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JAMA Patient Page
July 16, 2019

Steroid Side Effects

Author Affiliations
  • 1JAMA, Chicago Illinois
  • 2Midwestern University, Downers Grove, Illinois
JAMA. 2019;322(3):282. doi:10.1001/jama.2019.8506

Steroid medications, which are prescribed in many different forms for many different conditions, have a multitude of side effects.

Corticosteroid medications—often just called steroids by clinicians and patients—are used to reduce inflammation and inhibit the immune system. They are also associated with many side effects.

Corticosteroid medications are synthetic versions of the human steroid hormone cortisol, which is produced in the adrenal glands. These are different from the synthetic versions of the human steroid hormone testosterone used by some athletes (anabolic steroids) or the synthetic versions of the human steroid hormone estrogen used by some women after menopause (hormone therapy).

Formulations

Steroids can be taken as a tablet for simple rashes or mild asthma attacks or given intravenously for flares of autoimmune diseases such as inflammatory bowel disease or rheumatoid arthritis. To minimize the side effects of oral or intravenous steroids, steroid treatments that act locally were developed. Examples include

  • Topical application to the skin for conditions like eczema or psoriasis

  • Nasal inhalation for allergy symptoms

  • Inhalation into the lungs to control asthma symptoms

  • Injection into joints to reduce pain and inflammation

  • Eye drops to reduce swelling after eye surgery

Side Effects

Some patients find taking steroids to be difficult because of side effects; other patients like how steroids make them feel. Side effects are most common with oral or intravenous steroids, but sometimes enough locally directed steroid is absorbed systemically to cause side effects. Life-threatening side effects include

  • Infection: Steroids are effective in treating autoimmune diseases because they reduce the ability of the immune system to function (immunosuppression). Patients taking steroids are not only more susceptible to infections but more likely to have severe or unusual infections. These patients should be aware of their increased risk of infection, and their physicians may recommend additional anti-infective medications.

  • Adrenal crisis: Cortisol is produced in the adrenal glands. It has many effects throughout the body, including regulating blood pressure. Because steroids are so similar to cortisol, prolonged use of systemic steroids at higher doses can cause the adrenal glands to stop making cortisol. If the systemic steroid is stopped suddenly, this adrenal suppression and resulting lack of steroid can cause a wide range of symptoms, such as dangerously low blood pressure.

Health care practitioners are cautious in prescribing steroids because of the side effects. They prescribe them only when necessary and for as short a time as possible. Local rather than systemic therapy is preferable and prescribed when possible. If a patient needs to stop taking a systemic steroid after taking it for a long time, they are prescribed a gradually reduced dose to give the adrenal glands time to “wake up” and start producing cortisol again. When longer courses of higher-dose systemic steroids are necessary, as in some autoimmune conditions, the patient is monitored closely for side effects.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Zoorob RJ, Cender D. A different look at corticosteroids. Am Fam Physician. 1998;58(2):443-450.

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