Long-term steroid tablets: side effects and steroid cards

Steroid medicines are copies of hormones made by the adrenal glands. The NHS lists conditions they help treat, including asthma, allergies, rheumatoid arthritis, Crohn's disease and some cancers, and notes that they are not the same as the anabolic steroids some people use illegally to build muscle. Tablets, capsules and liquids act throughout the body, unlike creams and inhalers that act mainly where applied.

Because they act throughout the body, their side effects can too. For many illnesses, steroids are the best available way to bring inflammation under control, and the decision is about balancing that benefit against the risks, using the lowest dose that works for the shortest time possible.

The NHS describes these common effects of prednisolone, each of which happens in more than 1 in 100 people, along with practical tips.

Steroids lower resistance to infection. The NHS lists a high temperature, a sore throat, a cough, pain when passing urine, mouth sores or a wound that will not heal as possible signs of infection that need a call to a doctor or NHS 111. It also lists signs of high blood sugar (very thirsty, passing urine often, breath that smells like fruit), Cushing's-type changes (upper back and belly weight gain, a rounded face), low potassium, pancreas problems and adrenal gland problems.

Long-term use can lead to thinner bones, poorly controlled diabetes, eyesight problems and high blood pressure, according to the NHS. The MHRA has also described central serous chorioretinopathy, a retinal disorder linked to systemic steroids and reported after local routes such as inhaled, nasal, epidural, joint and skin use; anyone should report blurred vision or other visual disturbances during steroid treatment. In children and teenagers, higher doses for a long time can slow growth, so height is monitored.

Black or dark-brown vomit, or vomiting blood, needs a 999 call or A&E.

The MHRA states that psychiatric side effects can occur with all systemic steroids. They range from irritable, euphoric, depressed or changeable moods and suicidal thoughts to mania, delusions, hallucinations, anxiety, sleep disturbance, confusion and amnesia. They typically begin a few days or weeks after starting, may be more likely with higher doses, and usually recover after the dose is reduced or the steroid is stopped, although specific treatment may be needed.

The MHRA cites an upper estimate of severe psychiatric reactions in adults as high as 5 to 6 per cent. Reactions have also been reported when steroids are withdrawn. The NHS tells people to call a doctor or 111 for new mood changes and to call 999 or go to A&E if they have thoughts of harming themselves. Families and carers are often the first to spot a change, so telling them what to look for helps.

There are two different cards. The blue steroid treatment card is given when prednisolone is taken for longer than 3 weeks or at a high dose; it records your doctor, the dose and the expected length of treatment, and explains how to reduce side effects. The MHRA says anyone taking systemic steroids for more than 3 weeks, or high-dose inhaled steroids, should not stop abruptly and should be given a steroid card.

The emergency steroid card (red card) is different. It may be recommended when the adrenal glands could be suppressed, which is more likely with high doses over a long time, especially as tablets and injections, or when several kinds of steroid are used together such as a nasal spray and an inhaler. If you need medical or dental treatment, surgery or an invasive procedure, show it so the team can give extra steroids if needed.

Carry the card at all times and show it when you are unwell, in an emergency department, or at the dentist.

The NHS says it can be dangerous to stop prednisolone suddenly, especially after a high dose for a long time. The condition may flare, and withdrawal effects such as severe tiredness and weakness can occur. The dose is usually reduced gradually, and you should not stop without speaking to your doctor.

If you miss a dose, take it as soon as you remember; if you remember only the next day, skip it and do not double up. Taking the tablet as a single dose with breakfast is generally best unless told otherwise.

Prednisolone makes infections more likely, so tell your doctor if you have symptoms or test positive for COVID-19, and keep away from people with measles, chickenpox or shingles if you have never had them. If you are vomiting and cannot keep tablets down, or become acutely unwell, urgent medical advice is needed rather than waiting to see how you feel.