Synthetic corticosteroids are used to treat a variety of diseases. For some reason, some patients cannot produce the vital corticosteroid hormone (cortisol) naturally, and they therefore need to be given this hormone. Corticosteroid is also used to treat diseases characterised by inflammation, e.g. allergies such as asthma and anaphylactic shock (after a wasp or a bee sting for example). However, corticosteroid is also used to treat diseases such as rheumatoid arthritis, inflammatory bowl diseases (Crohn's disease and ulcerative colitis) and a number of diseases of the liver, kidneys and bone marrow.
The treatment is often given as tablets or inhalations, but sometimes injections (into the muscle or a vein) are also given - especially in cases of emergency.
As with all other treatments, corticosteroid may have side effects. The potential side effects will depend on whether the medicinal product is given in tablet form, inhaler form or as an injection as well as on whether the duration of treatment is short or long.
In many cases, corticosteroid is vital for the prevention or treatment of acute exacerbation of a serious disease. Consequently, treatment should not be omitted or stopped without advice from the treating physician.
You can find a complete list of adverse reactions associated with corticosteroid (including frequency) for the product concerned in the summary of product characteristics at the Danish Medicines Agency's website (www.produktresume.dk).
Corticosteroid therapy in tablet form is used either as short term course to treat exacerbation of asthma or chronic obstructive pulmonary disease (COPD) or as longer-term therapy to treat chronic diseases of the kidneys, liver, lungs, intestines, or muscles/joints. Long-term treatment may be associated with a number of adverse reactions such as restlessness, euphoria, sleeplessness or other psychiatric reactions. Furthermore, subcutaneous bleeding of the skin, thin skin, osteoporosis, growth retardation in children, muscle pain, cataract, hypertension and worsening of diabetes are also seen. Corticosteroid damps the body's reaction to inflammation (e.g. fever), which means that patients must be aware of the risk that reactions may be overlooked.
Corticosteroid injections are given in emergencies and only one time or very few times. All of the adverse reactions associated with long-term treatment may also occur when corticosteroid is injected, however, they are much rarer. Any injection (in particular injections into a vein) may - regardless of product - be associated with a serious, acute allergic reaction, also known as anaphylactic shock. Anaphylactic shock following corticosteroid injection is very rare, and is seen in less than one in 10,000 cases. The risk of anaphylaxis should not keep a doctor from using corticosteroid to treat life-threatening conditions. When corticosteroid injections are given, the same precautions must be observed as with any other injections.
Inhaled corticosteroid therapy is used for the treatment of asthma and COPD, in which case treatment is often lifelong. The adverse reactions associated with long-term treatment with tablets are only seen very rarely following corticosteroid inhalation because the dose inhaled is much lower and because a much smaller quantity of the product is absorbed by the body. Inhalation therapy may, however, be associated with hoarseness, fungal infection of the mouth and throat (calling for good oral hygiene after inhalation) and, in very rare cases, asthma attacks and allergic reactions, including anaphylaxis.
Other local treatment with corticosteroid is to treat various skin disorders - often allergic rashes. The adverse reactions seen after long-term treatment with tablets are rarely seen following local treatment because of the much lower dose given and because of the much lower quantity absorbed by the body. The adverse reactions seen are often local irritation and hypersensitivity. Furthermore, long-term treatment may cause thin skin and minor bleeding of the skin.
For further information, please contact Chief Medical Officer Steffen Thirstrup, +45 4488 9187.
The Danish Medicines Agency, 7 January 2008.
