, osteoporosis, and immunosuppression, particularly when used long-term or at high doses, as evidenced by recent studies such as 1 and 2. The main side effects of synthetic corticosteroids can be categorized into several groups, including:

• Hormonal imbalances, such as decreased testosterone production in men and menstrual irregularities in women
• Cardiovascular problems, including increased risk of heart attack, stroke, and high blood pressure
• Psychological effects, such as mood swings, aggression, and depression
• Physical changes, including acne, hair loss, gynecomastia in men, and masculinization in women
• Other common side effects, including fluid retention, increased risk of infections, tendon injuries, and sleep disturbances These side effects are more likely to occur with prolonged use or high doses of corticosteroids, as seen in studies such as 2 and 3. The severity of side effects typically depends on dosage, duration of use, and individual susceptibility, with some individuals being more prone to certain side effects than others, as noted in 1 and 4. It is essential to weigh the benefits and risks of corticosteroid use and to monitor patients closely for potential side effects, as recommended in guidelines such as 5 and 2. In general, the use of synthetic corticosteroids should be carefully considered and monitored, with the goal of minimizing side effects while achieving therapeutic benefits, as supported by the most recent and highest quality studies, including 1 and 2.

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 6, 7, 8

From the Research

Main Side Effects of Synthetic Corticosteroids

The main side effects of synthetic corticosteroids (steroids) include:

• Weight gain 9, 10
• Osteoporosis 9, 10
• Diabetes mellitus 9, 10
• Mood changes, such as hypomania, mania, and depression 9, 10
• Cognitive changes, particularly deficits in verbal or declarative memory 9, 10
• Psychosis 10
• Hyperglycemia 11
• Elevated blood pressure 11
• Mood and sleep disturbance 11
• Sepsis 11
• Fracture 11
• Venous thromboembolism 11

Management of Side Effects

To minimize the side effects of corticosteroids, the following measures can be taken:

• Use the minimum dose necessary to control the disease 12
• Consider the factors summarized in Table 1 before embarking on a long-term course of corticosteroids 12
• Provide a full discussion with the patient to explain the benefits and risks of corticosteroid treatment 12
• Advise patients not to stop taking corticosteroids suddenly and to see a doctor if they become unwell 12
• Inform patients of the increased susceptibility to infections, especially chickenpox 12
• Discuss the serious side effects that may occur and provide a patient information leaflet 12
• Suggest a single morning dose, early dietary modification, and awareness of possible errors of judgment on high doses 12