Short- and Long-Term Side Effects of Systemic Steroids

Steroids come in both topical (applied to the skin) and systemic forms. Systemic steroids are taken by mouth or injected. "Systemic" means they affect the entire body, not just the skin. These steroids are used for treating a wide range of diseases.

Although these drugs are often necessary and sometimes even life-saving, they can have both short-term and long-term side effects. Some of the long-term side effects can be serious.

This article explains why you might be prescribed a systemic steroid, what to know about short-term and long-term side effects, and how to manage them.

What Are Systemic Steroids?

Systemic steroids are a synthetic (man-made) version of cortisol, a hormone produced by the adrenal glands that plays many important roles in the body. Systemic steroids mimic the anti-inflammatory effects of cortisol.

Types of Systemic Steroids

Systemic steroids are also called glucocorticoids or cortisones. They include:

• Prednisone
• Prednisolone
• Methylprednisolone
• Beclomethasone
• Betamethasone
• Dexamethasone
• Hydrocortisone
• Triamcinolone

Prednisone is the most commonly prescribed oral steroid.

Steroids commonly given via an injection (sometimes called "cortisone shots") include tramcinolon, methylprednisolone, and betamethasone.

When Systemic Steroids Are Prescribed 

Systemic steroids are typically prescribed for diseases and conditions that cause inflammation in the body. Conditions that may be treated with oral steroids include:

Short term uses:

• Allergic rhinitis
• Acute bronchitis
• Connective tissue and joint disorders
• Asthma
• Skin disorders (such as eczema)
• Bell's palsy
• Acute gout

Long-term uses:

• Lupus erythematosus
• Rheumatoid arthritis
• Multiple sclerosis
• Vasculitis
• Inflammatory bowel disease
• Certain blood cancers

Injectable steroids are used to relieve acute pain from low back pain, arthritis, cervical radiculopathy, bursitis, tendonitis, and carpal tunnel syndrome. They're typically given only three to four times a year,

Systemic Steroid Side Effects

Oral steroids can cause different side effects depending on how long they are used.

Short-Term Side Effects of Steroids

Side effects are usually temporary in people prescribed systemic steroids for short periods (a month or less). Most effects resolve within a few days after stopping the medication.

If you are otherwise healthy, the most common side effects you can expect are:

• Insomnia
• Changes in mood or behavior
• Flushing of your face
• Increased appetite
• Short-term weight gain due to increased water retention

Certain underlying medical conditions can worsen when you take steroids. For example, your blood sugar levels can increase if you have type 2 diabetes. Similarly, your blood pressure can become elevated if you already have high blood pressure. And if you have glaucoma, taking steroids might increase your eye pressure. You can also retain water if you have congestive heart failure.

Long-Term Side Effects of Steroids

If you use systemic steroids for a long period of time (more than three months) or take them on multiple occasions, you may experience more serious side effects. For this reason, doctors tend to prescribe the lowest dose for the shortest period of time.

You can reduce the risk of certain side effects by taking a steroid every other day rather than daily, even if the total dose winds up being the same.

Side effects of long-term steroid use include:

• Glaucoma
• Cataracts
• High blood pressure
• Heart disease
• Diabetes mellitus
• Obesity
• Osteoporosis
• Redistribution of body fat
• Myopathy
• Increase in certain types of infections
• Cushing syndrome

Long-term side effects often go away once you stop taking a steroid, but sometimes they can be permanent. 

Managing Side Effects

Regardless of your overall health, it's important that you are closely monitored if you are taking a systemic steroid.

Your blood pressure, weight, and blood sugar levels will be checked regularly. Because of the risk of osteoporosis, bone density scans are usually recommended for people who take steroids for three months or longer.

Sometimes a bisphosphonate drug such as Fosamax (alendronate) or Boniva (ibandronate) is prescribed to prevent osteoporosis.

Patients on prednisone may also be advised to avoid non-steroidal anti-inflammatory drugs, such as Advil (ibuprofen) and Tylenol (acetaminophen).

Alternatives to Systemic Steroids

When systemic steroids are not effective, or side effects are too severe, your healthcare provider may start by lowering your dose to see if that helps.

If lowering the dose does not reduce side effects, there are other options in the case of some diseases, though these alternatives may not be as effective in controlling symptoms of the disease.

In patients with multiple sclerosis who cannot tolerate steroids, injections of corticotropin, a protein may be used.

A 2020 study found that in some cases, patients with rheumatoid arthritis, lupus, or vasculitis who could not tolerate steroids might experience similar effects with drugs including disease-modifying antirheumatic drugs (DMARDs), Protopic (tacrolimus), and Tavneos (avacopan).

Summary

Systemic corticosteroids are drugs that control inflammation in a wide variety of diseases, including asthma, some skin disorders, lupus, and rheumatoid arthritis. They are take orally for these conditions. They can also be given via an injection for acute back pain and tendinitis.

Oral corticosteroids may be given for a short or long periods of time, depending on the situation. It is common to experience side effects from these medications. Side effects that may occur with short-term use are typically less severe than those that occur with long-term use.

A Word From Verywell

Systemic steroids can be very effective in controlling symptoms. If your healthcare prescribes them , be sure to ask how long you'll need to take them and what kinds of side effects you can expect. If you find the side effects difficult to tolerate, let your provider know. They can suggest ways to minimize the effects. Depending on why you are taking them, you may even be able to switch to a different drug.