Glucocorticoids

Glucocorticoids are a type of corticosteroid hormone that is very effective at reducing inflammation and suppressing the immune system. Inflammation is the way our immune system responds to harmful substances and trauma and is part of our healing process. However, if the usual control mechanisms that turn the process of inflammation off aren’t functioning properly and it continues unabated, our tissues can become damaged. Continued inflammation is associated with many chronic conditions.

Are glucocorticoids considered safe?

When given at recommended dosages for short durations of time, glucocorticoids are considered safe. One-off doses of glucocorticoids, even if they are large, or short-course therapies of less than one-week have few harmful effects. However, more regular or extended dosing has been associated with a number of severe side effects.

• If glucocorticoids are given on a daily basis (at a dose equivalent to prednisone 15mg/day for more than three weeks), the adrenal glands stop producing glucocorticoids and tissue in the adrenal cortex begins to atrophy (die off). This is of concern if the glucocorticoid is suddenly stopped because the adrenal tissues will not immediately begin producing glucocorticoids again. This is called acute adrenal insufficiency and symptoms include irritability, nausea, joint pains, dizziness and low blood pressure. To avoid this happening, steroid medication should be withdrawn slowly, over several weeks or months, to allow the adrenal cortex to resume its full functioning capacity again.
• For people who are taking glucocorticoids long-term, extra doses of glucocorticoids should be given during times of acute stress, such as severe infection or surgery, to mimic the cortisol surge that is normally produced by the body during particularly stressful events, otherwise healing may be delayed or incomplete.
• Evening dosages of glucocorticoids should be discouraged as they can cause insomnia. Instead, glucocorticoids are normally taken just once a day, or if taken twice a day, they should be dosed in the morning and again at noon.
• Because glucocorticoids suppress the immune system, they increase the risk of infection. Certain viral infections, such as chickenpox or measles may have a more severe course in people taking glucocorticoids.
• Long-term use of glucocorticoids can also cause Cushing’s syndrome. Symptoms include a fatty hump between the shoulders, a round face, weight gain, irregular menstrual cycles, fatigue, and depression.

For a complete list of severe side effects, please refer to the individual drug monographs.

What are the common side effects of glucocorticoids?

Glucocorticoids have been associated with several common side effects including:

• Agitation and irritability
• Blurred vision
• Cataracts or glaucoma
• Difficulty concentrating
• Dizziness
• Facial hair growth in females
• Fast or irregular heartbeat
• Fluid retention
• A headache
• High blood pressure
• Increase in blood sugar, cholesterol, or triglyceride levels
• Increase in the risk of gastric ulcers or gastritis
• Loss of potassium
• Osteoporosis due to a suppression of the body’s ability to absorb calcium
• Reactivation of latent tuberculosis
• Shortness of breath
• Sleeplessness
• Weight gain.

For a complete list of side effects, please refer to the individual drug monographs.