What are the side effects of corticosteroids?

July 5, 2024


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What are the side effects of corticosteroids?

Corticosteroids are potent anti-inflammatory and immunosuppressive medications used to treat a variety of conditions, including autoimmune diseases, allergic reactions, and chronic inflammatory conditions. Despite their effectiveness, corticosteroids can cause a range of side effects, especially when used at high doses or for prolonged periods. The side effects can be categorized into short-term and long-term effects.

Short-Term Side Effects

  1. Gastrointestinal Issues
    • Nausea and Vomiting: Common gastrointestinal symptoms.
    • Stomach Ulcers: Increased risk of developing peptic ulcers, particularly when combined with NSAIDs.
    • Indigestion: General discomfort and bloating.
  2. Mood and Behavioral Changes
    • Mood Swings: Rapid changes in mood, including irritability and anxiety.
    • Insomnia: Difficulty sleeping or disturbances in sleep patterns.
    • Euphoria or Psychosis: Rarely, high doses can lead to euphoria or even psychosis.
  3. Increased Blood Sugar Levels
    • Hyperglycemia: Corticosteroids can cause elevated blood glucose levels, particularly in diabetic patients.
  4. Fluid Retention and Weight Gain
    • Edema: Swelling due to fluid retention, especially in the lower limbs.
    • Weight Gain: Rapid weight gain due to increased appetite and fluid retention.
  5. Elevated Blood Pressure
    • Hypertension: Temporary increase in blood pressure due to fluid retention and other metabolic effects.
  6. Increased Risk of Infections
    • Immunosuppression: Reduced immune response can increase susceptibility to infections.

Long-Term Side Effects

  1. Musculoskeletal Effects
    • Osteoporosis: Decreased bone density leading to an increased risk of fractures.
    • Avascular Necrosis: Bone death due to reduced blood supply, particularly in the hip joints.
    • Myopathy: Muscle weakness and atrophy.
  2. Metabolic Effects
    • Hyperglycemia: Prolonged elevated blood glucose levels can lead to diabetes.
    • Dyslipidemia: Increased levels of cholesterol and triglycerides.
  3. Endocrine Effects
    • Adrenal Suppression: Long-term use can suppress the hypothalamic-pituitary-adrenal (HPA) axis, leading to adrenal insufficiency.
    • Cushingoid Features: Physical changes such as a moon face, buffalo hump, and central obesity due to prolonged corticosteroid use.
  4. Skin and Hair Changes
    • Skin Thinning: The skin becomes thin and fragile, leading to easy bruising and slow wound healing.
    • Acne and Hirsutism: Increased acne and excessive hair growth.
    • Striae: Development of stretch marks.
  5. Ocular Effects
    • Cataracts: Increased risk of cataract formation.
    • Glaucoma: Elevated intraocular pressure leading to glaucoma.
  6. Cardiovascular Effects
    • Hypertension: Persistent high blood pressure can lead to cardiovascular disease.
    • Increased Risk of Atherosclerosis: Long-term corticosteroid use can contribute to the development of atherosclerosis.
  7. Psychiatric Effects
    • Depression and Anxiety: Chronic use can contribute to mood disorders.
    • Psychosis: In rare cases, long-term use can lead to severe psychiatric conditions.

Special Considerations

  1. Tapering Off
    • Gradual Reduction: To prevent withdrawal symptoms and adrenal insufficiency, corticosteroids should be tapered off gradually rather than stopped abruptly.
  2. Monitoring
    • Regular Check-ups: Patients on long-term corticosteroid therapy should have regular monitoring for blood pressure, blood glucose levels, bone density, and other potential side effects.
  3. Preventive Measures
    • Calcium and Vitamin D Supplements: To prevent osteoporosis.
    • Bone Density Scans: Regular scans to monitor bone health.
    • Lifestyle Modifications: Diet and exercise to counteract weight gain and maintain bone health.

Conclusion

While corticosteroids are highly effective for managing a range of medical conditions, their use is associated with significant short-term and long-term side effects. The risk of these side effects underscores the importance of using the lowest effective dose for the shortest possible duration and closely monitoring patients on corticosteroid therapy. In cases where long-term use is necessary, preventive measures and regular check-ups are essential to manage and mitigate these side effects.


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