Understanding Oral Corticosteroid Side Effects

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Oral corticosteroids (OCS) play an important role in helping control chronic conditions. The medications are also called systemic glucocorticoids, systemic corticosteroid therapy, or oral steroids. They treat asthma, allergies, COPD, skin diseases, and other chronic diseases.

Oral corticosteroids come primarily as pills or a liquid. Understanding the effects of the therapy is essential. OCS helps reduce inflammation in the body. It can also keep symptoms from worsening.

But OCS also involves the risk of serious side effects, especially with long-term use. Side effects can include weight gain, high blood pressure, and bone loss. This makes proper usage and monitoring of the medication essential.

Patients and healthcare providers should be aware of the benefits and risks of OCS. Work together to ensure treatment plans involving OCS are both safe and effective.

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What are oral corticosteroids (OCS)?

Oral corticosteroids are pills used to reduce and control inflammation in the body. They are used for respiratory, allergic and skin diseases. They treat flare-ups of symptoms, such as for an asthma attack or eczema episode. They can stop inflammation from getting worse and can also reduce the risk of a severe flare-up.

Oral corticosteroids are different from the anabolic steroids or injections used for muscle building.

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Side effects of oral corticosteroids: short-term use

Short-term use of OCS (about 3-5 days) can cause the following side effects:

  • Weight gain, particularly in abdomen, face or neck
  • Eye problems
  • Muscle weakness
  • Insomnia and sleep problems
  • High blood pressure
  • Elevated blood sugar levels
  • Swelling in lower legs
  • Gastrointestinal issues (heartburn, nausea)
  • Mood changes and irritability
  • Depression and anxiety
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Side effects and health risks of oral corticosteroids: long-term use

Long-term use of OCS can lead to the following side effects:

  • Skin thinning and easy bruising
  • Osteoporosis and bone loss or weakness
  • High blood pressure and cardiovascular risks
  • Diabetes onset
  • Slow growth in children
  • Immune system suppression and increased infection risk
  • Adrenal gland suppression and hormonal imbalance
  • Glaucoma and cataracts

How to manage and reduce OCS side effects

Talk with your doctor about OCS side effects, especially if taking them long-term. You’ll need to balance the benefits vs. risks of taking OCS.

  • Make lifestyle adjustments and healthy diet choices.
  • Monitor and reduce dosage safely.
  • Review alternative treatment options with your doctor.

When to seek medical advice for side effects of OCS

If you experience persistent or severe adverse effects from OCS, seek medical advice. Contact your healthcare provider if you notice:

  • Significant mood changes, including depression or anxiety
  • Persistent high blood sugar levels, especially if you have diabetes
  • Severe stomach pain, nausea, or vomiting
  • Unusual weight gain or swelling in the face, legs, or abdomen
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Signs of serious side effects

Some side effects require immediate medical attention. Seek emergency care if you experience:

  • Sudden or severe vision changes
  • Unexplained bruising or bleeding
  • Signs of infection, such as fever, chills, or persistent sore throat
  • Nausea or vomiting
  • Severe muscle weakness or fatigue
  • Dizziness
  • Shortness of breath or swelling in the legs

Speak to your doctor about risk management

It’s important to have open discussions with your doctor about managing the risks of OCS. Here are some topics to discuss:

  • Alternative treatments. Are there non-steroid options or lower doses available for your condition?
  • Monitoring side effects. What tests or check-ups should you have to track potential complications?
  • Lifestyle changes. What dietary or exercise recommendations can help reduce side effects?
  • Tapering off OCS after long-term use. What is the safest way to reduce or stop OCS to lower the risk of adrenal insufficiency?

Questions & answers (Q&A) on side effects of oral corticosteroids

Whether used in a short course or long-term, oral corticosteroids come with a risk of serious side effects. Here are some common questions we receive about using OCS. If you have a question that is not asked below, please email the editor.

OCS can increase appetite and cause cravings, often leading to overeating. OCS may also cause fluid retention. This can result in bloating and temporary weight gain. It can also cause fat redistribution to areas like on the face, abdomen and back. Prolonged OCS use can slow metabolism and reduce energy, making it harder to stay active.

These side effects can develop within the first two months. The risk is higher with larger corticosteroid doses and longer duration of treatment.

To manage OCS side effects, focus on a nutrient-dense diet and limit sodium. Get regular exercise and stay hydrated. If weight gain becomes significant, consult your healthcare provider.provider will determine the best treatment based on your condition, severity of symptoms, and overall health.

Yes, OCS can cause mood swings and anxiety. The medications can affect brain chemistry and impact the balance of hormones in the body. This can lead to a range of psychological side effects. Common mood-related effects include:

  • irritability
  • anxiety
  • depression
  • restlessness
  • even feelings of euphoria at times

Prolonged or high-dose use may increase the severity of these symptoms. In some cases, OCS may also contribute to insomnia, which can lead to mood changes.

If you have significant mood changes or anxiety while on OCS, talk with your healthcare provider. Discuss a possible medication change or coping strategies.

To reduce side effects of oral steroid therapy, consider these strategies:

  1. Use the lowest effective dose. Work with your doctor to determine the lowest dose that manages your symptoms.
  2. Limit the duration of use. If possible, aim to use OCS for the shortest time necessary. Your doctor might taper the dose to reduce withdrawal symptoms.
  3. Supplement with calcium and vitamin D. OCS can weaken bones, so it’s important to take steps to support bone health. Talk to your healthcare provider about calcium and vitamin D supplements.
  4. Watch for blood sugar changes. OCS can increase blood sugar levels. Check your blood sugar regularly, especially if you have diabetes or are pre-diabetes.
  5. Stay active. Exercise can help maintain bone density, muscle strength, and overall health.
  6. Eat a balanced diet. Focus on healthy meals rich in fruits, vegetables, lean proteins, and whole grains. This can help you control weight gain and other metabolic side effects of OCS.
  7. Address anxiety, depression or mood swings. If you think oral steroids are affecting your mental health, talk with your healthcare provider immediately.
  8. Consider other medications. Depending on your condition, there might be alternative medications or therapies. These may help you reduce the need for OCS and help reduce side effects.

Always talk with your healthcare provider before making changes to your medication or treatment plan.

No, biologic medications are not the same as oral corticosteroid therapy. While both treat inflammatory and autoimmune conditions, they work in different ways.

  • Oral corticosteroids (prednisone or prednisolone) are synthetic drugs that mimic the body’s natural cortisol. They work by broadly suppressing the immune system to reduce inflammation. However, they can cause significant side effects, especially with long-term use.
  • Biologics are made from living cells. They target specific parts of the immune system, such as certain proteins that cause inflammation. Unlike corticosteroids, biologics are usually given as injections or infusions. They are not taken by mouth.

Doctors may recommend biologics as an alternative to corticosteroids, especially for severe asthma or rheumatoid arthritis. They can help reduce over-reliance on oral steroids.

Yes. OCS can lower the activity of the immune system. The immune system is your body’s natural defense against illness and infection. When used long-term, steroids may weaken the immune system’s protective functions. This can increase your risk of getting infections.

Corticosteroid side effects vary in duration. It depends on factors like the type of corticosteroid, dosage, length of use, and an individual’s lifestyle. Here’s a general timeline:

Short-term use (a few days to weeks)

  • Mild side effects. Side effects like insomnia, mood changes, or increased appetite typically subside within a few days to a week after stopping.
  • Fluid retention. This may resolve within a few weeks.

Long-term use (months or more)

  • Adrenal suppression. When corticosteroids are used for a long time, the adrenal glands may need time to recover. This can take weeks to months.
  • Bone health. Loss of bone density may not reverse quickly and may need specific treatment.
  • Skin changes: Thinning skin or bruising can take months to improve.
  • Weight gain: Gradual weight loss may occur over several months after discontinuation.
  • Blood sugar control: Elevated blood sugar may normalize within weeks after stopping.

Gradually tapering the OCS dose from long-term use can help minimize side effects. It can also reduce the risk adrenal suppression. A healthy lifestyle and diet can help speed up recovery and reduce symptoms.

If you experience persistent or severe side effects, consult with a healthcare provider.

Yes. Several medication options are available for chronic conditions like asthma, allergies, or other autoimmune diseases. These medications help reduce inflammation while reducing the risk of side effects.

Alternative therapies may include:

  • inhaled corticosteroids (ICS)
  • biologic medications (for moderate to severe disease)
  • leukotriene modifiers

For some, lifestyle changes may help. Diet, exercise, stress management, and trigger avoidance can improve symptoms without steroid therapy.

Talk to your doctor if you experience any of the following:

  • weight gain
  • skin swelling
  • increased appetite
  • mood changes like irritability or anxiety
  • skin issues such as thinning or bruising
  • signs of infection like fever or sore throat
  • muscle weakness
  • joint pain
  • vision changes like blurred vision
  • unexplained fatigue or dizziness

Long-term or high-dose use may increase the risk of side effects. It’s important to check for side effects and consult your doctor for adjustments to your treatment.

Yes, long-term use of OCS can cause permanent damage if not managed correctly. The risk of permanent damage can often be reduce by:

  • careful monitoring by a healthcare provider;
  • appropriate dosing;
  • ensuring the lowest effective dose for the shortest time necessary.

If you’re on long-term OCS therapy, regularly assess any potential side effects. Take preventive measures to protect your health.

Because cortisone is involved in balancing normal levels of glucose (sugar) in the blood, long-term corticosteroids use can lead to elevated blood sugar levels, especially if you live with diabetes.

Yes, steroid therapy can lead to thinning bones. This is called osteoporosis or osteopenia. It can increase the risk of bone fractures.

Before or early in your steroid treatment, you may undergo a bone density test, particularly if your dosage is high. If your bone density is low, you may take a follow-up text to assess how preventive measures are working. Preventing bone loss is essential. Up to 10% to 20% of bone mass can be lost within the first six months of corticosteroid therapy.

Adults and older adults have a higher risk of complications with osteoporosis. Women are more likely than man to develop this bone disease.

Steroid use can cause an increase in body hair. This is a condition called hirsutism. The extent to which this side effect of steroids occurs can vary among patients.

Adrenal suppression occurs when the adrenal glands reduce or stop producing cortisol naturally. Cortisol is a hormone essential for managing stress, blood sugar levels, and immune function. Adrenal suppression can happen with long-term corticosteroid use when the steroid therapy mimics the effects of cortisol. This causes the body to slow down or stop natural cortisol production.

Long-term corticosteroid users with adrenal suppression may have a reduced ability to produce cortisol. This can impair their stress response. It can also increase the risk of life-threatening adrenal crises during illness or trauma.

Symptoms may include:

  • chronic fatigue
  • weakness
  • low blood sugar
  • electrolyte imbalances, which need careful monitoring and management

How to prevent adrenal suppression? Your doctor may recommend you to taper off corticosteroid use gradually rather than stopping abruptly. Work together with your doctor to ensure this process is safe and effective.

Yes. Certain populations are more at risk for corticosteroid side effects. This is due to various factors such as:

  • age of the patient
  • pre-existing health conditions
  • genetic factors
  • use of other medications
  • higher dosage patients
  • longer-use patients

Yes, oral corticosteroid use can affect fertility and reproductive health. These medications are synthetic versions of glucocorticoids. When used for long periods or in high doses, they can disrupt the hormonal balance that regulates the reproductive system.

Corticosteroids can impact female fertility in several ways, including:

  • menstrual cycle disruption
  • reduced ovarian function
  • increased risk of pregnancy complications

In men, corticosteroids may lower testosterone levels and affect sperm production.

Drinking alcohol while taking OCS can irritate the gastrointestinal lining. This increases the risk of ulcers or bleeding. Alcohol may also worsen other side effects of corticosteroids. These include mood changes, weight gain, and high blood pressure.

It’s safest to avoid alcohol while taking oral corticosteroids. Occasional, moderate consumption might be permissible for some individuals. Always consult your healthcare provider for specific advice on OCS and alcohol.

Oral corticosteroids can interact with various medications and supplements. These include anticoagulants, NSAIDs and certain antibiotics. The interactions can alter the effect of OCS or cause adverse reactions, such as:

  • electrolyte imbalances
  • insulin resistance
  • reduced vaccine effectiveness

The reaction may depends on the dosage and the type of medication or supplement.

Give your doctor a list of all your medications and supplements before starting OCS.

This can lead to adrenal insufficiency or suppression. It happens because the body’s natural production of cortisol has been suppressed or stopped completely. This can lead to symptoms such as:

  1. Fatigue and weakness. You may feel tired, weak, or lethargic due to a lack of cortisol.
  2. Nausea and vomiting. Digestive symptoms are common when cortisol levels drop too quickly.
  3. Low blood pressure and dizziness. A sudden drop in cortisol can cause blood pressure to fall, leading to dizziness or fainting.
  4. Joint and muscle pain. Oral corticosteroid withdrawal can trigger pain or stiffness in the muscles and joints.
  5. Adrenal crisis. In severe cases, sudden withdrawal can lead to a life-threatening adrenal crisis. This is characterized by confusion, low blood sugar, and shock.

To avoid these effects, oral corticosteroids should be tapered off gradually under medical supervision. This allows the body’s adrenal glands to resume normal cortisol production. Always talk with your doctor before stopping or changing your corticosteroid regimen.

Yes, OCS therapy can cause an allergic reaction, but it is uncommon. Symptoms may range from mild to severe. Some people may have an allergy to the corticosteroid itself. Others may have an allergy to the inactive ingredients within the medication.

Reviewed by:
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as Medical Director with Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).

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