What are they?

These are groups of steroid hormones, (e.g. cortisol); produced by the outer layer (cortex) of the adrenal glands, which are located on top of the kidneys.

Synthetic preparations are usually more powerful than the normally occurring hormones and are given to enhance their effect on disease in the body. These include:
• Hydrocortisone
• Dexamethasone
• Prednisolone
• Budesonide

What are they used for?

They are used mainly to control inflammation and the immune response in the body. They can also be used to replace low levels of naturally occurring steroids in the body when production of these is insufficient.

How do I take them?

They can be given in various forms depending on the severity of the condition and the site of the disease:

1. Tablet (e.g. Prednisolone, Dexamethasone)
This is swallowed and may be sugar coated or uncoated. It is absorbed through the stomach into the bloodstream and so has an effect throughout the body.

2. Injection (e.g. Hydrocortisone, Dexamethasone, Methylprednisolone)
The steroid is injected into a vein or muscle to allow a more rapid effect. Again, it has effects throughout the body. This form of treatment is used in severe cases of inflammatory bowel disease.

3. Topical preparations
These are applied directly to the area to be treated, thus causing minimal effects on other areas of the body. As treatment is direct, dosage is usually lower. Examples of these preparations include:
• Steroid enemas and suppositories, (e.g. Predsol, Predfoam, Colofoam)
• Hydrocortisone anal and rectal creams
• 5-Aminosalicylic Acid enemas and suppositories, (e.g. Asacol, Pentasa)

At the beginning of treatment it is usual to give a large dose to achieve remission. Once the disease is under control the dosage can gradually be reduced to prevent side effects.

You should not suddenly stop corticosteroids if you have been taking them for more than a few days as they usually cause the body's own adrenal gland to stop working. Sudden withdrawal may result in steroid deficiency, which can be dangerous, causing fatigue, vomiting and diarrhoea. Your doctor will advise you on how to reduce the dosage safely.

Are there any precautions?

You should avoid contact with chicken pox or Herpes Zoster (shingles) whilst taking treatment and for three months after stopping it. If you should come into contact with these diseases, you may need to be given an injection of immunogloblins (antibodies against shingles or chicken pox) as your own immunity may be greatly reduced due to the steroids. If you have had the diseases or have been immunised against them you need not worry.

You must let your doctor know all the medications you are taking as steroids can also have an affect on these, especially:

• Aspirin or other non-steroidal anti-inflammatory drugs e.g. Volterol
• Warfarin
• Diabetic tablets
• Blood pressure tablets
• Diuretics (water tablets)

Use in pregnancy

Studies have shown that the reported incidence of increased risk of spontaneous miscarriage, stillborn babies and premature labour is likely to be secondary to the disease rather than to the treatment. Active disease itself can be harmful to the foetus therefore controlling the disease may outweigh any potential side effects from these drugs.

Are there any side effects?

There are many side effects, which may occur from taking steroids, and the aim of treatment is to achieve maximum benefit with minimum side effects. Side effects most often occur when doses greater than 12.5 mg are given daily for prolonged periods. The doctor should monitor such doses very closely.

Courses of drugs tend to be short and sharp and often in combination with other drugs in order to further reduce the likelihood of long-term side effects. However, some of the side effects, which may occur, could include:

• excessive weight gain (referral to a dietitian may help).
• the face becomes reddened and rounded (moon face)
• suppression of growth in children
• raised blood pressure
• fluid retention due to increased sodium (a salt) in the body
• muscle weakness due to potassium loss (a salt) from the blood
• thinning of the bones (osteoporosis)
• raised blood sugar causing diabetes
• mood changes (depression or euphoria)
• stomach ulcers
• cataracts
• increased risk of infection
• increase in body hair (hirsutism)