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Types and Usage of Oral Steroids

What are steroids?

Steroids (also known as cortisone or corticosteroids) are chemicals (hormones) that occur naturally in the body. Steroids decrease inflammation, suppress the body's immune system, block DNA from being made, as well as blocking a chemical called histamine (released during an allergic reaction). Steroid medicines are man-made but are similar to these natural hormones.

The type of steroids used to treat disease are called corticosteroids. They are different to the anabolic steroids which some athletes and bodybuilders use. Anabolic steroids have very different effects. Steroids are available as tablets, soluble tablets, and solutions, creams, ointments, inhalers, and injections.

When are oral steroids usually prescribed?

Oral steroids are used to treat a large number of conditions. Some examples include:

• Inflammatory bowel diseases
• Autoimmune diseases 
• Joint and muscle diseases

They are also used to treat some cancers. In addition they can be prescribed as replacement treatment for people who have stopped making their own steroids

Some general points about oral steroids

• 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.
• A common treatment plan is to start with a high dose to control symptoms. Often the dose is then slowly reduced to a lower daily dose that keeps symptoms away. The length of treatment can vary, depending on the disease. Sometimes the steroid treatment is gradually stopped if the condition improves. However, steroids are needed for life for some conditions, as symptoms return if the steroids are stopped.

When use oral steroids

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.