Side effects of corticosteroids include:
- Difficulty falling asleep or staying asleep
- Increased sweating
- Increased hair growth
- Moon face
- Thinning of the skin
- Easy bruising or bleeding
- Tiny purple spots on the skin
- Irregular periods
- Eye problems
- Muscle pain or weakness
- Water retention (swollen feet, ankles, or legs)
- Black or tarry stool
- High blood pressure
- High blood sugar
- Bone fractures
Hydrocortisone side effects depend on the dose, the duration and the frequency of administration. Short courses of hydrocortisone usually are well tolerated with few and mild side effects. Long term, high doses of hydrocortisone usually will produce predictable and potentially serious side effects. Whenever possible, the lowest effective doses of hydrocortisone should be used for the shortest possible length of time to minimize side effects.
Hydrocortisone and other corticosteroids can mask signs of infection and impair the body's natural immune response to infection. Patients on corticosteroids are more susceptible to infections, and can develop more serious infections than healthy individuals. For instance, chickenpox and measles viruses can produce serious and even fatal illnesses in patients on high doses of hydrocortisone. Live virus vaccines, such as the smallpox vaccine, should be avoided in patients taking high doses of hydrocortisone, since even vaccine viruses may cause disease in these patients.
Some infectious organisms, such as tuberculosis (TB) and malaria, can remain dormant in a patient for years. Hydrocortisone and other corticosteroids can reactivate dormant infections in these patients and cause serious illness. Patients with dormant TB may require anti-TB medications while undergoing prolonged corticosteroid treatment. Prolonged use of hydrocortisone can depress the ability of body's adrenal glands to produce corticosteroids. Abruptly stopping hydrocortisone in these individuals can cause symptoms of corticosteroid insufficiency, with accompanying nausea, vomiting, and even shock. Therefore, withdrawal of hydrocortisone is usually is gradually tapered. Gradually tapering hydrocortisone not only minimizes the symptoms of corticosteroid insufficiency, it also reduces the risk of an abrupt flare of the disease under treatment. The insufficient adrenal gland function may not recover fully for many months after stopping hydrocortisone. These patients need additional hydrocortisone treatment during periods of stress, such as surgery, to avoid symptoms of corticosteroid insufficiency and shock, while the adrenal gland is not responding by producing its own corticosteroid.
Hydrocortisone impairs calcium absorption and new bone formation. Patients on prolonged treatment with hydrocortisone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. More aggressive treatment may be necessary if osteoporosis occurs.
In rare individuals, destruction of large joints (aseptic necrosis) can occur while undergoing treatment with hydrocortisone or other corticosteroids. These patients experience severe pain in the joints involved, and can require joint replacements. The reason behind such destruction is not clear.
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