Oral Steroids - Cautions and contraindications

Authored by Dr Mary Harding, 05 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Prof Cathy Jackson, 05 Jul 2017

There are very few people who cannot take oral corticosteroids. Only people who have serious infections (and are not taking treatment for the infection) should not take oral steroids. This is because steroids suppress your immune system.

Steroids are used with caution in people who:

  • Have a liver which is not working well.
  • Have a history of mental health problems.
  • Have open wounds which are healing. (Steroids can interfere with wound healing.)
  • Have a history of stomach ulcers or duodenal ulcers.
  • Have 'thinning' of the bones (osteoporosis).
  • Have cataracts.
  • Have certain heart conditions, such as a recent heart attack, heart failure, or high blood pressure (hypertension).
  • Have diabetes.
  • Have epilepsy.
  • Are pregnant. (If you take steroids in the first 12 weeks of pregnancy there is possibly a small extra risk of your baby being born with a cleft lip and/or palate. A long course of steroids can affect your baby's growth.)
  • Are breast-feeding. (Ideally do not breast-feed within four hours of taking steroid medicines. The baby may need monitoring if you are taking high-dose steroids and breast-feeding.)

If you have taken a short course of 1-2 weeks of an oral steroid, you can simply stop taking the tablets at the end of the course.

When not to stop taking oral steroids suddenly

Do not stop taking oral steroids suddenly if you have been taking them for more than three weeks. It probably does no harm to forget the odd dose. However, you may have serious withdrawal effects once your body is used to the steroids. These may develop within a few days if you stop oral steroids suddenly. Any change in dose should be supervised by a doctor. Any reductions in dose are done slowly, over a number of weeks.

Why is it necessary to reduce the dose gradually before stopping oral steroids?

Your body normally makes steroid chemicals by itself which are necessary to be healthy. When you take oral steroids for a few weeks or more, your body may reduce or stop making its own steroid chemicals. If you then stop taking oral steroids suddenly, your body does not have any steroids. This can cause various withdrawal symptoms until your body resumes making natural steroids over a few weeks. The withdrawal symptoms can be serious, even life-threatening and include:

  • Weakness.
  • Tiredness.
  • Feeling sick (nausea).
  • Being sick (vomiting).
  • Diarrhoea.
  • Tummy (abdominal) pain.
  • Low blood sugar (hypoglycaemia).
  • Low blood pressure (hypotension) which can cause dizziness, fainting or collapse.

If the dose is reduced gradually, the body gradually resumes its natural production of steroids and the withdrawal symptoms do not occur.

  • Do not take anti-inflammatory painkillers (such as ibuprofen) whilst taking steroids (unless advised by a doctor). The two together increase the risk of a stomach or duodenal ulcer developing.
  • Most people who take regular steroids carry a steroid card which should be provided by the person who prescribes or supplies your medicine, and/or they wear a medical emergency identification bracelet or equivalent. This gives details of your dose, your condition, etc, in case of emergencies. For example, if you were knocked unconscious in an accident, it is important that the doctors know that you take steroids and need to take them regularly.
  • The dose of steroid may need to be increased for a short time if you are ill with other conditions. For example, if you have a serious infection, or have an operation. This is because you need more steroids during physical stress.
  • See a doctor if you have any concerns about your steroid treatment.

Further reading and references

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