Taking steroids long term

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

Taking steroids long term is helpful to treat conditions associated with inflammation, but ongoing steroid use can cause side effects. Prednisone is the most commonly prescribed steroid. Other examples of steroids include dexamethasone, hydrocortisone and methylprednisolone.

On this page, you can find the following information:

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. 

Common side effects of long-term steroids
  • 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

Why is it important to stop long-term steroids slowly?

If you have been on a long course or high doses of steroids, it is really important to reduce the dose of steroids 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 have: 

  • received more than 40 mg of prednisone (or equivalent) per day for more than 1 week
  • received steroids at a lower dose regularly for more than 3 weeks
  • are taking your prednisone doses in the evening
  • recently had repeated courses
  • have taken another short course within 1 year of stopping long-term therapy
  • other possible causes of adrenal suppression.

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. 

If you have been taking high dose or long-term steroids and your dose is reduced gradually, your body gradually starts its natural production of steroids and the withdrawal symptoms do not occur.

What are the symptoms of steroid withdrawal?

Stopping steroids suddenly 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)
  • shaking
  • sweats
  • tummy (abdominal) pain
  • low blood sugar (hypoglycaemia)
  • low blood pressure (hypotension) which can cause dizziness, fainting or collapse

What is a steroid withdrawal plan?

A steroid withdrawal plan is a written document to help you remember how to reduce your steroid dose gradually over a few weeks. The following is an example of a steroid withdrawal plan.

Steroid withdrawal plan

I am taking the steroid (choose the option that applies to you): 

□ Prednisone
□ Hydrocortisone 
□ Methylprednisolone
□ Dexamethasone
□ Other:___________________________________


I am taking steroids for
:

_________________________________________________________________________

My dose is:

___________________________

___________________________

 For how long:

___________________

___________________
How to reduce my steroid dose gradually over a few weeks:
Date:   Dose:
Date: Dose:
Date: Dose:
Date: Dose:
Date: Dose:
Notes:





What is a sick day plan?

A sick day plan gives you advice on how to manage your usual steroid medicine if you are unwell. 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.

When you become ill, your body would naturally increase the output of steroid hormones from your adrenal glands. Therefore, if you are taking replacement steroids, it is essential to mimic or copy this effect by increasing your dose of steroids. Taking a higher dose of steroids for a short period of time while you are ill is necessary and is not harmful.  

References

  1. Cautions and contra-indications of corticosteroids NZ Formulary
  2. Prednisone treatment – follow dosing recommendations Medsafe, NZ, 2021 
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 18 Jun 2021