Corticosteroids - Side effects 

Side effects of corticosteroids 

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you are taking. It is run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.

Hormones are powerful chemicals that affect many different processes in the body, from the strength of your bones to your weight. As corticosteroids are hormones, they can have a wide range of side effects.

If you are prescribed corticosteroids, any side effects and their severity will depend on three factors:

  • the type of corticosteroid medicine you're taking – steroid tablets (oral corticosteroids) are more likely to cause side effects than inhalers or injections
  • the strength of the dosage – the higher the dose, the greater the risk of developing side effects
  • the length of time you are using it for – for example, it is highly likely you will develop more serious side effects if you take oral corticosteroids for more than three months or if you have three to four courses of treatment a year

Inhaled corticosteroids

If inhaled corticosteroids are taken for a short period, most people tolerate them well and have few or no side effects.

Long-term use to treat a condition such as asthma can cause oral thrush. This is a fungal infection that develops inside your mouth.

Rinsing your mouth out with water after using inhaled corticosteroids can help prevent oral thrush.

Injected corticosteroids

Corticosteroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days. Over time, repeated steroid injections into a muscle can weaken it.

Corticosteroids are usually only injected directly into the blood when there is an urgent need for treatment. Corticosteroids injected into the blood can cause side effects including:

  • stomach irritation, such as indigestion
  • rapid heartbeat (tachycardia)
  • nausea
  • insomnia
  • a metallic taste in the mouth

You may also experience mood changes. For example, you could go from feeling very happy one minute to being irritable, depressed or restless the next.

Oral corticosteroids

Side effects of oral corticosteroids used for short periods include:

  • increased appetite that often leads to weight gain
  • acne – a skin condition that affects most people at some point
  • mood changes, such as becoming aggressive, irritable and short tempered with people
  • rapid mood swings, such as feeling very happy one minute and very sad and weepy the next

Side effects of oral corticosteroids used for longer than three months include:

  • further weight gain
  • thinning skin which can bruise easily
  • muscle weakness
  • a combination of fatty deposits that develop in the face (moon face), stretch marks across the body and acne – this is known as Cushing’s syndrome
  • weakening of the bones (osteoporosis)
  • the onset of diabetes, or worsening of existing diabetes
  • high blood pressure
  • glaucoma – an eye condition where fluid gathers inside the eye
  • cataracts – an eye condition where cloudy patches develop at the front of the eye
  • delayed wound healing
  • reduced growth in children
  • increased risk of infection

These side effects should improve if you're able to reduce your dosage. 

However, osteoporosis can be a persistent problem, particularly if you are over 65. This can make you more vulnerable to breaking a bone.

Your GP can prescribe medication and calcium and vitamin D supplements, which help strengthen your bones and can compensate for the effects of prednisolone. Find out more information about treatment for osteoporosis.

You may also be referred for a type of X-ray called a dual energy X-ray absorptiometry (DEXA) scan. This can be used to assess how strong your bones are. You may require several DEXA scans during the course of your treatment. See diagnosing osteoporosis for more information.

Stomach ulcers can be another problem for people who take high doses of oral corticosteroids on a long-term basis. To protect against stomach ulcers, you may be prescribed a type of medication called a proton pump inhibitor (PPI). This reduces the amount of acid in your stomach, which will make you less vulnerable to developing stomach ulcers. Find out more about treating stomach ulcers.

You will also probably have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take oral corticosteroids on a long-term basis.

Mental heath

About 1 person in 20 who takes the oral corticosteroid prednisolone experiences changes in their mental state. These changes may include:

  • feeling depressed and suicidal
  • feeling manic (very happy and full of energy and ideas)
  • feeling very anxious
  • feeling very confused
  • hallucinations (seeing or hearing things that are not really there)
  • having strange and frightening thoughts

If you experience any of these, contact your GP as soon as possible.

Vulnerability to infection

Oral corticosteroids will make you more vulnerable to infection, particularly the viruses that cause:

You may become very ill if you develop these viral infections, even if you have been previously infected.

Avoid close contact with anyone who has a chickenpox, shingles or measles infection.

Seek medical advice immediately if you think you have been exposed to an infection that causes chickenpox, shingles or measles or if a member of your household develops one of these infections.

Page last reviewed: 18/04/2013

Next review due: 18/04/2015

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Comments

The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

dozym said on 04 May 2014

I have been on prednisolone for a lung condition since 20th December 2013...starting at 30mg/day for 1 month then reducing to 20mg...am now on 15mg/day and 10mg/day alternate days....I have had many side effects, panic attacks, exhaustion, pain (osteoarthritis) and whole body weak. lots of pain in hands wrists and lower legs and ankles...told to take paracetamo;..I do have diverticulitis, so take lansoprazole 30mg each day....(at the moment increased to one also at late afternoon before a meal for three weeks as stomach pain every morning....the lansoprazole does help quite a lot...the doc has prescribed Alveolic cid? but am too scared to take this at ht moment once per week because of the stated side effects on the package insert...doc remark when \I told of this was "It is only one per week", but with the side effects I amhaving with prednisoone an anxious about the new medication...I am slowly reducint the prednisolone in the hope I can get back to some sort of normality....and get out and enjoy life a bit...cannot sleep at night and memory apses all over the place, horrid.

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IanCummings said on 17 April 2014

I have had several courses of prednisolone for episodes of uveitis. I got the side effects of mood swings and weight gain, but those went when I stopped the tablets and the tablets saved my eyesight, I would likely be registered blind by now if I hadn't taken them.

I wanted to register the fact that it's not all bad, yes they are powerful drugs and you should monitor them closely, but they can be a powerful tool too

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IanCummings said on 17 April 2014

I have had several courses of prednisolone for episodes of uveitis. I got the side effects of mood swings and weight gain, but those went when I stopped the tablets and the tablets saved my eyesight, I would likely be registered blind by now if I hadn't taken them.

I wanted to register the fact that it's not all bad, yes they are powerful drugs and you should monitor them closely, but they can be a powerful tool too

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Scottish79 said on 10 September 2013

I got addisons disease - adrenal failure - as a result of too much injected steroids for my atopic eczema over 10 years ago. This is a condition i will have for life now.

Pre diagnosis, i developed muscle wastage in my hips, depression, gastric problems, anorexia, lost 2st quick despite having a good appetite, alopecia, low white blood count, severe bruising i looked like a battered woman, loss of vision few times, extreme tiredness.

Post diagnosis, ive had three adrenal crisis almost ending up in icu, two stomach bleeds, visual loss, migraines and sinusitis and behavioural changes all around menstrual time, slight weight gain, my shoulder injury hasnt healed after a year of physio. I am in and out of hospital, cant work and i am nly 34. I am a research project for all the drs when im admitted, its hard work. I often get refused treatment in out of office hours walk in centres cos im too complex and treated badly when an inpatient.

I am treated on a sub cut insulin pump full of steroids and i am only 1 in 3 in my area to be on it and 1 in 5 in the uk.

If i knew then what i knew now i wouldnt have taken the steroids but it did relieve my symptoms if all for two weeks instead of three months.

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guineaperson said on 20 August 2013

I was put on seratide(prednisone) after becoming asthmatic in my 60's after a dentist cut down 10 teeth in my mouth to compensate for an error he made with a crown.. My front teeth have been breaking since.
3/4 of my hair has fallen out, I have gained 7 kilos, bone loss, thinning skin, problems sleeping, anxiety, panic attacks, drooping eyelids, depression, eyes not as good: my twin does not have the sagging lower face and looks in her 40's. and has full above shoulder length thick hair.

Japanese researchers found that 80% of asthmatics recover after TMJ and teeth correction.. ie rehab reconstruction in my case at huge expense.

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Kazza19 said on 07 July 2013

I had a cortisone injection in my hip 6 days ago for bursitis. Whilst my hip feels lovely now the side effects still go on - flushed face, itching hands and feet (very dry skin now) and massively excessive thirst and consequently urination. I have been up every hour in the nights since. The Specialist oddly never warned me that it would affect my diabetes so badly and I have struggled all week. Also had some massive mood swings so whilst I would probably go through it all again to be pain free, it would have been good to have been told before he did it!

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Codsall Ian said on 03 October 2012

I took predinisolone and symbicort for just one week and my symptoms of anxiety returned for the first time in years. I had heart palpitations too, together with hot flushes and shortness of breath. I've stopped both now and will keep the site updated on the result.

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weemarie said on 02 April 2012

I recieved a steroid injection to my shoulder , exactly a week on I am still enduring palpitations and feelings of anxiety as well as no sense of taste. Have been to GP who after taking BP, O2 sats and ECG concludes that it is in my head and prescribed Diazepam. I remain unconvinced and firmly believe that it is the injection that is responsible.

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