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Corticosteroid Report

Corticosteroids are a family of drugs which include both the adrenal steroid hormone cortisol (hydrocortisone) and synthetic drugs (prednisone etc.) that are related to cortisol. 

They are usually taken by mouth to treat autoimmune and inflammatory diseases including asthma and other lung conditions, bursitis, skin disorders, tendonitis,  ulcerative colitis, etc. In addition, they are used to treat severe allergic reactions and prevent rejection after organ transplant. Inhaled by nose, they are used to treat symptoms of seasonal allergies. They are often combined with antibiotics to treat ear, eye and skin infections.

Partial list by type and brands include:

  • Beclomethasone 
            Beconase, Beclovent, Vancenase, Vanceril, QVAR
  • Budesonide
            Pulmicort, Rhinocort
  • Dexamethasone
            Decadron, Decadron Phosphate Turbinaire, etc.
  • Dexamethasone/Tobramycin
            Tobradex
  • Flunisolide
            AeroBid, Nasalide
  • Fluticasone
            Cutivate, Flonase, Flovent, Advair
  • Hydrocortisone
            Cortef, Hytone, etc.
  • Methylprednisolone
            Medrol
  • Mometasone
            Elocon
  • Prednisone
            Deltasone, Orasone, etc.
  • Prednisolone
            Delta-Cortef, Pediapred, etc.
  • Triamcinolone
            Aristocort, Azmacort, Nasacort, Etc.

Side Effects:

Note: The side effects listed here are generalizations only, and should be viewed as guidance only. You should consult your Primary Care Provider and your Pharmacist for the side effects for any specific drug which you are using, since each has different specific side effects. 

In general, the Corticosteroids may possibly cause dizziness, nausea, indigestion, increased appetite, weight gain, osteoporosis, edema, bruising, slow healing, headaches, convulsions, acne, rash, psychic disorders (steroid psychosis, weakness or sleep disturbances. In addition, the use of certain corticosteroids may mask the signs and symptoms of infection.

 As a general rule, the inhaled Corticosteroids have less severe side effects. 

Note: See the 5 interaction categories below for additional information on side effects.

Interactions -- Dietary Supplements:

Folic Acid - Some possible loss of this B Vitamin with corticosteroid use. Folic acid plays a role in cell division, and can reduce the risks of heart attacks and birth defects. 

Magnesium - The loss of this essential nutrient mineral with corticosteroid use may be increased. Muscle relaxation, blood clotting, and the manufacture of ATP (the body's main energy module) may be effected. Some nutritional doctors suggest 3-400 mg of magnesium daily for long term use (over two weeks).

N-Acetyl CySteine (NAC)
- one study indicated further improvement with 600mg - 3 times daily with prednisone for treatment of fibrosing alveolitis, a rare lung disease.

Potassium - Some possible increased loss in urine with corticosteroid use. This mineral plays a role in sodium balance, plus blood pressure control and hypertension. Since the loss is not significant for most people, it can usually be offset by using more potassium rich fruits, such as bananas.  NOTE: Diuretic use combined with corticosteroid use may aggravate this loss considerably. Consult your health care provider for guidance regarding this.

Vitamin A - Corticosteroid use often results in impaired wound healing. One study indicated that 80% of the people treated with vitamin A had improved wound healing capabilities. Since theoretically, Vitamin A might also reverse some of the benefits of corticosteroids, definitely consult with your health care provider before starting Vitamin A supplements.

Vitamin B-6 Some possible increased loss is possible with corticosteroid use. This vitamin's principal uses are heart disease prevention, morning sickness, asthma and PMS. Some nutritional Doctors recommend 25-50mg daily replacement to prevent deficiency if  using corticosteroids for long term (over 2 weeks).

Vitamin B-12 - Some increased loss is possible with corticosteroid use. The principal use is for pernicious anemia, with lesser possible influence for infertility, asthma, diabetic neuropathy, MS, depression, and osteoporosis.  Also possibly needed for potassium deficiency. Consult your health care provider for guidance regarding this. 

Calcium and Vitamin D - There is a reduction in the body's ability to activate Vitamin D when taking corticosteroids, thus increasing the risk of bone loss as well as cataracts. The list of other possible benefits of Calcium and Vitamin D is extensive ranging from cancer prevention to heart disease to mental conditions. People taking corticosteroids on a long term basis (2 or more weeks) should ask their health care provider to be tested for vitamin D deficiency and to possibly be put on  calcium and vitamin D supplements. Note: Calcium is an essential nutrient that is obtainable only from foods and supplements.

Dehydroepiandrosterone (DHEA) - Some studies have indicated that inhaled steroids (beclomethasone) may reduce levels of DHEA in women. This may provide a possible clue to a contributing factor to osteoporosis, but this needs much more research. 

Melatonin - Further research is needed (especially for long term use), however, early indications are that a high percentage of people show a reduction in the production of melatonin. 

Selenium - -Corticosteroids may cause some possible loss of this trace mineral which has antioxidant implications.

Sodium - - Corticosteroid use causes sodium retention in the body. Consult your health care provider for guidance regarding the restricting of salt intake. 

Zinc - - - -Corticosteroids may cause some possible loss of this important element which supports the functioning of over 300 enzymes. 

Other Information - Corticosteroids increase the urinary loss of Vitamin K and Vitamin C. Although the significance of  this is unclear, you should consult your Health Care  Provider about these if you are taking corticosteroids for 2 or more weeks.

Interactions -- Herbs

Aloe (aloe-vera) - When applied along with cortisone there have been anti-inflammatory benefits according to early animal studies. 

Digitalis (digitalis purpurea) - This herb, from the foxglove family of herbs, has similar characteristics to the commercial drug digitalis. This use might increase the possibility of side effects from the use of corticosteroids.

Ephedra sinica (Ma Huang) - People taking Dexamethasone should avoid edephra and products containing ephedrine, since it increases the clearance of the  drug from the body, decreasing its effectiveness. Consult your health Care provider on any use of ephedra.

Licorice (Glycyrrhiza glabra) - Licorice has been shown to reduce the clearance of prednisone from the body of test animals. If this occurs with people, it will result in lengthening and possible strengthening of the drug's activity, as well as a possible increase in side effects.

Indications are that it might prevent the immunosuppressive actions of cortizone.

It has been shown to increase the activity of hydrocortisone when applied topically. 

Consult your health Care provider before taking Licorice with corticosteroids. 

Interactions -- Foods - Corticosteroid can cause stomach upset and should be taken with food.

Interactions -- Protein - Doctors often ee a high protein diet for people taking corticosteroids to offset the protein wasting side effects. Since there is some possible link between high protein diets and some other medical conditions, you should consult your health care provider before starting a high  protein diet.

Interactions -- Alcohol - Corticosteroid use can cause stomach irritation, which can be aggravated with alcohol use. 

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This is provided as an information resource only, with the goal of helping to provide you with the knowledge to help you make more  informed choices and to help you work more effectively with your primary health care provider. Nothing can replace the knowledge and services of a qualified health-care  provider, however, you can and should be empowered though knowledge to have a major role in the selection of medical treatment options. 

The data as presented in the various forums has been collected from a wide range of resources. This information is provided as a starting point for assisting you in gaining the desired knowledge. All information provided should be discussed with a qualified health care professional before any remedy or therapy is started. 

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