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Corticosteroids - Adverse effects
Treatments with corticosteroids for short duration (lower than one week), even at high doses, have few adverse effects.
The risk of adverse effects grows with treatment duration and increase in the dosage. Various disorders can be observed:
- Cushing syndrome characterised by lipid redistribution the face, edema and fluid retention (to be prevented by a diet low in sodium), hypokalemia, increase in blood pressure, aggravation of diabetes, atrophies, muscular weakness, fatigability, menstrual cycle disturbances, growth retardation in children.
- Adrenal insufficiency at withdrawal of the treatment, which occurs even in neonates when the mother was treated during pregnancy. The discontinuation of the treatment can also induce various symptoms: fever, myalgias, arthralgias.
- Bone disorders: development of osteoporosis which can be attenuated by the maintenance of exercice, calcium and vitamin D supplementation, a hormonal substitutive treatment after menopause or by a bisphosphonate treatment. In addition, osteonecrosis of the femoral head can be exceptionally observed.
- Neuropsychiatric disorders, various, difficult to envisage: nervousness, insomnia, depression, aggravation of epilepsy, increase in intracranial pressure in children.
- Ocular disorders after local and general administration: glaucoma, cataract.
- Hematologic modifications: increase of leukocytes and thrombocytes, decrease of T lymphocytes .
- Digestive disorders, ulcer with an atypical symptomatology and cause of bleedings, as well as pancreatic damages.
- Infections: increase in the risk of infections, bacterial (tuberculosis) or viral (chicken pox, herpes zoster herpes), or mycotic (candidiasis). The infection generally evolves with low noise, without fever. The vaccination of people treated by corticoids is disadvised, especially with live vaccines.
- Growth retardation: administered to children, long term administration to children can induce growth retardation requiring treatment with growth hormone.
- Exceptionally shock during their administration by intravenous route.
Drug interactions are possible: the enzymatic inducers by accelerating the degradation of corticosteroids can reduce their efficacy.
The risk of adverse effects of certain antiarrhythmic drugs, cardiac glycosides, anticoagulants, is increased in patients treated by corticoids, probably because of hypokalemia. The prescription of a corticosteroid to a diabetic can worsen his diabetes and decrease insulin efficacy.
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