Systemic Corticosteroid Therapy (Prednisone, Decadron, Hydrocortisone) Adverse Effects
Oral and intravenous corticosteroids (such as prednisone, Decadron and hydrocortisone) are frequently prescribed to address inflammatory conditions. As is true with the use of any medication, a balance between the anticipated benefit and potential risks must be made in the course of pursuing a treatment plan. In general, the lower the dose and the shorter the duration of treatment, the less likely a complication will occur. Recognized complications are presented in the table below.
Table below adapted from reference Poetker and Reh 2010 who conclude that "there exists a paucity of data on the adverse effects associated with shorter courses and smaller doses of corticosteroids". Review by Rafii et al (2014) identifies that "common short term adverse effects include hypertension, hyperglycemia, and behavioral/cognitive changes ranging from mood alterations to frank psychosis" that may be present even after a few days of use.
Affected Body Part |
Side Effect |
Comment |
|---|---|---|
|
Body |
Moon Facies/Buffalo Hump/Truncal Obesity |
Redistribution of fat may occur with prolonged use at higher doses |
|
Blood |
Increased blood sugar |
Glucose metabolism usually returns to normal after stopping steroids |
|
Resistance to Infection |
Bacterial/viral/fungal |
Usually apparent only with prolonged courses; One study identified no increased risk of infection with less than 700 mg of prednisone or a daily dose less than 10 mg/day |
|
Wound Healing |
Delayed Healing |
|
|
Bone |
Decreased bone density/ avascular necrosis (most commonly in head of femur) |
Retrospective study of 1352 patients treated with corticosteroids for neurosurgical problems identified 4 cases of avascular necrosis (0.03%) following a mean cumulative dose (673 mg of prednisone) and mean duration (20 days of treatment) (ref Wong 2005). |
|
Eye |
Cataracts/Glaucoma |
Most report at least 10 mg daily for at least a year before developing cataracts (ref Carnahan MC 2000) |
|
Skin Changes |
Skin fragility/bruising/hirsutism |
37 out of 80 (46%) on a mean dose of 31 mg of prednisone over three months developed hirsutism, spontaneous bruising or altered wound healing (ref Fardet 2007) |
|
Gastrointestinal |
Gastritis |
Although patients using prednisone more commonly complain of peptic-ulcer-type symptoms, meta-analysis of 93 randomized trials found no association between ulcer development and prednisone use (ref Conn 1994) |
|
Suppression of adrenal glands |
Multiple systemic effects |
May require gradual tapering of dose; the normal, non-stressed adult adrenal gland secretes 10-20 mg of cortisol per day (equivalent to 5-7 mg of prednisone per day) (ref Asare 2007) |
|
Muscle |
Atrophy of proximal limb muscles |
Usually resolves after 1-4 months following cessation; rarely involves muscles other than proximal limbs - identified by difficulty climbing stairs (ref Bowyer 1985) |
|
Cardiovascular |
Potential increased risk of heart attack |
Observational studies from the U.K. (ref Wei 2004) and (ref Souverein 2004) |
|
Circulation |
Increased blood pressure |
Usually transient |
|
Psychiatric (Mild) |
Anxiety/insomnia/restlessness |
Usually dose dependent and reversible with stopping medications (ref Warrington 2006) |
|
Psychiatric (Severe) |
Mania/depression/aggressiveness |
An older study (ref The Boston Collaborative 1972) reported a 1.3% incidence of psychiatric symptoms with a daily prednisone dose less than or equal to 40 mg, a 4.6% incidence with 41 to 80 mg daily, and an 18.4% incidence in those receiving more than 80 mg daily. |
|
Kidney |
Kidney stones and diuresis |
Glucocorticoids lead to an increase in urinary calcium and uric acid excretion which may precipitate to form kidney stones. |
References
Poetker DM, Reh DD. A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin North Am 2010;43:753-76
Poetker DM, Smith: What Rhinologists and Allergists Should Know About the Medico-Legal Implications of Corticosteroid Use: A Review of the Literature. Int Forum Allergy Rhinol. 2012;2(2):95-103
Wong GK, Poon WS and Chiu KH: Steroird- induced avascular necrosis of the hip in neurosurgical patients: epidemiological Study. ANZ J Surg 2005;75:409-10
Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 2000;11:478-83
Fardet L, Flahault A, Kettaneh A et al Corticosteroid-induced clinical adverse events: freuqncy, risk factors and patients's opinion Br J Dermatol 2007; 157:142-8
Conn HO and Poynard T. Corticosteroids and peptic ulcer: metaanalysis of adverse events during steroid therapy J Intern Med 1994;236:619-32
Asare K. Diagnosis and treatment of adrenal insufficiency in the critically ill patient. Pharmacotherapy 2007;27:1512-38
Bowyer SL, LaMothe MP, Hollister JR. Steroid myoplathy: incidence and detection in a population with asthma. J Allergy Clin Immunol 1985;76:234-42
Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescritpion is associated with subsequent cardiovascular disease. Ann Intern Med 2004;141:764-70.
Souverein PC, Berard A, Van Staa TP et al Use of oral glucocorticoids and risk of cardiovascular and cerebrovacular disease in a population based case-control study. Heart 2004;90:859-65
Warrington TP and Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 2006; 81:1361-7
The Boston Collaborative Drug Surveillance Program Acute adverse reactions to prednisone in relation to dosage. Clin Pharmocol Ther 1972;13:694-8