Oral Steroids - Side-effects

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

A short course of steroids usually causes no side-effects. For example, a 1- to 2-week course is often prescribed to ease a severe attack of asthma. This is usually taken without any problems.

Side-effects are more likely to occur if you take a long course of steroids (more than 2-3 months), or if you take short courses repeatedly.

The higher the dose, the greater the risk of side-effects. This is why the lowest possible dose which controls symptoms is aimed for if you need steroids long-term. Some diseases need a higher dose than others to control symptoms. Even for the same disease, the dose needed often varies from person to person.

For many diseases, the benefits of taking steroids usually outweigh the side-effects. However, side-effects can sometimes be troublesome. You should read the information leaflet that comes with your medicine packet for a full list of possible side-effects. The main possible side-effects include the following:

  • 'Thinning' of the bones (osteoporosis). However, there are some medicines that can help to protect against this if the risk is high. For example, you can take a medicine called a bisphosphonate to help prevent bone loss.
  • Weight gain. You may also develop puffiness around the face.
  • Increased chance of infections, as steroids may suppress the immune system. In particular, you are at risk of having a severe form of chickenpox if you have not had chickenpox in the past (and so are not immune). Most people have had chickenpox as a child and are immune to it. If you are taking corticosteroids and have not had chickenpox in the past:
    • Keep away from people with chickenpox or shingles.
    • Tell a doctor if you come into contact with people with these conditions.
    Also, tuberculosis (TB) may flare up again if you had it in the past, even many years ago.
  • Increase in blood pressure. So, have your blood pressure checked regularly. It can be treated if it becomes high.
  • High blood sugar (hyperglycaemia) which may mean extra treatment if you have diabetes. Steroids may occasionally cause diabetes to develop. If you take long-term steroids, your doctor may arrange a yearly blood sugar test to check for diabetes - in particular, if you have a family history of diabetes.
  • Skin problems such as poor healing after injuries, thinning skin, and easy bruising. Stretchmarks sometimes develop.
  • Muscle weakness. This improves after the steroid is stopped, and physiotherapy may help treat this.
  • Mood and behavioural changes. Some people actually feel better in themselves when they take steroids. However, steroids may aggravate depression and other mental health problems, and may occasionally cause mental health problems. If this side-effect occurs, it tends to happen within a few weeks of starting treatment and is more likely with higher doses. Some people even become confused, and irritable; they may develop delusion, and suicidal thoughts. These mental health effects can also occur when steroid treatment is being withdrawn. Seek medical advice if worrying mood or behavioural changes occur.
  • An increased risk of developing cataracts.
  • An increased risk of duodenal ulcers and stomach ulcers. Tell your doctor if you develop indigestion or tummy (abdominal) pains.

The above are only the main possible side-effects which may affect some people who take steroids. There is often a balance between the risk of side-effects against the symptoms and damage that may result from some diseases if they are not treated. Some of the less common side-effects are not listed above but will be included on the leaflet that comes with your medicine.

Clinical Editor's comment (September 2017)
Dr Hayley Willacy draws your attention to the recent advice from the MHRA that patients taking local or systemic corticosteroids should be warned to report any blurred vision or other visual disturbances in view of the rare risk of central serous chorioretinopathy (CSCR). Blurred vision is an established side-effect of steroid treatment and may be a symptom of cataract and glaucoma. In rare cases, however, it could indicate the presence of CSCR. If you have received corticosteroid treatment and have visual symptoms, your healthcare professional should consider referral to an eye specialist for evaluation of possible causes.

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address:www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • Information about the person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.

Further reading and references

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