Side Effects Of Long Term Steroid Use – Manage Them With Expert Guidance

Introduction

Steroids are well known as life-saving medications for years. While steroid medicines are used in treating several medical conditions, they come along with their own set of side effects as any other medicine. Steroids are best for short-term use, although certain conditions necessitate their administration over longer periods. They have side effects both in short-term as well as long-term usage. These side effects call for attention. The steroid is a broad term that can refer to some hormones or some medicines. Here in this article, we are talking about the steroid medications prescribed for immunosuppressive and anti-inflammatory action in acute and chronic conditions like asthma, rheumatoid arthritis, severe allergic reaction, autoimmune disorders, etc.

Possible Side Effects of Steroids

You may wonder, why did your doctor prescribe you a medication with possible side effects? Well, doctors always weigh the risks associated with treatment and the expected benefits. In some cases, it is important to prescribe steroid medications to save you from serious illnesses. Some short term side effects of steroids may include – 

• Weight gain
• Moon face
• Acne
• Irritability
• Change in sleep pattern
• Mood swings
• Fatigue
• Restlessness and agitation
• Change in appetite, food cravings
• Menstrual irregularities in women

Persistent use, even in low doses, in addition to many of the side effects of short term use, has often been found to lead to:

• Delayed healing of cuts
• Easy bruising
• Salt and water retention leads to the risk of an increase in blood pressure
• Impaired blood glucose
• Increased risk of osteoporosis (weakening of bones)
• Changes in mood and behaviour
• Risk of eye disorders like cataracts and glaucoma

It is important to know that most of the side effects of steroid medications are reversed when the medicine is discontinued. Not every patient will experience all the side effects, so do not get scared of the long list mentioned above. 

For many serious disorders, steroids are the mainstay of the treatment. While they do have their own side-effects, they are advised when the risks outweigh their benefits. Talk to your doctor if you are experiencing any serious side effect, but never ever stop ongoing steroids suddenly on your own Your doctor will evaluate your health and gradually taper the dose if needed.

Dr. Arpit Verma, MBBS, MD (Pharmacology)

Manage Side Effects of Steroid Use-Experts’ Advice

Many Side Effects of Steroids can be Minimised by Following these Tips:

• Adhere to standard protocol: Usually, steroids are prescribed for use over a limited period, short term. Side effects generally show up with use over 2 to 3 months. Doctors generally try and contain the administration of steroids within this period. Follow the advised dosage and duration. Do not miss even a single dose of the medicine prescribed. Take them only under expert medical advice – Steroids are to be administered only under expert medical advice and supervision. Self-administration is best avoided. Your doctor will usually prescribe steroids only when their benefits outweigh the associated risks.
• Stay in close contact with your doctor: In circumstances where prolonged use of steroids is unavoidable, the advice of your doctor should be followed. Staying in frequent contact with your doctor is strongly advised in such cases for monitoring the signs of the advent of side effects.
• Guard against osteoporosis: One of the most common side effects of prolonged use of steroids is the thinning of bones in your body or osteoporosis. You will be often guarded against this through a prescription of vitamin D and calcium supplements that you should take without fail.
• Do not stop steroids abruptly: Never stop your steroid medicines abruptly. Your doctor is likely to reduce your dosage gradually before stopping it completely. Eat healthily and exercise – Experts also advise healthy eating and exercise as effective ways to fight the side effects of steroid medication on your body.
• Maintain Sodium & Potassium levels: Maintaining a low-salt diet while on steroids helps reduce the tendency toward an increase in blood pressure often associated with steroid medication. Similarly, the consumption of potassium-rich diets like carrots, broccoli and fruits compensate for the potassium loss associated with steroid medication.
• Keep a tab on your BP and sugar levels: A regular check on blood pressure and blood sugar is recommended by experts while on steroids.
• Be aware of weight gain: Steroids are often associated with weight gain. According to the experts, a calorie-controlled diet regime and regular exercise can help to minimise this side effect. 
• Do not fear steroid diabetes: You may notice high levels of blood sugar when on steroids.”. You will be prescribed antidiabetic medications as needed for the management of blood sugars, but in many cases, blood sugars get back to normal after steroids are discontinued. Modification in your diet is recommended. If you are already having a history of diabetes, you should inform your doctor at the point of his prescribing steroid as your treatment.

Patients taking steroids rarely report serious side effects when used for only a few days or up to two or three weeks at the most. But it’s still important to not continue treatment any longer than necessary and to use the lowest dosage that is effective. Long-term or repeated use increases the risk of side effects especially when used beyond 3-4 weeks, depending on the steroid and the mode of use.

Dr. Ashish Bajaj, M.B.B.S., M.D. in Clinical Pharmacology and Toxicology

• Guard against low immunity: Steroids bring about a reduction in your immunity to infections. If you continue to be on steroids, experts recommend getting a vaccine against influenza annually. Seeking further input from your doctor for any other specific vaccine is also advised. Take care to reduce your risk of exposure to infections. Eg. Wear a mask when going to hospitals or crowded places and maintain good hygiene.
• Keep your gut healthy: Gastrointestinal problems like acidity are known to be a side effect of steroids. At the first signs of any abdominal pain or black ”tar-like” stool, experts suggest a consultation with your doctor on an immediate basis. They also recommend that your dose of steroids after a full meal or other medicines to overcome acidity can be prescribed by your doctor. 
• Outwit any insomnia: If insomnia or change in sleep patterns affects you, talk to your doctor. You may also try guided meditation and sleep hygiene practices for better sleep. Change your dose, not your mood – If your mood swings/mood change is pronounced, you are advised to consult your doctor for a change in your dose of steroid. Try breathing exercises, yoga and meditation right from the beginning of your treatment. If persistent mood and behaviour changes are affecting you, consult a counsellor for better management. But do not discontinue the medicine unless advised by your doctor. 
• Routine health tests: When on steroid therapy, you can minimise the risk of complications by being aware of them. Routine eye checkups, dental checkups and complete health checkups can help your doctor assess the early signs of any serious adverse effect. This can help them manage it early on by modifying your therapy if needed. Take note of hip pain – Experts advise that you bring any newly developed hip pain or joint pain to the notice of your treating doctor if you are on steroid medication.

Steroid tablets taken for longer than 3 weeks can cause: Increased appetite – which may lead to weight gain if you find it difficult to control what you eat.
acne. Rapid mood swings and mood changes – becoming aggressive, irritable and short-tempered with people. Thin skin that bruises easily, Steroid induced Diabetes

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

Conclusion

Steroids have become an integral part of medicine in the present day. They are administered by doctors when the benefits outweigh the side effects. The relief accrues to you as do the side effects. Awareness is the key to your winning over possible side effects and taking complete advantage of the benefits of your steroid therapy. Many people discontinue the treatment abruptly due to the fear of side effects. Never stop or start steroid medications without the prescription of a doctor. In case of any doubts or fears, speak to your doctor for authentic advice and guidance.

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability, or usefulness of the information; and disclaims any liability arising thereof.

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