Glucocorticoids Medicines - Adverse Effects of Glucocorticoids

Glucocorticoids can cause many adverse effects such as fat deposition on face (moon-life face), shoulders (buffalo hump) and abdomen (pot belly). Skin becomes friable easily and there are linear marks over the abdominal skin.

Precipitation of diabetes due to high blood sugar, muscle weakness and thin legs, proneness to infections and delayed healing of wounds, epigastric pain, activation and silent perforation of peptic ulcer, water accumulation in body, weight gain and rise in blood pressure may occur. Long use of glucocorticoids can lead to loss of calcium and weakness of bones and thereby increasing the risk of fractures. Mental irritability and psychosis, rise in tension in eye (glaucoma), cataract formation, growth retarded or stunted in children and foetal damage when used in pregnancy are some of the adverse effects.

Adverse Effects Due to Sudden Stoppage After Long Term Use: When the steroids are taken for a longer period, normal pituitary control on adrenal is markedly suppressed and adrenal gland shrinks in size. On sudden withdrawal of external steroids, these small adrenals are unable to cope up with increased needs leading to symptoms like generalized body muscles and joint pains and fall in blood pressure. This is called adrenal crisis, and needs to be avoided by gradual withdrawal of steroids under medical supervision. A similar situation may occur in surgical stress because adrenals cannot cope up for extra need so additional doses are needed. Any patient who takes more than 20 mg hydrocortisone in the last one year may require steroid protection during stress (infection or surgery). Doctors usually give doses on alternate days (alternate therapy) to reduce atrophy of adrenal gland. For this a short or intermediate acting drugs (prednisolone) is chosen.

With the knowledge of all undesirable and often dangerous effects, it is evident that these drugs should be taken only if there is no other choice. All precautions must be observed meticulously to minimize adverse effects.

Precautions

The doctor should be consulted frequently to keep the dosage at a minimum level and to know how to stop these drugs at a later stage.

Never take corticosteroids on an empty stomach. Patients of hyperacidity or peptic ulcer, should take an antacid tablet or at least milk, along with the medication.

A diet rich in proteins should be taken to minimize muscle wasting.

Patients of diabetes, should get their blood sugar checked regularly and, if necessary, dosages of insulin maybe increased.

Patients of high blood pressure need to get blood pressure checked frequently and adjust the dosages of the anti-hypertensive drugs if required. It may be necessary to supplement potassium chloride and restrict sodium intake. Hypertensive drugs (oral diuretics) and corticosteroids cause loss of potassium from the body.

Intensive antibiotic therapy must be instituted without stopping steroids, if there is any kind of infection.

Extra calcium and vitamin D should be taken to prevent osteoporosis.

Never stop corticosteroids abruptly. Sudden withdrawal may cause unpleasant symptoms such as fever, headaches, nausea, vomiting, restlessness, and muscle and joint pains. The best way to withdraw is by supplementing them with other conventional drugs and reducing the doses of corticosteroids gradually over a period of time.

Mineralocorticoid

A mineralocorticoid differs from the glucocorticoids in that it retains the sodium in the body longer than normal. Deoxycorticosterone is one such preparation used as a replacement therapy in chronic primary adrenocortical insufficiency. It is available in a combination with anabolic steroid (Docabolin).

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