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- What are systemic corticosteroids and how do they work?
- What are some examples of systemic (oral and injectable) corticosteroids?
- For what conditions are systemic corticosteroids used?
- Are there any differences among the different types of systemic corticosteroids?
- What are the side effects of systemic corticosteroids?
- With which drugs do systemic (oral and injectable) corticosteroids interact?
What are the side effects of systemic 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.
- 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
- Muscle weakness
- Puffiness of the face (moon face)
- Facial hair growth
- Thinning and easy bruising of the skin
- Slow wound healing
- 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.
With which drugs do systemic (oral and injectable) corticosteroids interact?
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 (Coumadin) along with corticosteroids, there may be 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 with corticosteroids.
REFERENCE: FDA Prescribing Information.
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