Steroid Prescriptions

One of the most misunderstood class of drugs in medicine is a group known as steroids. It is easily confusing because actually steroids are a group of different hormones that are naturally produced by the body. Within this group are several different types that have very different functions, which depend on slight changes in the chemical structure of the steroid hormone.

Almost everyone knows that some body builders take steroids to increase their muscle size. What they are taking is actually some variation of the male hormone testosterone. Estrogen and progesterone are examples of female steroid hormones, a great example of how different their effects can be.

The steroid group most commonly prescribed, however, is an entirely different group which includes cortisone. The cortisone group includes brand name drugs like Predisone, Decadron, Celestone and many others. Almost all of the most commonly used nasal sprays for allergy fall into this group as well, including Flonase, Nasonex, Rhinocort etc. (They all work about the same). When doctors mention steroids, they are almost always referring to drugs in the cortisone group.

It is important to understand this group because they are very commonly used and because they can have some serious side effects which mostly depend on how much is taken and for how long. The reason this cortisone type of drug is prescribed so often is because it works incredibly well to reduce unwanted reactions by the body’s immune system. It is the action of the immune system’s various cells and chemicals that causes allergy, asthma, arthritis, and many other inflammatory conditions throughout the body. Virtually nothing is more powerful or works better than steroids to counteract the immune system when it creates these unwanted conditions. But cortisone drugs also can have unwanted side effects that increase with dosage and duration of treatment.

The inhaled nasal steroids for allergy like Flonase have been extensively tested and because they are not significantly absorbed are very safe even when used everyday. Short courses of steroids for less than two weeks, which include injections, mainly risk making preexisting conditions worse. Because cortisone type drugs increase blood sugar significantly, diabetics should try to avoid them. Steroids increase the risk of stomach ulcers (especially when given with aspirin-type drugs), can worsen glaucoma and raise blood pressure. Common side effects include increased appetite, fluid retention, facial flushing, insomnia, weight gain, and just feeling good. Very rare complications of short-term use include tissue death of the hipbone requiring hip replacement and temporary psychosis. Longer-term use beyond two weeks involves too many serious complications to discuss here.

Steroids are wonderful for many conditions affecting the ears, nose, and throat because they reduce swelling in areas where swelling leads to complications. They also help pain by reducing inflammation. Unfortunately, they do not help viral infections and may prolong viral shedding. While they are wonderful for asthma and allergy, frequent shots or pills should be reserved for more severe cases.

Whenever your doctor or nurse prescribes a steroid, you should make sure they know your complete medical history and follow their directions precisely. That way, you will get maximum benefit while minimizing any risks. And, as with any medication, if you are experiencing unexplained side effects, let your doctor know about it.