Steroids

Steroids (sometimes called corticosteroids) are substances that are naturally produced in the body. They help reduce inflammation and control different functions in our bodies such as the immune system or the way the body uses food.

Steroids can also be man-made and used as part of your cancer treatment. Steroids can be taken as tablets or liquids by mouth or by injection, depending on the type your doctor prescribes.

Steroids may cause side effects. They will vary according to the dose given, and from person to person. The most common side effects are tummy pain and/or indigestion, raised blood sugar levels, build-up of fluid, increased appetite and mood changes.

It’s important to take steroids exactly as prescribed by your doctor. You will have regular appointments with your doctor to monitor the effect of the steroids. If you are taking steroids for a long time your doctor will give you a card to carry that explains what you are taking.

What are steroids?

Steroids (sometimes called corticosteroids) are substances that are naturally produced in the body. They are made by the adrenal glands. There are two adrenal glands - one sits on the top of each kidney.

They help control many different functions in our bodies, like the way the body uses fats, proteins and carbohydrates. They regulate our immune system and the balance of salt and water in our bodies. They also help to reduce inflammation.

Steroids can be manufactured synthetically as drugs. There are different types of steroids and they all have different effects on the body. Common types of steroids used in cancer treatment are: hydrocortisone, dexamethasone, methylprednisolone and prednisolone.

Steroids can be used:

  • as part of your treatment to help destroy cancer cells and make chemotherapy  more effective
  • to help reduce an allergic reaction to certain chemotherapy drugs
  • in low doses as anti-sickness drugs to improve your appetite.

In these situations, steroids are usually given only for short periods of time, and the side effects described here won’t usually occur.


What steroids look like

  • Some are clear fluids used for injection.
  • Some are available as tablets. The colour and dose of the tablets depends on the type of steroid used.
  • Soluble tablets of prednisolone and a dexamethasone syrup are available for people who have difficulty swallowing.


How steroids are given

Steroids can be given in the following ways: 

  • As tablets, which are swallowed with plenty of water or milk (orally). They may need to be taken at set times each day. They are often given in short courses rather than continuously. It’s important to make sure you know how long you need to take them for. Soluble tablets of prednisolone and dexamethasone syrup are available for people who have difficulty swallowing. 
  • By injection into a muscle (intramuscularly).
  • By injection through a tube (cannula) inserted into a vein, either as a quick injection, or as a drip which takes up to 30 minutes (intravenously). 
  • By injection through a central line, a tube which is inserted under the skin into a large vein near your collarbone (intravenously). 
  • By injection through a PICC line, a tube inserted into a vein in the bend of your arm near the elbow (intravenously).


Possible side effects of steroids

It’s important to remember that each person’s reaction to a drug is different and some people have very few side effects. The side effects will also vary according to the dose of the steroid that you are having, and may be different if you are also having other drugs. 

We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any side effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist. 

Tummy pain and/or indigestion 

Steroids can irritate the stomach lining. Let your nurse or doctor know if you have pain in your tummy or indigestion. They can prescribe drugs to help reduce stomach irritation.

Take your tablets with food to help protect your stomach. Some steroid tablets are coated to help reduce irritation. 

Raised blood sugar levels 

Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms. 

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust your insulin or tablet dose.

Build-up of fluid 

You may put on weight or your ankles and legs may swell because of fluid building up. This is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.

Increased appetite 

Steroids can make you feel much hungrier than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you’re worried about gaining weight, talk to your doctor or nurse. 

Increased chance of infection and delayed healing 

This is more likely to happen if you are having high-dose or long-term treatment. Tell your doctor if you notice signs of infection such as inflammation, redness, soreness or a temperature, or if cuts take longer than usual to heal. To help prevent infection, it's especially important to be careful with things like washing your hands. 

Changes to your periods 

Women may find that their periods become irregular or stop. 

Mood and behaviour changes 

Steroids can affect your mood. You may feel anxious or restless, have mood swings or problems sleeping. Taking your steroids in the morning may help you sleep better. 

Tell your doctor or nurse if you have any of these side effects. They may make some changes to your treatment if the side effects become a problem. 

Discomfort in your bottom 

If the steroid dexamethasone is given quickly into a vein, it can cause a strange sensation in the perineal area – the area just in front of your back passage. This only lasts for a short time.


Less common side effects of steroids

We have listed some less common side effects that may develop with long-term use of steroids, which is when you take steroids for more than a few months. 

Eye changes 

Cataracts or glaucoma may develop. There is also an increased risk of eye infections. Tell your doctor if you notice any eye problems. 

Cushing’s syndrome 

This can cause acne, puffiness of the face, facial hair in women and dark marks on the skin. Cushing’s syndrome can be reduced a little by taking the steroids early in the morning, taking them on alternate days instead of every day or reducing the dose – but discuss this with your doctor first. 

Muscle wasting 

Your legs may feel weaker. When the steroids are stopped, you may have muscle cramps for a short time. 

Bone thinning (osteoporosis) 

Let your doctor know if you have any pain in your bones, especially in the lower back.


Additional information

You’ll be given a steroid card if you have to take steroids at home. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if you are only having a short course of steroids.

If you need to have any dental work, tell your dentist you are having steroid treatment.

If long-term steroid use is suddenly stopped, withdrawal effects can occur. For this reason, it's important to take the prescribed dose at the times recommended by your doctor. When the steroid treatment is over, the dose is gradually reduced. Your doctor will advise you on this.


Things to remember about steroid tablets

  • Keep the tablets in a safe place, out of the reach of children.
  • If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
  • Tell your doctor if you are sick just after taking a tablet, as you may need to take another one.
  • If you forget to take your tablet, do not take a double dose. Ask your doctor or nurse for advice. 
  • If you're having a short course of steroids as part of your treatment, do not get more from your GP.


Back to Supportive therapies

Blood transfusions

Some cancers or cancer treatments can cause anaemia, which is a low number of red blood cells. Blood transfusions are used to treat anaemia.

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G-CSF

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Nephrostomy

A nephrostomy is a tube that drains urine from the kidney if there is a blockage in your urinary system.

Plasma exchange

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Platelet transfusions

Platelets are cells that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets and you may need a platelet transfusion.