What Do Corticosteroids Do and When Do You Need Them?

Ruth Jessen Hickman, MD
·10 min read
<p>Jane Rubtsova / Getty Images</p>

Jane Rubtsova / Getty Images

Medically reviewed by Kristie Reed, PharmD

Corticosteroids are important, sometimes life-saving therapies and the most widely prescribed drugs worldwide. They play a role in treating a variety of inflammatory medical conditions, including inflammatory bowel disease, asthma, psoriasis, multiple sclerosis, and rheumatoid arthritis, among many others. However, they can have significant side effects at high doses or when prescribed long-term.

Technically speaking the term “corticosteroids” refers to a group of hormones produced by your adrenal glands (the glands at the top of each kidney) as well as closely related substances made in a lab. However, the term is commonly used to refer to a subset of corticosteroids called “glucocorticoids.” Sometimes people also just refer to corticosteroids as “steroids.” However, that can be confusing, as these steroids aren’t the same as the steroids that people sometimes use to build muscle (“anabolic steroids” such as synthetic testosterone).

Depending on the clinical situation, you might take a corticosteroid orally or in many other ways, such as eye drops. Most are only available through a prescription, but you can purchase some versions applied to the skin over the counter (OTC).

What Do Corticosteroids Do?

Corticosteroids can help tone down your body's natural immune response if it is triggering excess inflammation, which generally occurs in people with an autoimmune condition or during some allergic responses. Corticosteroids help regulate your immune system through a variety of complicated processes.

Less commonly, you might need to take corticosteroids if your body isn’t able to make them in normal amounts.

Corticosteroids are used to treat many different medical conditions that can involve excess inflammation or abnormal immune system responses. Some examples include:

Corticosteroids may take three to eight hours or so before they start to take effect. However, depending on the situation, you might not get the full results for a few days or longer.

Types of Corticosteroids

Cortisol is the name of the corticosteroid hormone that your body naturally makes. People don’t usually receive cortisol itself as a treatment, but there are closely related corticosteroids (which have many similar characteristics) that can be used if your body doesn't produce enough cortisol naturally.

Some corticosteroids are more potent than others, so you could take a smaller dose of one to have the same effects as another. These drugs also differ a bit in how much they affect factors like salt and water levels in the body, which can affect your blood pressure.

Generally, corticosteroids are categorized by how long they work and how they are taken. The categories and some of their most commonly prescribed brands include:

  • Short-acting glucocorticoids: These affect the body for about 8-12 hours. Some important examples are Hydrocort (hydrocortisone) and Cortone (cortisone acetate).

  • Intermediate-acting corticosteroids: These work for about 18 to 36 hours. Examples include Rayos and Omnipred (both prednisone) and Solumedrol (methylprednisolone).

  • Long-acting corticosteroids: The corticosteroids in this group work for 36 hours or longer. Decadron (dexamethasone) is a key example, as is Celestone (betamethasone). Both are also very potent glucocorticoids.

  • Inhaled corticosteroids: Scientists developed certain corticosteroids because their properties made them better suited for being inhaled. Some key examples are Pulmicort (budesonide) and Flonase (fluticasone).

Keep in mind that many corticosteroids have multiple brand names and most are referred to by their generic names.

How Are Corticosteroids Taken?

Corticosteroids can be taken through many different routes: orally, intravenously, inhalation, topically, or via your eyes, nose, rectum, ears, joints, or spine. These differences can also affect how long the drug is effective and how quickly it works. Your dose and treatment duration will vary based on the medical situation and the specific corticosteroid prescribed.

For example, intravenous steroids might make more sense if you can’t take oral medicine, or if you need the steroid to get into your body as quickly as possible. Suppositories are also an option for young children who can’t reliably swallow medicines, or for certain kinds of rectal problems.

For mild skin conditions, you might take an over-the-counter preparation, such as one with hydrocortisone. For others, you might need a prescription-strength version, like Diprolene (betamethasone dipropionate), but for only a limited time (e.g., a few weeks). These are available as foams, gels, ointments, creams, lotions, etc.

Some people get occasional corticosteroid injections into their joints for conditions like osteoarthritis or rheumatoid arthritis, to help relieve pain.

Inhaled corticosteroids are another important route, especially for conditions like asthma, COPD, or allergic rhinitis. They may especially be important for people whose disease can’t be controlled with alternative methods. The steroids can be given through nebulizers, mouth inhalers, or nasal inhalers.

Prescription corticosteroid eye drops can also be helpful for inflammation of the outer layer of the eye. For problems related to inflammation deeper within the eye, you might receive a corticosteroid injection into the eye itself from an ophthalmologist, if needed.

The following are some examples of corticosteroids taken using different methods:

  • Deltasone (prednisone pills)

  • Decadron (pill form of dexamethasone)

  • Pediapred (prednisolone liquid)

  • Anusol-HC (hydrocortisone acetate suppository)

  • Solu-medrol (methylprednisolone given via injection or intravenously)

  • Cortizone-10 (hydrocortisone cream)

  • Pulmicort (budesonide inhaled into the lungs)

  • Flonase (fluticasone inhaled into the nose)

  • Pred Forte (prednisolone eye drops)

Minimizing Use

Corticosteroid treatment usually works better as a short-term therapy. For example, someone having a flare of rheumatoid arthritis might need to take a short course of corticosteroids to help get their disease under control.

However, when taken long-term, corticosteroids have the increased potential to cause unpleasant side effects.

Ideally, the affected person can take different medications long-term to help prevent future flares. If needed long-term, the lowest effective dose should be used.

Potential Side Effects

Although corticosteroids are very important treatments, they come with a wide range of potential side effects. Side effects are more likely if you are taking larger doses. Taking corticosteroids for a long period of time, even if at a low dose, also increases your chance of experiencing side effects.

Some of these potential side effects include:

  • Musculoskeletal: Osteonecrosis, death of bone tissue (at high and prolonged doses); muscle breakdown (myopathy) leading to weakness; osteoporosis, weakened bones increasing the risk of bone breaks, especially if taken for long periods

  • Metabolism and growth: Worsened or new-onset diabetes; increased appetite; redistribution of fat to the abdomen and face; growth impairment in children

  • Heart: Fluid retention, causing swelling and weight gain; increased risk of high blood pressure and heart attack

  • Gastrointestinal: Upset stomach; stomach ulcer; bleeding in the gastrointestinal tract; fatty liver disease

  • Skin: Increased bruising; skin thinning; acne; excess hair growth; skin coloration changes

  • Eye: Increased risk of cataracts and glaucoma

  • Immune effects: Slowed wound healing; increased risk of infections which goes up with higher doses; possible allergy in a small minority of people, which in some can be severe (e.g., with difficulty breathing)

  • Psychiatric: Insomnia; increased anxiety; in some, initial sense of well-being or mania which may be followed by depression

Most side effects will quickly resolve when you are able to stop taking the corticosteroid. However, some side effects, like osteoporosis that has developed over months or years, may not fully resolve without additional treatment.

Differences in Side Effects

Corticosteroids that you take orally or through your veins tend to cause more side effects compared to those directly applied (e.g., to the skin, inhaled, into the joint). That’s because you can get the medical effect at lower doses.

However, additional side effects can occur due to these other applications. For example, you might experience nerve tingling and a little pain from a steroid injection, skin color changes from a steroid cream, or irritation of your gums from an inhaled steroid.

Some factors that also increase your risk of side effects include the following:

  • Older age

  • Other medical conditions like diabetes or some infections

  • Severe disease that’s being treated

  • Poor nutrition

  • Use of other agents that suppress the immune system

It’s important that you and your healthcare provider weigh these and other factors when considering glucocorticoid therapy, especially if you need to take it long-term. Some people may need monitoring if they take these agents for a long time, such as bone scans to check for osteoporosis or blood tests to check for diabetes.

Adrenal Insufficiency and Tapering Doses

When you take corticosteroids, it can cause your body to start making smaller amounts of the natural compound cortisol. This is especially the case for people who take large doses over a long period of time

Therefore, if you stop taking a corticosteroid abruptly, it can cause symptoms of something called adrenal insufficiency. Symptoms are often relatively mild but might cause issues like fatigue, nausea, headache, and poor mood.

However, in certain situations, coming off corticosteroids abruptly might be much more serious. This can cause symptoms like very low blood pressure, decreased consciousness, and seizures. This may be more likely if another trigger is also present, like surgery or illness.

You may need to have your corticosteroid dose slowly lowered as a result. For example, if you’d been taking 60 milligrams of prednisone for three weeks, you might slowly lower your dosage by 10 milligrams to 5 milligrams each day, with the guidance of a healthcare professional.

When to Call Your Healthcare Provider

It’s common to notice some side effects from corticosteroids, like changes to your energy level or some mild skin changes. You can check in about these, and potentially about lowering your dose, at a follow-up appointment.

Call your healthcare provider promptly for issues that might be more serious, like changes in your vision, increased urination, yellowish skin or whites of the eyes, swelling, or signs of infection such as fever.

For any urgent, potentially life-threatening problem, like sudden severe chest pain or difficulty breathing, call 911.

A Quick Review

Corticosteroids are an important class of drugs for treating a wide variety of medical problems, including many inflammatory and autoimmune conditions. Sometimes they are life-saving therapies.

These treatments are available in a variety of formulations, including pills, liquids, intravenous preparations, lotions, injections, inhaled products, suppositories, and eye drops. The mode of administration and strength will depend on the specific medical situation.

Corticosteroids come with a long list of potential side effects. However, these are more of a concern if you need to take them orally or intravenously, particularly at high doses or over a long period. Ideally. You’ll likely only need to take corticosteroids for a brief time. In some cases, you may need to taper your dose after you stop taking them.

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