Glucocorticoids: Uses, common brands, and safety info

Glucocorticoids are a commonly prescribed class of prescription medications used to treat various inflammatory conditions. Usually referred to simply as “steroids”, these medications should not be confused with the anabolic steroids that some athletes abuse. Our bodies actually produce a natural steroid hormone called cortisol, which is secreted by the adrenal cortex found on the adrenal glands. There are a number of glucocorticoid drugs on the market, and they are used to mimic the anti-inflammatory effects that are produced by the natural hormone cortisol. Continue reading to learn more about steroids, including brand names, pricing, and safety information.

What are glucocorticoids?

Glucocorticoids are one of two main types of corticosteroids produced naturally in the body, the other being mineralocorticoids. Glucocorticoids are powerful anti-inflammatory steroids that are utilized to treat many different health conditions. These steroids also possess properties that suppress the immune system, which is another reason doctors will prescribe them. Prednisone and dexamethasone are two examples.  

Steroids are used in a wide variety of conditions, ranging from acute asthma attacks to autoimmune diseases like rheumatoid arthritis, to nausea and vomiting caused by chemotherapy. Glucocorticoids are usually used to treat acute or severe inflammatory conditions for short periods of time. They are not typically meant for long-term or maintenance use, and even with a short therapy, doses often need to be tapered down slowly in order to be discontinued.

How do glucocorticoids work?

Glucocorticoids bind glucocorticoid receptors (GR) inside the cell, forming a glucocorticoid-GR complex. This complex is then able to enter the nucleus and act as a transcription factor. This means that steroids can alter the synthesis of mRNA and DNA, which results in an increased production of certain proteins and a decreased production of other proteins, depending on which area of the gene is affected. This ability to interfere with gene expression is the genomic mechanism of action that allows glucocorticoids to have a wide range of treatment properties, encompassing anti-nausea, vomiting effects, and immunosuppressive effects. 

Specifically relating to inflammation, in addition to interfering with the production of pro-inflammatory proteins, glucocorticoid action also activates a group of enzymes known as lipocortins. Lipocortins have been found to help block the production of arachidonic acid. Free arachidonic acid in the body is made into inflammatory chemicals that may worsen various health conditions. Furthermore, glucocorticoids are able to decrease the presence of lymphocytes at sites of inflammation within the body. Lymphocytes are white blood cells like t-cells and b-cells, which create inflammation to help fight infections that arise within the body. However, in autoimmune diseases, the body develops antibodies to harmless areas within itself, which these lymphocytes mistakenly attack by creating an inflammatory response to try and stop what it deems as an “infection.” Through inhibition of arachidonic acid and the decrease in lymphocyte activity, glucocorticoids are able to help suppress the production of inflammatory cytokines in the body. 

What are glucocorticoids used for?

• Rheumatology (Rheumatoid arthritis)

• Psoriatic arthritis

• Ankylosing spondylitis 

• Bursitis

• Osteoarthritis

• Gouty arthritis

• Systemic Lupus Erythematosus

• Stevens-Johnson Syndrome

• Severe seborrheic dermatitis

• Severe allergies

• Acute asthma exacerbation

• Ophthalmic inflammatory conditions

• Ulcerative colitis

• Crohn Disease

• Thyroiditis

• Tuberculosis

• Myasthenia gravis

• Duchenne Muscular Dystrophy

• Multiple Sclerosis exacerbations 

• Organ transplants

• Many other inflammatory conditions

Who can take glucocorticoids?

Adults 

Adult men and women can take glucocorticoids. Dosage is often based on each person’s individual weight.  What is important to keep in mind is the length of therapy. For acute inflammatory conditions, glucocorticoid therapy does not usually extend past 14 days. Even with short-term use, your healthcare provider will most likely taper down the dose slowly as you discontinue the medication. For chronic conditions that require prolonged use of glucocorticoids, it is important to discuss with your provider the potential side effects.

Children

While glucocorticoids may be used in children, there is evidence that steroid use can stunt physical growth in children. Therefore, if use is necessary, the lowest dose and shortest therapy should be considered. As with adults, dosages are based on weight. If the desired glucocorticoid dose is not available commercially or if your child has allergies to certain components of the commercial product, your provider may elect to send the prescription to a compounding pharmacy to be made according to your specifications. 

Seniors

It is safe for the elderly population to take glucocorticoids. Dosing is generally the same as in the adult population and as with any age group, low-dose steroid therapy should be chosen over high doses whenever possible. Potential side effects should be reviewed with your provider and monitored throughout your therapy. 

Are glucocorticoids safe?

Glucocorticoids recalls

• Promise Pharmacy: Voluntary recall of prednisolone/gatifloxacin eye drops due to particulate presence

• Sagent Pharmaceuticals: Voluntary recall of methylprednisolone Injection due to impurities

• Altaire Pharmaceuticals: Voluntary recall of multiple ophthalmic products due to quality assurance concerns

• Lucky Mart, Inc.: Voluntary recall of Piyanping Anti-Itch Lotion due to inaccurate active ingredient

• Synergy Rx Pharmacy: Voluntary recall of products including betamethasone creams due to quality assurance concern

Glucocorticoids restrictions

Do not take glucocorticoids if you have any history of hypersensitivity reactions to other glucocorticoids. Glucocorticoids should not be taken if you currently have a fungal infection in your body. 

You should also avoid getting “live” or “live attenuated” vaccinations while you are taking a glucocorticoid because these medications can weaken the immune system. If you are receiving a vaccine and are unsure of whether or not it is a live vaccine, inform your healthcare provider that you are on a glucocorticoid before getting the vaccine.

Other warnings include:

• Hypothalamic-pituitary-adrenal (HPA) axis suppression

• Cushing’s Syndrome can occur from elevated levels of cortisol

• Adrenal insufficiency if medications is suddenly discontinued

• Increased blood glucose levels over long term and can cause diabetes

• Immunosuppression: Glucocorticoid use can weaken the immune system, especially over long term use.

• Increased risk of fractures and osteoporosis

• Stomach ulcers and stomach bleeding

• Cardiovascular issues. Certain steroids, such as hydrocortisone, can cause sodium and fluid retention. This can result in elevated blood pressure, especially at high doses of the glucocorticoid. Steroid-use can also result in elevated cholesterol levels.

• High steroid use can cause muscle damage and can affect the kidneys and ultimately cause renal failure. 

Can you take glucocorticoids while pregnant or breastfeeding?

Glucocorticoids are not recommended for use during pregnancy, especially during the first trimester. There is limited data in humans, but evidence shows a potential for low birth weight and premature birth if a glucocorticoid is taken during the first trimester of pregnancy. Furthermore, animal studies have demonstrated a chance of developmental malformations such as cleft palates. However, glucocorticoids are not completely restricted for use during pregnancy. 

If it is necessary to take a glucocorticoid during pregnancy, your provider should prescribe the lowest possible dose and for the shortest course that is needed for effective treatment. If you do need to take a glucocorticoid during pregnancy, Deltasone is the preferred steroid because lower amounts of this drug pass into the embryo compared to other glucocorticoids. Topical versions of glucocorticoids may pose less risk during pregnancy because they are intended for local use rather than in vivo use. If you are using large quantities, make sure to double-check with your healthcare provider first. 

Because glucocorticoids pass into breast milk, it is not recommended to take a glucocorticoid if you are nursing. You and your provider may discuss the decision to either discontinue breastfeeding or discontinue the glucocorticoid. 

Are glucocorticoids controlled substances?

No, glucocorticoids are not controlled substances.

Common glucocorticoids side effects

Some common serious side effects of glucocorticoids are listed below. While these are generally less significant than other adverse effects, if any of these symptoms persist for longer than seven days, inform your provider. The most common side effects of glucocorticoids include:

• Upset stomach or throwing up

• Headache

• Thinning hair

• Feeling dizzy, weak, or tired

• Weight gain

• Increased sweating

• Difficulty sleeping

• Hiccups

• Restlessness 

• Increased hunger

How much do glucocorticoids cost?

Glucocorticoids are made in a variety of different formulations. The oral version is the most common way that doctors will prescribe glucocorticoids. A popular steroid pack called the Medrol Dosepak costs around $100 without insurance. However, a SingleCare coupon may lower the price to $10 for a treatment pack. 

The injectable forms of glucocorticoids range in price from around $20 to $80 without insurance, and are generally less commonly prescribed outside of a hospital setting. Triderm, the topical brand name cream for triamcinolone, costs more than $200 for a jar. With a SingleCare coupon, you could pay as low as $12 for the prescription. Most insurances will cover common steroid formulations like the Dosepak, but if they do not, be sure to check SingleCare’s coupons to ensure that you are paying the best price for your medication.  

References

• Adrenal Insufficiency & Addison’s Disease

• Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trial

• Cushing’s Syndrome

• Dexamethasone

• Drug spotlight program: Systemic corticosteroid therapy: pharmacology and endocrinologic considerations

• Glucocorticoids

• Prednisone package insert

• Prednisone prescribing information

• The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting

• The effect of long-term glucocorticoid therapy on pituitary–adrenal responses to exogenous corticotropin-releasing hormone