Corticosteroids

January 7, 2016

Corticosteroids are powerful anti-inflammatory drugs that help to suppress the immune system. These drugs are effective in treating many ailments, particularly autoimmune diseases, and have been used effectively for many years.

Corticosteroids (cortisol, corticosterone, cortisone, and aldosterone) are produced naturally in the body by the Cortex, which is the outer portion of the adrenal gland, and can be broken down into two categories:

  1. Glucocorticoids: These act to suppress the immune system and lessen inflammation, while also assisting in the breakdown of fats, carbohydrates, and proteins
  2. Mineralocorticoids: These regulate the balance of salt and water in the body

Synthetic corticosteroids mimic the actions of naturally occurring corticosteroids and are often used as a replacement in people with dysfunctional adrenal glands which are unable to produce adequate amounts of the chemicals.

Systemic corticosteroids refer to corticosteroids given orally, or via injection, and distributed throughout the body. These do not include corticosteroids used in the eyes, ears, nose, on the skin, or that are inhaled.

Examples of synthetic corticosteroids:

  • Betamethasone
  • Budesonide
  • Cortisone
  • Hydrocortisone
  • Prednisone
  • Prednisolone
  • Triamcinolone
  • Methylprednisolone
  • Dexamethasone

Corticosteroids are used to treat a long list of ailments and diseases. These include:

  • Asthma
  • Allergic rhinitis (hay fever)
  • Chronic Obstructive Pulmonary Disease (obstructive disease caused by poor airflow through the lungs)
  • Bronchitis
  • Hives
  • Sarcoidosis
  • Eosinophilic pneumonia (where a type of white blood cell, eosinophil, accumulates in the lungs)
  • Systemic Lupus
  • Atopic and Contact dermatitis (atopic and contact eczema)
  • Anaphylaxis (allergic reactions)
  • Food and drug allergies
  • Pemphigus vulgaris (chronic blistering skin disease)
  • Adrenal insufficiency and Congenital adrenal hyperplasia
  • Ulcerative colitis
  • Crohn’s disease
  • Autoimmune hepatitis
  • Lymphoma
  • Leukaemia
  • Autoimmune haemolytic anaemia (anaemia caused by the abnormal breakdown of red blood cells)
  • Immune thrombocytopenic purpura (low platelet count resulting in purpuric rash and increased tendency to bleed)
  • Rheumatoid arthritis
  • Polymyalgia rheumatic (chronic pain or stiffness in usually the neck, shoulders, and hips)
  • Polymyositis (chronic inflammation of the muscles)
  • Dermatomyositis (connective tissue disease that causes the inflammation of the muscles and skin)
  • Vasculitis (disorder that destroys the blood vessels via inflammation)
  • Polyarteritis nodosa (systemic vasculitis of the small or medium-sized arteries)
  • Uveitis (inflammation of the uvea which is the pigmented layer between the inner retina and the outer tissue of the sclera and cornea)
  • Keratoconjuctivitis (inflammation of the cornea and conjunctiva)
  • Prostate cancer
  • Multiple sclerosis
  • Severe psoriasis
  • Addison’s disease
  • Low blood pressure
  • Nephrotic syndrome
  • Chronic hepatitis
  • Cerebral edema
  • Nausea

 

SIDE EFFECTS:

  • Cushing’s syndrome
  • Sodium and fluid retention causing weight gain and edema (leg swelling)
  • High blood pressure (hypertension)
  • Loss of potassium (hypokalaemia)
  • Muscle weakness
  • High sodium levels (hypernatremia)
  • Permanent eye damage (induces central serous retinopathy)
  • Facial puffiness /‘moon face’
  • Increased growth of facial and body hair
  • Thinning and easy bruising of the skin
  • Slow wound healing
  • Glaucoma
  • Cataracts
  • Stomach ulcers
  • Increased insulin resistance
  • Increased blood sugar levels (hyperglycaemia)
  • Menstrual irregularities
  • ‘Buffalo hump’, or, rounding of the upper back due to the movement of body fat
  • Osteoporosis
  • Obesity
  • Growth retardations in children
  • Convulsions
  • Psychiatric disturbances such as anxiety, depression, mood swings, euphoria, insomnia, and personality changes
  • Psychotic behaviours such as mania, psychosis, hallucinations, aggression, and violence
  • Heightened risk of infections due to suppressed immune system
  • Reduced effectiveness of antibiotics and vaccines
  • Atrophy (shrinking) of the adrenal glands
  • Adrenal necrosis of the hip joints
  • Addiction
  • Skin rashes, lesions, and acne (when used topically)
  • Increased thirst
  • Frequent urination
  • Flushed face/cheeks
  • Increased appetite

 

WARNINGS:

Corticosteroids can interact badly with many other medications, so people using this drug must always consult with a doctor or pharmacist before using in conjunction with other medicines.

These drugs lower the effectiveness of antibiotics and vaccines, cause low blood pressure and heart failure when combined with medications that lower potassium levels, and have their effectiveness rapidly increased with the supplementation of estrogens.

Corticosteroids should never be taken without advice and consultation with a physician.

These medications should be taken with food, not mixed with drugs or alcohol, and abstained from when pregnant or breastfeeding.

A person taking corticosteroids should be a low sodium, high potassium, high protein, and low-calorie diet.

Due to decreased immune system efficiency, people taking this medication should avoid people with contagious illnesses and infections, particularly children using this medication.

This drug should not be stopped suddenly, as an adrenal crisis may occur. This is characterized by nausea, vomiting, and shock.

 

REFERENCES:

https://en.wikipedia.org/wiki/Corticosteroid

http://www.medicinenet.com/corticosteroids-oral/page2.htm

http://www.mayoclinic.org/steroids/art-20045692?pg=1

https://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease

https://en.wikipedia.org/wiki/Atopic_dermatitis

http://www.allergy.org.au/patients/skin-allergy/angioedema

https://en.wikipedia.org/wiki/Eosinophilic_pneumonia

https://en.wikipedia.org/wiki/Immune_thrombocytopenic_purpura

https://en.wikipedia.org/wiki/Polymyalgia_rheumatica

https://en.wikipedia.org/wiki/Polymyositis

https://en.wikipedia.org/wiki/Dermatomyositis

https://en.wikipedia.org/wiki/Polyarteritis_nodosa

https://en.wikipedia.org/wiki/Uveitis

https://en.wikipedia.org/wiki/Keratoconjunctivitis

http://www.mayoclinic.org/drugs-supplements/corticosteroid-oral-route-parenteral-route/description/drg-20070491

http://my.clevelandclinic.org/health/drugs_devices_supplements/hic_Corticosteroids

http://www.nhs.uk/conditions/Corticosteroid-(drugs)/Pages/Introduction.aspx

http://www.livestrong.com/article/553515-what-teas-can-you-have-while-on-prednisone/