Taking steroids long term

Key points about steroids long-term

  • Some people are prescribed steroid medicines on an ongoing basis for the treatment of long-term conditions.
  • Taking steroids long term is helpful to treat conditions associated with inflammation, but ongoing steroid use can cause side effects.
  • Prednisone is the most commonly prescribed steroid. Other examples of steroids include dexamethasone, hydrocortisone and methylprednisolone.
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Some people are prescribed steroid medicines on an ongoing basis for the treatment of long-term conditions. Prednisone is the most commonly prescribed steroid. Other examples of steroids include dexamethasone, hydrocortisone and methylprednisolone. Taking steroids long term is helpful to treat conditions associated with inflammation, but ongoing steroid use can cause side effects. Read more about  common side effects of long-term steroids below.

Taking steroids for longer than 2 weeks can also cause other effects on your body that require you to be extra careful.

  • Reduce your dose gradually: If you've been taking steroid tablets for more than a few weeks, you usually need to reduce your dose gradually. Stopping suddenly can cause your adrenal gland, which makes important hormones for the body, to stop working. This is called steroid withdrawal. The withdrawal symptoms can be serious and even life threatening. Read more about the importance of stopping steroids slowly and the symptoms of steroid withdrawal
  • Have a sick day plan: Taking steroids long-term reduces your body's ability to respond to stress resulting from things such as surgery, infection or being unwell. This usually means you'll need a higher dose of steroid at times of stress. If you're taking or have been on steroid medication and you become unwell or need to have a procedure or surgery, your doctor will talk to you about a sick day plan. Read more about sick day plans.  

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.

If you have been on a long course or high doses of steroids, it's really important to reduce the dose of steroids slowly over a few weeks or months. Do not stop taking steroids suddenly. This can cause a severe, life-threatening condition caused called adrenal insufficiency.

 

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.

Symptoms of steroid withdrawal
  • weakness
  • tiredness
  • feeling sick (nausea)
  • being sick (vomiting)
  • runny poos (diarrhoea)
  • shaking
  • sweats
  • tummy (abdominal) pain
  • low blood sugar (hypoglycaemia)
  • low blood pressure (hypotension) which can cause dizziness, fainting or collapse.

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.

Steroid withdrawal plan

I am taking the steroid (choose the option that applies to you): 

□ Prednisone
□ Hydrocortisone 
□ Methylprednisolone
□ Dexamethasone
□ Other:


I am taking steroids for
:

My dose is:





 For how long:



How to reduce my steroid dose gradually over a few weeks:
Date:   Dose:
Date: Dose:
Date: Dose:
Date: Dose:
Date: Dose:
Notes:





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.

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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