Steroids – long term

Some people are prescribed steroid medicines on an ongoing basis for the treatment of long-term conditions.

Steroid medicines are available in different forms such as tablets (taken by mouth), creams, inhalers, injections and nasal sprays. 

Taking steroid tablets long term is helpful to treat conditions associated with inflammation, but continued steroid use can cause side effects. Examples of steroid tablets include prednisone, hydrocortisone and dexamethasone. Read more about steroid tablets.  

What are the common side effects with long-term steroids?

A short course of steroids usually causes very few side effects. For example, a 1–2 week course is often prescribed to ease a severe attack of asthma or gout. This is usually taken without any problems.

Side effects are more likely to occur if you take a long course of steroids (more than 2–3 months), or if you take short courses often. 

The most common side effects with ongoing steroids are:

  • difficulty sleeping
  • weight gain
  • skin thinning, easy bruising and tearing, slow wound healing
  • osteoporosis
  • stomach ulcers
  • high blood pressure (hypertension)
  • diabetes (either new onset or difficult to control)
  • weakened immune system with a high chance of infections
  • mood changes, especially if you already have mood disturbances or you drink a lot of alcohol.

Stop steroids slowly – do not stop suddenly

If you have been on a long course of steroids, it is really important to reduce the dose slowly over a few weeks or months. Do not stop taking steroids suddenly. This can cause a severe, life-threatening condition caused called adrenal insufficiency.

You are most at risk if you are taking: 

  • steroid tablets in doses greater than 5 milligrams of prednisone per day, 20 milligrams of hydrocortisone per day or 0.5 milligrams of dexamethasone per day
  • inhaled steroids at high doses (doses great than 1500 micrograms of beclometasone or 750 micrograms of fluticasone daily). 

Your body normally makes steroids by itself as these are needed to be healthy. When you take oral steroids for a few weeks or more, your body may reduce or stop making its own steroids.

If you then stop taking oral steroids suddenly, your body does not have any steroids. This can cause various withdrawal symptoms until your body starts making more natural steroids over a few weeks. The withdrawal symptoms can be serious and even life threatening.

Symptoms of steroid withdrawal
  • weakness
  • tiredness
  • feeling sick (nausea)
  • being sick (vomiting)
  • runny poos (diarrhoea)
  • tummy (abdominal) pain
  • low blood sugar (hypoglycaemia)
  • low blood pressure (hypotension) which can cause dizziness, fainting or collapse

If the dose is reduced gradually, your body gradually starts its natural production of steroids and the withdrawal symptoms do not occur.

Have a sick day plan

If you are on long-term steroids and are unwell with an infection or injury, or are having an operation, you must contact your doctor. Your dose of steroid may need to be increased for a short time because you need more steroids during physical stress.

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 16 Sep 2020