Corticosteroids: Uses, common brands, and safety info

Corticosteroids are a class of medications designed to mimic the actions of naturally occurring hormones secreted by the body’s adrenal gland. Cortisol plays a wide variety of roles in your body related to inflammation, immune response, glucose production, and adrenaline response. These responses are critical in disorders such as rheumatoid arthritis, lupus, and asthma just to name a few. 

At times, your body’s natural cortisol response is insufficient to control the symptoms of a disease or process, and giving corticosteroid medication helps your body overcome the symptoms you are experiencing. 

Corticosteroids belong to two general drug classes: glucocorticoids and mineralocorticoids. Glucocorticoids mimic the actions of cortisol and are known for their anti-inflammatory effects and immunosuppressive properties. Mineralocorticoids mimic the actions of aldosterone more closely, while still possessing some anti-inflammatory and immunosuppressive properties. 

Corticosteroids are sometimes called “steroids,” but should not be confused with the anabolic steroids related to sex hormones or muscle building. Corticosteroids come in different forms including oral, respiratory, topical, and injections. We will discuss the various properties, common brand names, and safety of corticosteroids in the sections that follow.

Other corticosteroids

• Cortone (cortisone)

• Nasarel (flunisolide)

• Asmanex (mometasone)

What are corticosteroids?

Corticosteroids is a term used to classify a broad range of medications that are designed to mimic your body’s natural adrenal hormones. These hormones control mediate processes in the body related to immune response, inflammation, fluid retention, and glucose production. They are used in a variety of inflammatory and immune system disorders including but not limited to cystic fibrosis, chronic obstructive pulmonary disease (COPD), and allergic reactions. 

Each corticosteroid drug has a different level of potency. Hydrocortisone is the closest to the body’s natural hormone cortisol, and dose equivalents are expressed in ratios to hydrocortisone. For example, prednisone is four times as potent as hydrocortisone. Therefore the potency of a 5 mg dose of prednisone is approximately equal to that of a 20 mg dose of hydrocortisone.

How do corticosteroids work?

Corticosteroids work by reducing the production of the chemicals responsible for the inflammatory process. When the body is presented with something unknown such as a virus, bacteria, or other foreign body, it has a natural response to send white blood cells and other mediators to ward off the unknown substance. The body’s natural reaction to these foreign substances causes unwanted symptoms which can sometimes be dangerous such as swelling of joints or airways, redness, or pain. Ongoing inflammation is damaging to our organs and tissues, and therefore if the body cannot control the inflammatory response, treatment with corticosteroids may be necessary. Corticosteroids reduce the response of the body by decreasing the mediators released to cause this inflammatory reaction.

What are corticosteroids used for?

• Allergies

  • Allergic rhinitis

  • Hives

  • Anaphylaxis

  • Food allergies

  • Drug allergies

• Respiratory

  • Asthma

  • Chronic obstructive pulmonary disease (COPD)

  • Pneumonia

• Dermatological disorders/ skin conditions

  • Atopic dermatitis

  • Contact dermatitis

  • Eczema

• Rheumatological disorders/ autoimmune diseases (immunology)

  • Rheumatoid arthritis

  • Systemic lupus erythematosus (SLE or lupus)

  • Vasculitis

• Blood disorders (hematology)

  • Lymphoma

  • Leukemia

  • Hemolytic anemia

  • Multiple myeloma

• Eye disorders (ophthalmology)

  • Optic neuritis

  • Keratoconjunctivitis

• Other disorders

  • Cystic fibrosis

  • Multiple sclerosis

  • Organ transplant

  • Nephrotic syndrome (kidney disease)

  • Chronic hepatitis 

  • Colitis

  • Crohn’s disease

Types of corticosteroids 

Glucocorticoids

Glucocorticoids mimic the actions of the hormone cortisol and are known for their potent anti-inflammatory effects and immunosuppressive properties. Hydrocortisone is of equal potency to cortisol, and the potency of other glucocorticoids is compared in hydrocortisone equivalents. 

Examples: Medrol, Cortef, Kenalog, Orapred

Mineralocorticoids

Mineralocorticoids mimic the actions of aldosterone more closely, while still possessing some anti-inflammatory and immunosuppressive properties. Aldosterone is a hormone which controls sodium and water transport through the body through its actions on potassium and sodium channels. 

Example: Florinef 

Who can take corticosteroids?

Adults

Adults can take corticosteroids for a variety of conditions. While corticosteroids are sometimes used to treat hypersensitivity reactions, it is possible to have this type of reaction to a corticosteroid drug itself. Caution or avoidance should be used with any corticosteroid if a patient of any age is suspected of having a hypersensitivity reaction to any other drug in the class. 

Seniors

Corticosteroids can be used when necessary in seniors. However, caution should be used due to the immunosuppressive effects of corticosteroid use, especially high doses and long-term use. The immune system of a senior may already be decreased due to age and other factors leaving them at an increased risk of infections, some of which can be life-threatening.

Children

Some corticosteroids have approved uses in infants, children, and adolescents. Corticosteroids may not be appropriate in all children for all indications. Your pediatrician can provide more guidance and treatment options.

Renal and cardiovascular patients

Sodium retention and potassium loss can lead to fluid retention and edema. This may be more pronounced in patients on long-term corticosteroid therapy. Caution should be used when deciding whether or not to use corticosteroids in patients with kidney disease, hypertension, or congestive heart failure.

Diabetic patients

Corticosteroids are known to decrease glucose tolerance and produce hyperglycemia (high blood sugar). If steroid use is necessary for diabetic patients, the doses of insulin or oral anti-hyperglycemic medications may need to be increased to control blood sugar adequately. 

Are corticosteroids safe?

Corticosteroids recalls

Here are specific recalls in the past three years:

• Sagent Pharmaceuticals recall of methylprednisolone sodium succinate for injection due to impurities April 2020

• Altaire Pharmaceuticals Inc. recall of multiple ophthalmic products due to potential for non-sterility April 2019

• Apotex Corp. recall of fluticasone nasal spray for small glass particles in the solution May 2018

Corticosteroids restrictions

Corticosteroids are safe at recommended doses. Long-term (more than one week) dosing is associated with more side effects than short-term (less than one week). Higher doses for more than a few weeks will interrupt your body’s natural feedback system, and eventually lead your body to stop making its own cortisol. For this reason, dosing regimens of more than a few days long should be tapered down rather than being abruptly stopped so that your body has the chance to begin producing its own hormone again.

Corticosteroids should not be given in the evening hours because they can cause agitation and insomnia, or difficulty sleeping.

Corticosteroids cause immunosuppression and therefore increase the risk of infections. Some viral infections may have much more severe symptoms in patients who are on corticosteroid therapy. This immunosuppression can also cause slower wound healing.

Cushing’s syndrome is an adverse event of long-term use of corticosteroids. This syndrome is characterized by a fatty hump between the shoulders, fatigue, weight gain, a round face (sometimes called “moon face”), depression, and a change in menstrual cycle.

Can you take corticosteroids while pregnant or breastfeeding?

While not all corticosteroids have been given a pregnancy classification by the Food and Drug Administration (FDA), risk has not been ruled out, and in some cases, fetal harm has been shown. If corticosteroid therapy is absolutely necessary, the newborn should be monitored closely for signs of adrenal insufficiency. Corticosteroids do cross into breast milk, and if necessary, the lowest possible dose should be given to the lactating mother. Your healthcare provider can help you weigh the risks and benefits of corticosteroid treatment.

Are corticosteroids controlled substances?

No, corticosteroids are not controlled substances.

Common corticosteroids side effects

Corticosteroids can cause a variety of side effects. These will vary slightly based on the specific type of corticosteroid prescribed. Other factors for the prevalence of serious side effects are the dose and duration of treatment.

The  most common side effects for corticosteroids are:

• Agitation/ irritation

• Blurred vision

• Cataracts/ glaucoma

• Difficulty concentrating

• Dizziness

• Facial hair growth in females

• Fast or irregular heartbeat

• Fluid retention

• Headache

• Hypertension (high blood pressure)

• Increased blood sugar (hyperglycemia)

• Increased cholesterol and triglycerides

• Increased risk of gastric ulcers or gastritis

• Gastrointestinal disturbances

• Loss of potassium

• Mood changes/ mood swings

• Osteoporosis (bone loss)

• Reactivation of latent tuberculosis infections

• Shortness of breath

• Sleeplessness/ insomnia

• Weight gain

How much do corticosteroids cost?

Corticosteroids are available in a variety of dosage forms, and many are generically available on the U.S. market. Some of the most common oral corticosteroids are very affordable with the use of SingleCare coupons. For instance, a typical course of methylprednisolone is less than $15 through SingleCare, while a typical regimen of prednisone is less than $5 in many instances. Other dosage forms can be more expensive. For example, the QVAR inhaler is not yet available generically, however, SingleCare will help reduce your cost from more than $700 to less than $500. 

Your insurance may have formulary restrictions that will suggest that you try regimens of certain preferred drugs first before they will approve the use of more expensive medications. Before filling your corticosteroid prescription, always check with SingleCare to make sure you are paying the best price.