Steroid Tablets
A drug Information Sheet
Steroids can be given in many different ways. They can be given as tablets, or by injection into a muscle, a vein, or directly into a joint (see separate arc leaflet 'Local Steroid Injections'). This leaflet only deals with steroid tablets.
Prednisolone is the most commonly prescribed steroid tablet for people with rheumatoid arthritis and other rheumatic diseases. Prednisolone is available either as a plain tablet or in a special form, called 'enteric-coated', which is specially coated so that it does not dissolve quickly in the stomach. Your doctor may prescribe enteric-coated prednisolone if you have indigestion or you are taking a high dose.
Why am I being prescribed steroid tablets?
Some steroids, such as the hormone cortisol, occur naturally in the human body. Other steroids can help with several different types of rheumatic disease, including rheumatoid arthritis, systemic lupus erythematosus (SLE) and polymyalgia rheumatica (PMR). They are very effective against swelling and inflammation. However, they only suppress the disease and do not cure it.
When and how do I take steroid tablets?
Prednisolone is usually taken once a day, preferably in the morning, with or after food. Sometimes it is prescribed on an 'alternate-day' basis, which means that you take prednisolone on every second day. Enteric-coated tablets should be swallowed whole (not crushed or chewed).
What dose do I take?
Your doctor will advise you about the dose. This will depend on why prednisolone is being used, and on your body weight. Often your doctor will start you on a high dose and then reduce this as your symptoms improve. If you have been on steroids for a long time, then your doctor will make any reductions very slowly.
You should not stop taking your steroid tablets or alter the dose unless advised by your doctor. It can be dangerous to stop steroids suddenly.
When taking steroid tablets you must carry a Steroid Card, which records how much prednisolone you are on and how long you have been taking it. If you become ill, or are involved in an accident in which you are injured or become unconscious, it is important for the steroid to be continued and also the dose might need to be increased. This is because the treatment may prevent your body from being able to produce enough natural steroids in response to stress, as normally happens in this situation. Your doctor, rheumatology nurse specialist or pharmacist can give you a Steroid Card.
Your doctor may decide that you should continue on a small dose (a maintenance dose) of prednisolone indefinitely.
How long will steroid tablets take to work?
Prednisolone works very quickly. Usually you will notice a benefit within a few days.
What are the possible risks or side-effects?
In the case of prednisolone, the longer you are taking it, and the higher the dose, the more likely you are to have problems. Your doctor will take this into account and will keep you on the lowest possible dose that keeps your disease under control. However, very often steroids are necessary to control disease, so it is a question of carefully weighing up the risks and benefits of continuing on them. If you are on very low doses of steroids you may never experience any problems.
The most common side-effects are weight gain, a round face, thinning of the bones (osteoporosis), easy bruising, indigestion, stomach pains, stretch marks and thinning of the skin. Muscle weakness, changes in mood (e.g. feeling depressed) and cataracts can occur, and prednisolone can also make glaucoma worse. Steroids may occasionally interfere with the menstrual cycle.
The blood sugar may rise, causing diabetes, and if you have diabetes you may require a change in the treatment of your diabetes.
High doses of prednisolone can cause a rise in blood pressure. If you suffer from epilepsy, then it is possible that prednisolone could make the epilepsy worse.
Taking prednisolone can make you more likely to develop infections. If this happens or if you have a fever you should report to your doctor. Signs of infection can be disguised by prednisolone. So if you feel unwell or develop any new symptoms after starting prednisolone, it is important to tell your doctor or rheumatology nurse. If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should report to your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on steroid treatment. Therefore you may require antiviral treatment.
In children, taking steroids can suppress growth. However, some of the conditions for which steroids are prescribed can also affect growth.
What should I know about osteoporosis, and how can I reduce the risks?
Osteoporosis means thinning of the bones, making fractures more likely. Treatment with steroid tablets can cause osteoporosis. To reduce the risk it is a good idea to take regular exercise, make sure your calcium intake is adequate (see arc booklet 'Osteoporosis' for details of the calcium content of common foods), and avoid smoking and excess alcohol. You should also ask your general practitioner or hospital specialist for advice on your particular case. Your doctor may advise the use of drugs which have been shown to prevent bone loss due to steroids, e.g. calcium and vitamin D supplements and bisphosphonates (see arc leaflet 'Drugs for Osteoporosis').
What other treatments could be used instead of steroid tablets?
A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
Do I need any special checks while on steroid tablets?
Your doctor may check your general condition from time to time, e.g. your weight, blood pressure and blood sugar level.
May I take other medicines along with steroid tablets?
Steroids may be prescribed along with other drugs in treating your condition. Some drugs interact with prednisolone, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking prednisolone.
Do not take over-the-counter preparations without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while on steroid tablets?
It is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.
Pneumovax and yearly flu vaccines are safe and recommended.
May I drink alcohol while taking steroid tablets?
Since both alcohol and steroids can upset the stomach, drinking alcohol should be avoided, or restricted to small amounts. It is best to discuss this with your doctor.
Do steroid tablets affect pregnancy?
Although it is best not to take prednisolone during pregnancy, it is safer than some other drugs. If you are planning a family you should discuss this with your doctor beforehand. If you find you are pregnant and are on steroids, do not stop them, but discuss things with your doctor. Never stop steroids abruptly.
What about breastfeeding?
If you wish to breastfeed you should seek advice about this from your doctor beforehand.
Where can I obtain further information?
If you would like any further information about steroid tablets, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.
REMEMBER:
- Always carry your Steroid Card.
- Never stop steroids abruptly or alter your dose without discussing with your doctor first.
Remember to keep all medicines out of reach of children.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
