Table of ContentsView AllTable of ContentsWhat Are Systemic Steroids?Systemic Side EffectsManaging Side EffectsAlternativesFAQs
Table of ContentsView All
View All
Table of Contents
What Are Systemic Steroids?
Systemic Side Effects
Managing Side Effects
Alternatives
FAQs
Corticosteroids(steroid drugs) are often necessary and sometimes even life-saving treatments, but they can have short-termside effects. For instance, steroids can sometimes cause a flushed face for a few days.They also can lead to long-term side effects, some of them serious.
This article explains why you might be prescribed a systemic steroid, what to know about short-term and long-term side effects, and how to manage them.
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Types of Systemic Steroids
Systemic steroids are also called glucocorticoids or cortisones. They include:
Prednisone is the most commonly prescribed oral steroid.
Steroids commonly given via an injection (sometimes called “cortisone shots”) include triamcinolone, methylprednisolone, and betamethasone.
When Systemic Steroids Are Prescribed
Systemic steroids are typically prescribed for diseases and conditions that cause inflammation in the body. Conditions that may be treated with oral steroids include:
Short term uses:
Long-term uses:
Injectable steroids are used to relieve acute pain from low back pain, arthritis, cervical radiculopathy, bursitis, tendonitis, and carpal tunnel syndrome. They’re typically given only three to four times a year.
Systemic Steroid Side Effects
Steroids can cause different side effects depending on how long they are used.
Short-Term Side Effects of Steroids
Side effects are usually temporary in people prescribed systemic steroids for short periods (a month or less). Most effects resolve within a few days after stopping the medication.
If you are otherwise healthy, the most common side effects you can expect are:
Certain underlying medical conditions can worsen when you take steroids. For example, your blood sugar levels can increase if you have type 2 diabetes.
Similarly, yourblood pressure can become elevatedif you already have high blood pressure. And if you haveglaucoma, taking steroids might increase your eye pressure. You can also retain water if you havecongestive heart failure.
Reports of facial flushing tend to happen more in people assigned female at birth. It’s a short-term side effect that may last a few days, but it can occur again with future steroid injections.
Long-Term Side Effects of Steroids
If you use systemic steroids for a long period of time (more than three months) or take them on multiple occasions, you may experience more serious side effects. For this reason, healthcare providers tend to prescribe the lowest dose for the shortest period of time.
Side effects of long-term steroid use include:
Long-term side effects often go away once you stop taking a steroid, but sometimes they can be permanent.
With most cases, the discomfort of a flushed face or other steroid side effects will pass within a few hours or days. You also can make lifestyle changes to reduce the impact of steroids on a flushed face, such as limitingalcohol useor avoiding smoking.
Contact your healthcare provider if, after a week, you still experience symptoms from your shot that include:
Regardless of your overall health, it’s important that you are closely monitored for long-term side effects if you are taking a systemic steroid.
Your blood pressure, weight, and blood sugar levels will be checked regularly. Because of the risk of osteoporosis,bone density scansare usually recommended for people who take steroids for three months or longer.
Sometimes abisphosphonatedrug such as Fosamax (alendronate) or ibandronate is prescribed toprevent osteoporosis.
Patients on prednisone may also be advised to avoidnonsteroidal anti-inflammatory drugs (NSAIDs)such as Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Indocin (indomethacin).
Adults of either sex who use (or have taken) corticosteroids have a higher risk of fractures associated with bone density loss, with between 9% and 40% of people diagnosed with bone tissue death due to long-term use.Some experts suggest extra caution for use in people who are postmenopausal.Even children and teens can be affected, though.
An Overview of Osteoporosis
Alternatives to Systemic Steroids
If lowering the dose does not reduce side effects, there are other options in the case of some diseases, though these alternatives may not be as effective in controlling symptoms of the disease.
In patients with multiple sclerosis who cannot tolerate steroids, injections of the protein corticotropin may be used.
A 2020 study found that in some cases, patients with rheumatoid arthritis, lupus, or vasculitis who could not tolerate steroids might experience similar effects with drugs including Prograf (tacrolimus), Tavneos (avacopan), anddisease-modifying antirheumatic drugs (DMARDs)like Plaquenil.
People diagnosed witheczemaorpsoriasis, may experience a rebound effect of their symptoms (sometimes severely) if they suddenly stop using even a strong topical steroid.Symptoms that rebound also can occur with a number of conditions, includingsciaticatreated with steroid injections.
Sciatic Nerve Pain
Summary
Systemic corticosteroids are drugs that control inflammation in a wide variety of diseases, including asthma, some skin disorders, lupus, and rheumatoid arthritis. They are taken orally for these conditions. They can also be given via an injection for acute back pain and tendinitis.
Oral corticosteroids may be given for short or long periods of time, depending on the situation. It is common to experience side effects from these medications. Side effects that may occur with short-term use are typically less severe than those that occur with long-term use.
A Word From Verywell
Systemic steroids can be very effective in controlling symptoms. If they’re prescribed, be sure to ask your healthcare provider how long you’ll need to take them and the side effects you can expect. They can suggest ways to minimize the effects or perhaps even switch to a different drug.
Frequently Asked QuestionsLong-term use of systemic steroids can have a wide range of side effects, some of which can be serious. These include osteoporosis, effects on mood, weight gain, high blood sugar, high blood pressure, and Cushing syndrome.It depends on which steroid you are taking, what the dosage is, and for how long you’ve been taking them. Different people also process steroids differently. Steroids taken long-term will take more time to clear from your system.Learn MoreHow Long Do Steroids Stay in Your System?If you overdose on corticosteroids, you may experience altered mental status, burning or itching skin, seizures, and heart rhythm disturbances (rapid pulse, irregular pulse).
Frequently Asked Questions
Long-term use of systemic steroids can have a wide range of side effects, some of which can be serious. These include osteoporosis, effects on mood, weight gain, high blood sugar, high blood pressure, and Cushing syndrome.
It depends on which steroid you are taking, what the dosage is, and for how long you’ve been taking them. Different people also process steroids differently. Steroids taken long-term will take more time to clear from your system.Learn MoreHow Long Do Steroids Stay in Your System?
It depends on which steroid you are taking, what the dosage is, and for how long you’ve been taking them. Different people also process steroids differently. Steroids taken long-term will take more time to clear from your system.
Learn MoreHow Long Do Steroids Stay in Your System?
If you overdose on corticosteroids, you may experience altered mental status, burning or itching skin, seizures, and heart rhythm disturbances (rapid pulse, irregular pulse).
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Epidural Corticosteroid Injections.American Osteopathic College of Dermatology.Steroids (oral).Waljee AK, Rogers MAM, Lin P, et al.Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.BMJ. 2017;357:j1415. doi:10.1136/bmj.j1415Johns Hopkins Medicine.Injectable corticosteroids.DermNet NZ.Systemic corticosteroid.Filippini C, Saran S, Chari B.Musculoskeletal steroid injections in pregnancy: a review.Skeletal Radiol. 2023 Mar 14. doi:10.1007/s00256-023-04320-9.Shah A, Mak D, Davies AM, et al.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi: 10.1016/j.carj.2018.11.002Rice JB, White AG, Scarpati LM, Wan G, Nelson WW.Long-term systemic corticosteroid exposure: a systematic literature review.Clin Ther. 2017;39(11):2216-2229. doi:10.1016/j.clinthera.2017.09.011Fawi HMT, Hossain M, Matthews TJW.The incidence of flare reaction and short-term outcome following steroid injection in the shoulder.Shoulder & Elbow. 2017;9(3):188-194. doi: 10.1177/1758573217693808Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Tarar MY, Malik RA, Charalambous CP.Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis.Rheumatol Int. 2023 Feb;43(2):245-251. doi:10.1007/s00296-022-05232-y.Stout A, Friedly J, Standaert CJ.Systemic Absorption and Side Effects of Locally Injected Glucocorticoids.PM R. 2019 Apr;11(4):409-419. doi:10.1002/pmrj.12042.Neurology Live.Why alternatives to systemic steroids deserve a second look.Misra DP, Agarwal V.The perennial search for alternatives to corticosteroids in rheumatology: is there light at the end of the tunnel?.Clin Rheumatol39, 2845–2848 (2020). doi:10.1007/s10067-020-05357-0Schwarz CW, Loft N, Andersen V, Juul L, Zachariae C, Skov L.Are systemic corticosteroids causing psoriasis flare-ups? Questionnaire for Danish dermatologists, gastroenterologists and rheumatologists.Dermatology. 2020;237(4):588-594. doi:10.1159/000510712Chemeisani A, Hamade A, Kawtharani AA, Tarhini H, Hamze N, Msheik A.The Benefit of Early Epidural Corticosteroid Injections for Acute Sciatica-Associated Lower Back Pain: A Four-Year Case Series in Lebanon.Cureus. 2023 Feb 10;15(2):e34847. doi:10.7759/cureus.34847.National Institutes of Health. National Library of Medicine. Medline Plus. Corticosteroid overdose.Additional ReadingSaag KG, Furst DE. Up To Date.Major Side Effects of Systemic Glucocorticoids.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Epidural Corticosteroid Injections.American Osteopathic College of Dermatology.Steroids (oral).Waljee AK, Rogers MAM, Lin P, et al.Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.BMJ. 2017;357:j1415. doi:10.1136/bmj.j1415Johns Hopkins Medicine.Injectable corticosteroids.DermNet NZ.Systemic corticosteroid.Filippini C, Saran S, Chari B.Musculoskeletal steroid injections in pregnancy: a review.Skeletal Radiol. 2023 Mar 14. doi:10.1007/s00256-023-04320-9.Shah A, Mak D, Davies AM, et al.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi: 10.1016/j.carj.2018.11.002Rice JB, White AG, Scarpati LM, Wan G, Nelson WW.Long-term systemic corticosteroid exposure: a systematic literature review.Clin Ther. 2017;39(11):2216-2229. doi:10.1016/j.clinthera.2017.09.011Fawi HMT, Hossain M, Matthews TJW.The incidence of flare reaction and short-term outcome following steroid injection in the shoulder.Shoulder & Elbow. 2017;9(3):188-194. doi: 10.1177/1758573217693808Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Tarar MY, Malik RA, Charalambous CP.Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis.Rheumatol Int. 2023 Feb;43(2):245-251. doi:10.1007/s00296-022-05232-y.Stout A, Friedly J, Standaert CJ.Systemic Absorption and Side Effects of Locally Injected Glucocorticoids.PM R. 2019 Apr;11(4):409-419. doi:10.1002/pmrj.12042.Neurology Live.Why alternatives to systemic steroids deserve a second look.Misra DP, Agarwal V.The perennial search for alternatives to corticosteroids in rheumatology: is there light at the end of the tunnel?.Clin Rheumatol39, 2845–2848 (2020). doi:10.1007/s10067-020-05357-0Schwarz CW, Loft N, Andersen V, Juul L, Zachariae C, Skov L.Are systemic corticosteroids causing psoriasis flare-ups? Questionnaire for Danish dermatologists, gastroenterologists and rheumatologists.Dermatology. 2020;237(4):588-594. doi:10.1159/000510712Chemeisani A, Hamade A, Kawtharani AA, Tarhini H, Hamze N, Msheik A.The Benefit of Early Epidural Corticosteroid Injections for Acute Sciatica-Associated Lower Back Pain: A Four-Year Case Series in Lebanon.Cureus. 2023 Feb 10;15(2):e34847. doi:10.7759/cureus.34847.National Institutes of Health. National Library of Medicine. Medline Plus. Corticosteroid overdose.Additional ReadingSaag KG, Furst DE. Up To Date.Major Side Effects of Systemic Glucocorticoids.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Epidural Corticosteroid Injections.American Osteopathic College of Dermatology.Steroids (oral).Waljee AK, Rogers MAM, Lin P, et al.Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.BMJ. 2017;357:j1415. doi:10.1136/bmj.j1415Johns Hopkins Medicine.Injectable corticosteroids.DermNet NZ.Systemic corticosteroid.Filippini C, Saran S, Chari B.Musculoskeletal steroid injections in pregnancy: a review.Skeletal Radiol. 2023 Mar 14. doi:10.1007/s00256-023-04320-9.Shah A, Mak D, Davies AM, et al.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi: 10.1016/j.carj.2018.11.002Rice JB, White AG, Scarpati LM, Wan G, Nelson WW.Long-term systemic corticosteroid exposure: a systematic literature review.Clin Ther. 2017;39(11):2216-2229. doi:10.1016/j.clinthera.2017.09.011Fawi HMT, Hossain M, Matthews TJW.The incidence of flare reaction and short-term outcome following steroid injection in the shoulder.Shoulder & Elbow. 2017;9(3):188-194. doi: 10.1177/1758573217693808Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Tarar MY, Malik RA, Charalambous CP.Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis.Rheumatol Int. 2023 Feb;43(2):245-251. doi:10.1007/s00296-022-05232-y.Stout A, Friedly J, Standaert CJ.Systemic Absorption and Side Effects of Locally Injected Glucocorticoids.PM R. 2019 Apr;11(4):409-419. doi:10.1002/pmrj.12042.Neurology Live.Why alternatives to systemic steroids deserve a second look.Misra DP, Agarwal V.The perennial search for alternatives to corticosteroids in rheumatology: is there light at the end of the tunnel?.Clin Rheumatol39, 2845–2848 (2020). doi:10.1007/s10067-020-05357-0Schwarz CW, Loft N, Andersen V, Juul L, Zachariae C, Skov L.Are systemic corticosteroids causing psoriasis flare-ups? Questionnaire for Danish dermatologists, gastroenterologists and rheumatologists.Dermatology. 2020;237(4):588-594. doi:10.1159/000510712Chemeisani A, Hamade A, Kawtharani AA, Tarhini H, Hamze N, Msheik A.The Benefit of Early Epidural Corticosteroid Injections for Acute Sciatica-Associated Lower Back Pain: A Four-Year Case Series in Lebanon.Cureus. 2023 Feb 10;15(2):e34847. doi:10.7759/cureus.34847.National Institutes of Health. National Library of Medicine. Medline Plus. Corticosteroid overdose.
Johns Hopkins Medicine.Epidural Corticosteroid Injections.
American Osteopathic College of Dermatology.Steroids (oral).
Waljee AK, Rogers MAM, Lin P, et al.Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.BMJ. 2017;357:j1415. doi:10.1136/bmj.j1415
Johns Hopkins Medicine.Injectable corticosteroids.
DermNet NZ.Systemic corticosteroid.
Filippini C, Saran S, Chari B.Musculoskeletal steroid injections in pregnancy: a review.Skeletal Radiol. 2023 Mar 14. doi:10.1007/s00256-023-04320-9.
Shah A, Mak D, Davies AM, et al.Musculoskeletal corticosteroid administration: current concepts.Can Assoc Radiol J. 2019;70(1):29-36. doi: 10.1016/j.carj.2018.11.002
Rice JB, White AG, Scarpati LM, Wan G, Nelson WW.Long-term systemic corticosteroid exposure: a systematic literature review.Clin Ther. 2017;39(11):2216-2229. doi:10.1016/j.clinthera.2017.09.011
Fawi HMT, Hossain M, Matthews TJW.The incidence of flare reaction and short-term outcome following steroid injection in the shoulder.Shoulder & Elbow. 2017;9(3):188-194. doi: 10.1177/1758573217693808
Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30
Tarar MY, Malik RA, Charalambous CP.Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis.Rheumatol Int. 2023 Feb;43(2):245-251. doi:10.1007/s00296-022-05232-y.
Stout A, Friedly J, Standaert CJ.Systemic Absorption and Side Effects of Locally Injected Glucocorticoids.PM R. 2019 Apr;11(4):409-419. doi:10.1002/pmrj.12042.
Neurology Live.Why alternatives to systemic steroids deserve a second look.
Misra DP, Agarwal V.The perennial search for alternatives to corticosteroids in rheumatology: is there light at the end of the tunnel?.Clin Rheumatol39, 2845–2848 (2020). doi:10.1007/s10067-020-05357-0
Schwarz CW, Loft N, Andersen V, Juul L, Zachariae C, Skov L.Are systemic corticosteroids causing psoriasis flare-ups? Questionnaire for Danish dermatologists, gastroenterologists and rheumatologists.Dermatology. 2020;237(4):588-594. doi:10.1159/000510712
Chemeisani A, Hamade A, Kawtharani AA, Tarhini H, Hamze N, Msheik A.The Benefit of Early Epidural Corticosteroid Injections for Acute Sciatica-Associated Lower Back Pain: A Four-Year Case Series in Lebanon.Cureus. 2023 Feb 10;15(2):e34847. doi:10.7759/cureus.34847.
National Institutes of Health. National Library of Medicine. Medline Plus. Corticosteroid overdose.
Saag KG, Furst DE. Up To Date.Major Side Effects of Systemic Glucocorticoids.
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