- Definition
- Drug List
- Uses
- Side Effects
- Differences
- Drug Interactions
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What are corticosteroids?
Corticosteroids are steroid hormones that are either produced by the body or are man-made.
Systemic corticosteroids refer to corticosteroids that are given orally or by injection and distribute throughout the body. It does not include corticosteroids used in the eyes, ears, or nose, on the skin or that are inhaled, although small amounts of these corticosteroids can be absorbed into the body.
Naturally occurring corticosteroids, hydrocortisone (Cortef) and cortisone, are produced by the outer portion of the adrenal gland known as the cortex (hence the name, corticosteroid). Corticosteroids are classified as either:
- glucocorticoids (anti-inflammatory) which suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins, or as
- mineralocorticoids (salt retaining) that regulate the balance of salt and water in the body.
Synthetic corticosteroids mimic the actions of naturally occurring corticosteroids and may be used to replace corticosteroids in people with adrenal glands that are unable to produce adequate amounts of corticosteroids, however, they more often are used in higher-than-replacement doses to treat diseases of immunity, inflammation or salt and water balance.
Examples of synthetic corticosteroids include:
- bethamethasone, (Celestone)
- prednisone (Prednisone Intensol)
- prednisolone (Orapred, Prelone)
- triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog)
- methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- dexamethasone (Dexamethasone Intensol, DexPak 10 Day, DexPak 13 Day, DexPak 6 Day).
Some glucocorticoids also in addition to their anti-inflammatory actions have salt retaining properties but they are used mostly for their anti-inflammatory effects. Fludrocortisone (Florinef), a synthetic mineralocorticoid has strong salt retaining effects with significant anti-inflammatory actions, and is used mostly for it's salt retaining capabilities.
What are examples of oral and injectable corticosteroids?
The following is a list of the systemic (oral and injectable) corticosteroids that are available in the United States:
Glucocorticoids:
- hydrocortisone (Cortef)
- cortisone
- ethamethasoneb (Celestone)
- prednisone (Prednisone Intensol)
- prednisolone (Orapred, Prelone)
- triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog) Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- dexamethasone (Dexamethasone Intensol, DexPak 10 Day, DexPak 13 Day, DexPak 6 Day)
Mineralocorticoid:
- Fludrocortisone (Florinef)
What are corticosteroids used for?
Corticosteroids belonging to the glucocorticoid class influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as:
- arthritis (for example, rheumatoid arthritis),
- colitis (ulcerative colitis, and Crohn's disease),
- asthma,
- bronchitis,
- some situations involving skin rashes,
- allergic or inflammatory conditions involving the nose and eyes.
Glucocorticoid corticosteroids are used to treat systemic lupus, severe psoriasis, leukemia, lymphomas, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions.
Fludrocortisone (Florinef), a potent systemic oral mineralocorticoid corticosteroid is used to treat Addison's disease and diseases that cause salt loss as in congenital adrenal hyperplasia. It also is used commonly to treat conditions of low blood pressure (hypotension) although this is not a Food and Drug Administration (FDA) approved indication.
SLIDESHOW
See SlideshowWhat are the side effects of corticosteroids?
Corticosteroids have many side effects that can be mild or serious. These side effects are more apparent when corticosteroids are used at higher doses or for extended periods of time. This section lists only some of these side effects of corticosteroids.
Corticosteroids can:
- cause sodium (salt) and fluid to be retained in the body and cause weight gain or swelling of the legs (edema)
- High blood pressure
- Loss of potassium
- Headache
- Muscle weakness
- Puffiness of the face (moon face)
- Facial hair growth
- Thinning and easy bruising of the skin
- Slow wound healing
- Glaucoma
- Cataracts
- Ulcers in the stomach and duodenum
- Loss of diabetes control
- Menstrual irregularity
- "Buffalo hump," a condition described as a rounding of the upper back
The prolonged use of corticosteroids can cause obesity, growth retardation in children, and even lead to convulsions and psychiatric disturbances. Reported psychiatric disturbances include depression, euphoria, insomnia, mood swings, and personality changes. Psychotic behaviors also have been reported.
Corticosteroids, since they suppress the immune system, can lead to an increase in the rate of infections and reduce the effectiveness of vaccines and antibiotics.
The long term use of corticosteroids may cause osteoporosis which can result in bone fractures.
Shrinking (atrophy) of the adrenal glands can be caused by the long term use of corticosteroids resulting in the body's inability to produce cortisol, the body's natural corticosteroid, when the systemic corticosteroids are discontinued.
Another condition which can result from the long term use of corticosteroids is adrenal necrosis of the hip joints, a very painful and serious condition that may require surgery. Any symptoms of hip or knee pain in people taking corticosteroids require prompt medical attention.
Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis.
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What are the differences between the types of systemic corticosteroids?
Corticosteroids differ in their relative amount of anti-inflammatory and mineralocorticoid potency and they are used according to these effects. Among the systemic (oral and injectable) corticosteroids, fludrocortisone (Florinef) has the most significant mineralocorticoid (salt retaining) actions and is best used for this effect despite it's strong anti-inflammatory action.
Other systemically available corticosteroids have mostly glucocorticoid effects, and are used for their anti-inflammatory activities. Examples of these include the naturally occurring hydrocortisone (Cortef) and cortisone, and the synthetic corticosteroids including:
- bethamethasone (Celestone)
- prednisone (Prednisone Intensol)
- prednisolone (Orapred, Prelone)
- triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog)
- methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- dexamethasone (Dexamethasone Intensol, DexPak 10 Day, DexPak 13 Day, DexPak 6 Day).
Among all glucocorticoids, prednisone is not effective in the body unless it is converted to prednisolone by enzymes in the liver. For this reason prednisone may not be very effective in people with liver disease because of a reduction in their ability to convert prednisone to prednisolone.
What drugs interact with corticosteroids?
Certain drugs such as troleandomycin (TAO), erythromycin (Ery-Tab, EryPed 200), and clarithromycin (Biaxin) and ketoconazole (Nizoral) can reduce the ability of the liver to metabolize (breakdown) corticosteroids and this may lead to an increase in the levels and side effects of corticosteroids in the body. On the other hand, phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may reduce the blood levels of corticosteroids by increasing the breakdown of corticosteroids by the liver. This may necessitate an increase of corticosteroid dose when they are used in combination with these drugs.
- Estrogens have been shown to increase the effects of corticosteroids possibly by decreasing their breakdown by the liver.
- Corticosteroid effects on warfarin (Coumadin) can vary; therefore when taking warfarin, along with corticosteroids, there may be an increased need for monitoring coagulation levels more closely.
- Low blood potassium (hypokalemia) and a higher chance of heart failure can result from combining corticosteroids with drugs that reduce potassium in the blood (for example, diuretics, amphotericin B).
- Anticholinesterase drugs (for example, physostigmine) may cause severe weakness in some patients with myasthenia gravis when prescribed corticosteroids.
- Corticosteroids can increase blood glucose, so close monitoring of blood sugar and higher doses of diabetes medications may be needed.
- Cholestyramine can decrease the absorption of oral corticosteroids from the stomach and this could reduce the blood levels of corticosteroids.
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Summary
Oral and injectable systemic corticosteroids are steroid hormones prescribed to decrease inflammation in diseases and conditions such as arthritis (rheumatoid arthritis, for example), ulcerative colitis, Crohn's disease, asthma, bronchitis, some skin rashes, and allergic or inflammatory conditions that involve the nose and eyes. Examples of systemic corticosteroids include hydrocortisone (Cortef), cortisone, prednisone (Prednisone Intensol), prednisolone (Orapred, Prelone), and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol). Some of the side effects of systemic corticosteroids are swelling of the legs, hypertension, headache, easy bruising, facial hair growth, diabetes, cataracts, and puffiness of the face.
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Primary Biliary Cirrhosis (PBC) Treatment
Primary biliary cirrhosis (PBC) is thought to be an autoimmune disorder that involves the deterioration of the liver's small bile ducts. These ducts are crucial to transport bile to the small intestine, digesting fats, and removing wastes. Symptoms of PBC are edema, itching, elevated cholesterol, malabsorption of fat, liver cancer, gallstones, urinary tract infections (UTIs), and hypothyroidism. Treatments include ursodeoxycholic acid (UDCA); colchicine (Colcrys); and immunosuppressive medications, such as corticosteroids; obeticholic acid (Ocaliva); and medications that treat PBC symptoms. For PBC that is associated with cirrhosis of the liver, liver transplantation may be indicated in extreme cases.
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What Makes Guttate Psoriasis Worse?
Guttate psoriasis is often made worse by a bacterial infection, typically Streptococcus (strep throat). Learn about common triggers of guttate psoriasis.
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Multiple Sclerosis (MS) and Pregnancy
Multiple sclerosis or MS is a central nervous system disease in which the immune system attacks the myelin sheath (the protective coating around nerves). Symptoms of MS include pain, sexual problems, fatigue, numbness and tingling, emotional changes, and depression.Women who are pregnant and have multiple sclerosis may have more difficulty carrying a pregnancy. Multiple sclerosis does not affect ability to conceive, and does not seem to affect fertility. MS symptoms during pregnancy may stay the same or get better; however, they may worsen after giving birth. Pregnancy decreases the number of relapses, but flares increase in the first 3-6 months after delivery. Pregnant women with MS may carrying a pregnancy more difficult to tell when labor starts, and there is an increased need to use forceps or vacuum to assist with delivery or b7 C-section (Cesarean birth) increases. Some treatment MS drugs may be safe to use during pregnancy; however, some drugs should not be taken, for example, baclofen (Gablofen, Lioresal), fluoxetine (Prozac, Sarafem), or solifenacin succinate (VESIcare), and most disease-modifying therapies (DMTs). Talk with your healthcare team about vitamins, supplements, and medications that you are taking if you are pregnant and have MS.
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Castleman Disease
Castleman disease is a group of related conditions. It is a rare disease with an unknown prevalence. Castleman disease is caused by an abnormal growth of lymphocytes, a type of white blood cell. There are two types of Castleman disease; 1) unicentric, and 2) multicentric. Castleman disease is diagnosed by biopsy of the suspected lymph nodes. Castleman disease is treated with medications (for example, corticosteroids, chemotherapy drugs, immunodilating drugs, interferon-alfa, and antiviral medications), surgery, and radiation therapy. The life expectancy for a person with Castleman disease is difficult to determine because the condition is rare and takes different forms.
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What Causes Nail Psoriasis?
Nail psoriasis is caused by the same autoimmune mechanisms as other types of psoriasis. The immune system attacks normal tissues in the body and triggers rapid cell growth.
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Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.
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What Is IgA Nephropathy (Berger's Disease)?
Berger's disease or immunoglobulin A (IgA) nephropathy is a kidney disorder that presents with the passing of blood in the urine. This happens due to swelling of the glomeruli (filtering units of the kidney that produce urine). The swelling is usually caused due to a buildup of a substance called IgA in the kidneys.
Treatment & Diagnosis
- Rheumatoid Arthritis FAQs
- Psoriasis FAQs
- Eczema FAQs
- Rheumatoid Arthritis (RA): 17 Warning Signs of Serious Complications
- Will Rheumatoid Arthritis Nodules Go Away?
- What if I get COVID-19 with Rheumatoid Arthritis?
- Is Inflammatory Arthritis the Same as Rheumatoid Arthritis?
- Living With Rheumatoid Arthritis
- Rheumatoid Arthritis vs. Osteoarthritis
- Are Corticosteroids Safe for Pregnant and Nursing Women with Rheumatoid Arthritis?
- 5 Surprising Facts About Rheumatoid Arthritis
- Patient Story: Rheumatoid Arthritis and Pregnancy
- Medication Disposal
- Corticosteroid Side Effects
- Psoriasis, Lupus, Rheumatoid Arthritis Share One Gene
- Psoriasis Drugs Strike Immune Targets (Raptiva, Enbrel)
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- What Are the Side Effects of Asthma Inhalers?
- How Do You Get Psoriasis?
- Does Lipitor Help Rheumatoid Arthritis?
- Patient Story: Rheumatoid Arthritis Treatment
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
- prednisone
- methylprednisolone
- What Does Prednisone Do to Your Body?
- Prednisone Side Effects (Adverse Effects)
- Thiazides (Diuretics)
- Topical Corticosteroids
- prednisolone (Orapred, Pediapred)
- mycophenolate
- dalteparin injection (Fragmin)
- erenumab (Aimovig)
- corticosteroids-ophthalmic ointment
- Types of Psoriasis Medications
- What Are Immunosuppressive Drugs?
- corticosteroids-oral aerosol inhaler
Prevention & Wellness
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.