Corticosteroids

Complications /Information to beware of/General tips:

High dose corticosteroids use and side effects:

• Patients who are using high-dose steroids should be advised to inform the healthcare team responsible for their treatment if they fall ill for any reason, as this may affect the dose required.
• In addition, they should see a medical doctor if they have symptoms that could be related to their treatment (e.g. worsening fatigue, muscle weakness, loss of appetite, unintentional weight loss, dizziness, unexplained nausea, vomiting and diarrhoea).
• All patients taking are taking steroids who have never had chickenpox should be advised to avoid people with chickenpox or shingles, and to see a medical doctor if they come in contact with someone with either illness and then feel unwell.
• Inhaled corticosteroids do not usually interact with other medicines. However, they are metabolised by the cytochrome P450 isoenzyme CYP3A4, and some medicines (e.g. telaprevir, ritonavir and itraconazole) may increase plasma concentrations of inhaled budesonide and fluticasone, which increases the patient’s risk of adrenal suppression.
• Patients who smoke may require higher doses of steroids compared with non-smokers for the same therapeutic effect.
  • It is therefore important that all smokers using a steroid should be offered help to stop smoking, as this may reduce the dose required by the patient and minimise the risk of side effects.

Tomlinson JEM, McMahon AD, Chaudhuri R et al. Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma. Thorax 2005;60(4):282–287.

• Read all side effects involving steroids and beware of conditions i.e.
  • Diabetes
  • Decreased bone density
  • Adrenal suppression
  • Pneumonia
  • Tuberculosis

The Pharmaceutical Journal, PJ, 28 February 2015, Vol 294, No 7851;294(7851):DOI:10.1211/PJ.2015.20067896

Topical corticosteroids use (Under Medical Doctor advice only) and side effects:

Sources: Best Practice Advocacy Centre New Zealand; Pediatrics 2015,136(3)554-565; Journal of the American Academy of Dermatology 2016;75(2):306-11; Pediatric Dermatology 2016;33(2):160-4; National Institute for Health and Care Excellence

Side effects include:

• • Withdrawal symptoms include redness of the skin; a burning sensation; and itchiness, which may be followed by skin peeling distinct from the condition that  caused the patient to use corticosteroids in the first place.
  • Transient burning or stinging
  • Worsening and spreading of misdiagnosed fungal infection
  • Reversible thinning of the skin
  • Stretch marks
  • Allergic contact dermatitis
  • Acne vulgaris
  • Skin develops clusters of itchy and painful blisters, often on the face and neck, or is unwell with a fever and swollen local lymph nodes (signs of eczema herpeticum), this requires a same-day appointment.
  • Reversible, mild hypopigmentation (change of skin colour – becomes lighter skin)
  • Excessive hair growth at the site of application
  • Skin thinning

The risks of skin thinning with topical corticosteroids are increased with:

• • Using potent or very potent topical corticosteroids
  • Inappropriate long-term continuous use
  • Treating sensitive sites where the skin is thinner, e.g. face or genital areas
  • Using topical corticosteroids under occlusion, e.g. a nappy, dressing, or when applying in skin folds
  • Treating large areas.

The Pharmaceutical Journal, August 2021;Online:DOI:10.1211/PJ.2021.1.98990

The Pharmaceutical Journal, PJ, September 2021, Vol 307, No 7953;307(7953)::DOI:10.1211/PJ.2021.1.105786

Inhalers use:

• One can measure their respiratory condition by using a peak flow meter
• A big concern in respiratory condition is the use of inhalers :
  • Many develop a poor inhaler technique , always check with your pharmacist your inhaler technique.

Please let your medical prescriber know the following when undertaking using an inhaler:

• How often do you use your blue inhaler (more one uses, more poor control)?
• Do you taste your medication (press your MDI inhaler to early)?
• Do you feel a hit at the back of your throat (inhaling in too sharply/strongly)?
• Mouth coated in powder (not inhaling strong enough)?
• Spacer makes a whistling noise (inhaling too strongly)?

With inhaled steroids always rinse your mouth with a mouthwash after use with water and spit out or bushing their teeth or use a spacer device to reduce the risk of fungal infections.