Corticosteroid medications - side effects and risk
What are Corticosteroid medications
Anti-inflammatory medications that suppress INFLAMMATION and other aspects of the IMMUNE RESPONSE. Corticosteroid medications are synthetic variations of the body’s natural HORMONE CORTISOL, which the ADRENAL GLANDS produce. Corticosteroids come in injectable, oral, inhalant, and topical preparations.
How These Medications Work
Corticosteroid medications work by blocking a number of the pathways in the immune response, key among them those that produce inflammation. They suppress the COMPLEMENT CASCADE, activation of antibodies, and production of eosinophils (white BLOOD cells that become abundant in a HYPERSENSITIVITY REACTION). Eosinophils are also important for fighting INFECTION, so suppressing them reduces the IMMUNE SYSTEM’s ability to mount an effective defense when infection occurs. Corticosteroids also act to suppress MAST CELL release of HISTAMINE, LEUKOTRIENES, and PROSTAGLANDINS-biochemicals that facilitate inflammation.
There are three general types of corticosteroids, classified according to how they act in the body: glucocorticoids, mineralocorticoids, and ANDROGENS (the sex hormones). Glucocorticoids have the strongest anti-inflammatory action; most corticosteroid drugs are either glucocorticoids or a combination of glucocorticoid and mineralocorticoid. ALDOSTERONE, another hormone the adrenal cortex produces, is a mineralocorticoid used therapeutically as hormone replacement to treat ADDISON’S DISEASE (a condition in which the adrenal glands fail). However, aldosterone and other mineralocorticoids alone have very little anti-inflammatory action.
| CORTICOSTEROID MEDICATIONS | |
|---|---|
| betamethasone | cortisone |
| desoximometasone | fluticasone |
| dexamethasone | hydrocortisone |
| methylprednisolone | mometasone |
| prednisolone | prednisone |
| triamcinolone | |
Therapeutic Applications
Doctors may prescribe corticosteroid medications to relieve symptoms of moderate to severe hypersensitivity reaction, to prevent GRAFT VS. HOST DISEASE in bone marrow transplant recipients, and to treat chronic inflammatory conditions such as severe OSTEOARTHRITIS, RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS, PSORIASIS, SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), and INFLAMMATORY BOWEL DISEASE (IBD). Corticosteroids in nasal sprays and inhalant forms are effective treatments for ALLERGIC RHINITIS and ALLERGIC ASTHMA. Systemic corticosteroid medications are also among the treatment options for severe asthma and certain other chronic inflammatory lung conditions.
It is important to take or use corticosteroid products correctly, particularly inhalants and nasal sprays. Generally, corticosteroids are most effective when taken on a regular schedule to prevent the inflammatory process from developing, though they also can help suppress an inflammatory response after it begins. Because long-term corticosteroid therapy also suppresses the function of the adrenal glands, the body stops producing cortisol and becomes dependent on the external source of corticosteroids (the medication). It is important to reduce the dose over time (taper) when stopping a systemic corticosteroid, to allow the adrenal glands to resume cortisol production. Suddenly stopping systemic corticosteroid therapy can result in a rebound syndrome, with symptoms of inflammation, PAIN, and FEVER.
Risks and Side Effects
Side effects are uncommon with short-term systemic (oral and injection forms), inhalation, or topical corticosteroid use. However, corticosteroids tend to be less effective with repeated or chronic use. Injected corticosteroids, such as to treat inflammation in joints, can cause tissue damage over time. Doctors generally limit corticosteroid injections to prevent such damage. Long-term use of inhaled corticosteroids is often irritating to the tissues of the NOSE or THROAT. Long-term topical corticosteroids can cause thinning and darkening of the SKIN.
Long-term systemic corticosteroid therapy, such as for immunosuppression or to treat severe autoimmune disorders, has numerous side effects that require close monitoring to maintain optimal health. Key among them are increased risks for type 2 DIABETES and OSTEOPOROSIS. Systemic corticosteroids alter the body’s hormonal balance and interactions, affecting numerous endocrine functions such as regulatory mechanisms for INSULIN-GLUCOSE METABOLISM and calcium balance in the bones. Systemic corticosteroids also influence thyroid hormones, which may alter overall metabolism to result in side effects such as rapid weight gain (with a characteristic rounded face) and excessive tiredness. Some people experience mood swings, mood disorders, DEPRESSION, or GENERAL ANXIETY DISORDER (GAD) when taking longterm corticosteroid therapy, a consequence of the influence corticosteroids exert on BRAIN neurotransmitters.
Because they suppress the immune response and LEUKOCYTE (white blood cell) production, systemic corticosteroids also increase the risk for infection. Chronic COLDS, URINARY TRACT INFECTION (UTI), CANDIDIASIS (yeast infection), and wounds that are slow to heal are common with long-term systemic corticosteroid therapy. Early treatment with ANTIBIOTIC MEDICATIONS or ANTIFUNGAL MEDICATIONS can help the body fight such infections. Systemic corticosteroids interact with numerous other medications and, because they cause sodium and fluid retention, may increase BLOOD PRESSURE or cause HYPERTENSION.
See also BONE; CUSHING’S SYNDROME; DRUG INTERACTION; 5-AMINOSALICYLATE (5ASA) MEDICATIONS; NEUROTRANSMITTER; NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS); OPPORTUNISTIC INFECTION; ORGAN TRANSPLANTATION; PSYCHOSIS; THYROID GLAND; WOUND CARE.
