Oral Steroids: Even Brief Use Carries Risks?>

Oral Steroids: Even Brief Use Carries Risks

by UCB Health & Wellness Publications

Doctors prescribe corticosteroids to treat a remarkable variety of medical conditions. Yet it’s long been known that extended use of these potent drugs can cause severe and potentially debilitating side effects and complications. A study now suggests for the first time that even short-term use of some doses of oral corticosteroids, for periods as brief as two weeks, may carry some small, but significant, risks.

Corticosteroids—which include prednisone, methylprednisolone, dexamethasone, and hydrocortisone—work by reducing inflammation when the immune system mistakenly goes into overdrive in response to a medical condition or an injury. They are used to control symptoms of autoimmune disorders such as rheumatoid arthritis, inflammatory bowel disease, and lupus. They’re effective in treating skin disorders such as eczema and rashes, respiratory ailments such as asthma, osteoarthritis pain, and some cancers.

Short-term steroid use—new concerns

Doctors usually prescribe oral corticosteroids in the lowest effective dose for the briefest period possible—and for good reason. Long-term use, especially with high doses, increases the likelihood of developing side effects and complications. Chronic use of corticosteroids can have adverse effects such as blood clots, weight gain, puffiness (especially in the face), and mood changes. The drugs can also increase the risk for such medical conditions as osteoporosis (bone loss) and bone fractures, heart disease, high blood pressure, diabetes, cataracts, and glaucoma. And, because corticosteroids are immunosuppressive agents, there’s an increased risk of developing infections, such as sepsis (body-wide inflammation brought on by an infection that can lead to multi-organ failure).

While the risks associated with persistent use of corticosteroids are well known, doctors have long assumed that the drugs are relatively safe when taken for brief periods. That assumption was called into question by a study published in BMJ in 2017.

Researchers at the University of Michigan Medical School analyzed medical records for more than 1.5 million adults ages 18 to 64 who sought treatment at outpatient clinics. They found that more than 1 in 5 patients—327,452 people—had received at least one oral corticosteroid prescription for a short course (six days on average). The most common conditions that were being treated were respiratory tract infections and disorders, allergies, intervertebral disk disorders, and other spinal conditions.

The researchers looked at whether patients who started taking oral corticosteroids were treated for any of three common side effects the drugs may cause within 30 days of starting therapy: sepsis, blood clots, or bone fractures. Compared to similar patients who didn’t take the drugs, corticosteroid users were five times more likely to develop sepsis, three times more likely to have blood clots, and twice as likely to break bones.

Still, the risk of adverse effects is quite small: In the study, the risk of developing sepsis among 327,452 people taking corticosteroids was 0.05 percent, the risk of blood clots was 0.14 percent, and the risk of fracture was 0.51 percent.

Safe doses and alternatives

Many patients in the BMJ study took relatively large quantities of corticosteroids over a short period, primarily because of the widespread use of methylprednisolone “dose packs,” which gradually taper the amount of medicine a patient uses over six days. While convenient, dose packs may expose patients to more medication than needed, the authors suggested.

One study limitation was its focus on adults 64 and younger. Another limitation was that the study didn’t include older adults who had age-related chronic conditions and took other drugs, which could have influenced the results.

If you need to take corticosteroids, make sure to inform your doctor about any and all other drugs you use, including herbal remedies and supplements. Some diabetes medications and the blood thinner warfarin may require dose adjustments. If your doctor prescribes a dose pack, inquire as to whether a lower-dose prescription is an option. Better yet, ask your doctor about safer alternatives.

If you have any of these symptoms while taking oral corticosteroids, seek immediate medical attention:

  • Blood clots: Soreness, pain, or swelling in your leg; redness or a warm spot on your leg; sharp chest pains; difficulty breathing; coughing; or a rapid heartbeat.
  • Sepsis: Fever, rapid breathing, rapid heart rate, chills, confusion, decreased urine output, or skin rashes.

    Are Inhaled Corticosteroids Safe?

    Often used to treat asthma and other lung conditions, these medications carry a lower risk of adverse effects than oral steroids because a smaller amount is absorbed by the body.

This article first appeared in the 2019 UC Berkeley Arthritis White Paper, medically reviewed by John A. Flynn, MD.

Also see Steroid Shots: Benefits and Risks.