Taking steroids long term

A short course of steroids usually causes very few side effects. For example, a 1 to 2 week course is often prescribed to ease a severe attack of asthma or gout. 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 to 3 months), or if you take short courses often. 

Common side effects of long-term steroids

• Difficulty sleeping.
• Weight gain.
• Skin thinning, easy bruising and tearing, slow wound healing.
• Osteoporosis.
• Stomach ulcers.
• High blood pressure (hypertension).
• Diabetes (either new onset or difficult to control).
• Weakened immune system with a high chance of infections.
• Mood changes, especially if you already have mood disturbances or you drink a lot of alcohol.

Tendon problems

Although this isn't a common side effect, taking steroids can cause tendon problems, eg, tendinitis or tendon rupture.  The Achilles tendon in your ankle or calf is most likely to be affected but other tendons can also be involved.

You're at higher risk if you:

• are over 60 years of age
• are taking statins, eg, atorvastatin
• have chronic kidney disease or have had a kidney, heart or lung transplant.

Let your healthcare provider know straight away if you get pain and swelling in your joints. This can happen from a few hours after the first dose to several months after you've stopped the treatment. Read more about medicines and tendon problems.

You're most at risk if you: 

• have taken more than 40 mg of prednisone (or equivalent) per day for more than 1 week
• have  taken steroids at a lower dose regularly for more than 3 weeks
• are taking your prednisone doses in the evening
• recently had repeated courses
• have taken another short course of steroids within 1 year of stopping long-term therapy
• have other possible causes of adrenal suppression.

Your body normally makes steroids by itself, as these are needed to be healthy. When you take oral steroids for a few weeks or more, your body may reduce or stop making its own steroids.

If you then stop taking oral steroids suddenly, your body doesn't have any steroids. This can cause various withdrawal symptoms until your body starts making more natural steroids over a few weeks. The withdrawal symptoms can be serious and even life threatening. 

If you've been taking high dose or long-term steroids and your dose is reduced gradually, your body gradually starts its natural production of steroids and you can avoid withdrawal symptoms.

Stopping steroids suddenly can cause various withdrawal symptoms until your body starts making more natural steroids over a few weeks. The withdrawal symptoms can be serious and even life threatening.

A steroid withdrawal plan is a written document to help you remember how to reduce your steroid dose gradually over a few weeks. The following is an example of a steroid withdrawal plan.

A sick day plan gives you advice on how to manage your usual steroid medicine if you're unwell. If you're on long-term steroids and you're unwell with an infection or injury, or you're having an operation, you must contact your doctor. Your dose of steroid may need to be increased for a short time.

When you become ill, your body would naturally increase the output of steroid hormones from your adrenal glands. Therefore, if you're taking replacement steroids, it's essential to mimic or copy this effect by increasing your dose of steroids. Taking a higher dose of steroids for a short period of time while you are ill is necessary and isn't harmful.