Steroids

What are steroids?

Steroids are hormonal substances that are naturally produced in the body by the adrenal glands above the kidney and by the reproductive organs. Steroids can also be made as a drug. There are many different types of steroids and they all have different effects on the body. Some types of steroids help destroy some types of cancer cells and can make chemotherapy more effective.

Common types of steroids that are used in cancer treatment are hydrocortisone, dexamethasone, methylprednisolone and prednisolone. This information is about these types of steroids.

Dexamethasone may also be used in low doses as an anti-sickness drug, or to help reduce an allergic reaction to certain chemotherapy drugs, or to improve appetite. In these situations it is usually given only for short periods of time and the side effects described here will not usually occur.

What steroids look like

• Some are clear fluids for injection after being dissolved from powder
• Some steroids 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 they are given

Steroids can be given:

• by injection into a muscle (intramuscularly)
• through a tube (cannula) that is inserted into the vein, either as a quick injection, or as a drip which takes about 30 minutes
• through a central line, which is inserted under the skin into a large vein near the collar bone, or through a PICC line - a tube inserted into a vein in the bend of your arm near the elbow
• as tablets, which are swallowed with plenty of water. They may need to be taken at set times each day and are often given in short courses rather than continuously.

Possible side effects

It is important to remember that each person’s reaction to any drug is different and some people have very few side effects. The 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 and less common side effects, so that you can be aware of them if they occur. We have not included those that are very rare, however, and which are therefore extremely unlikely to affect you.

If you notice any effects that you think may be due to the drug, but which are not listed here, please discuss them with your doctor, chemotherapy nurse or pharmacist.

You will have regular appointments with your doctor to monitor the effect of the steroids. This information should help you to discuss any queries about your treatment and its side effects with your doctor or chemotherapy nurse, who are in the best position to help and advise you.

Irritation of the stomach lining Steroids can irritate the lining of the stomach and may cause a stomach ulcer, or make one worse. Some steroid tablets are coated to help reduce irritation. If the tablets are not coated, they should be taken with meals or a drink of milk to help reduce this side effect. Tell your doctor if you have indigestion, stomach pains or abdominal discomfort. Coated tablets are often a shiny red or brown colour.

You may be prescribed medication to reduce irritation of the stomach. You should not take any antacid medication that you have bought from your chemist, without first discussing it with your specialist. If you are taking 'coated' steroid tablets they should not be taken at the same time as any antacids, as antacids can dissolve the coating.

The levels of sugar in your blood may change temporarily This may happen if you have high-dose or long-term treatment. While you are having your steroid therapy, your blood-sugar levels may be checked by blood tests. You may be asked to test your urine for sugar. You will be shown how to do this.

People with diabetes should be more careful than usual about checking their blood-sugar levels and should contact their doctor if there is any problem with controlling their diabetes. Tell your doctor if you get very thirsty or if you are passing more urine than usual.

Fluid retention due to a changed salt and water balance You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen. This is usually a problem only with long-term treatment.

Increased appetite You may notice that you feel hungrier than usual while taking steroids and this can make you want to eat more than usual. If you are concerned about weight-gain speak to your doctor or dietitian, or contact our support service nurses.

Increased chance of infection and delayed healing of injuries This happens mainly with high-dose or long-term treatment. Tell your doctor if you notice signs of infection (inflammation, redness, soreness or a temperature) or if cuts take longer than usual to heal. It is important to maintain good personal hygiene to prevent infection.

Menstrual changes Women may find that their periods become irregular or stop.

Behavioural changes You may notice mood swings, difficulty in sleeping and perhaps anxiety or irritability. These effects happen mainly with high-dose or long-term treatment and will stop when the steroid therapy ends. Tell your doctor about any behavioural changes that are worrying you. Difficulty in sleeping may be helped by taking the steroids in the early part of the day, but discuss this with your doctor first.

Less common side effects

Eye changes Cataracts or glaucoma may develop with the long-term use of steroids. There is also an increased risk of eye infections. Tell your doctor if you notice any eye problems.

Cushing’s syndrome This is usually caused only by long-term use of steroids. It 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, by taking them on alternate days instead of every day, or by reducing the dose, but discuss this with your doctor first.

Muscle wasting With very long-term use of steroids, wasting of leg muscles may occur. This can cause weakness. When the steroids are stopped some people have muscle cramps for a short time.

Osteoporosis With very long-term use of steroids, calcium may be lost from the bones. This can result in pain (especially in the lower back), an increased susceptibility to fractures and loss of height.

Additional information

You will be given a steroid card if you have to take the steroids at home. A card is not necessary if the steroids are just being given as a short course, such as for anti-sickness medication. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. If you need to have any dental work, tell your dentist that you are having steroid treatment.

If long-term steroids are suddenly stopped, withdrawal effects can occur, so it is very 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.

If dexamethasone is given quickly into a vein, it can cause a strange sensation in the anal area (back passage). This only lasts for a short time.

Things to remember about steroid tablets

• Keep the tablets in a safe place where children cannot reach them
• 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
• If you are sick just after taking the tablet, tell your doctor, as you may need to take another one
• If you forget to take your tablet, do not take a double dose. Let your doctor or nurse know.

References

This section has been compiled using information from a number of reliable sources including:

• Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
• British National Formulary (50th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2005.

For further references, please see the general bibliography.

Via: http://www.cancerbackup.org.uk