Corticosteroid side effects are related to the total dose

The risk of experiencing significant side effects from corticosteroids increases with long-term use. That’s true even for people taking low doses, according to researchers who surveyed 2,446 people who had been treated with prednisone or a similar medication.

The researchers asked participants whether they had experienced any of eight adverse events often linked with corticosteroid use, such as sleep disturbance, acne, bruising or thinning of the skin, diabetes or high blood sugar, cataracts, or bone fractures. The subjects were asked to rate each as not bothersome, a little bothersome, or very bothersome.

The study participants were divided into four groups based on their cumulative corticosteroid doses. Group 1 had received the lowest dose: less than 1.7 grams (g)—for example, 10 milligrams (mg) per day for 6 months. Group 2 had received 1.7 to 2.8 g—e.g., 10 mg per day for 9 months. Group 3 had received 2.9 to 4.7 g—e.g., 10 mg per day for 12 months. Group 4 had received more than 4.7 g—e.g., 10 mg per day for 18 months.

Most of the respondents had experienced at least one adverse event related to corticosteroid use, and 55% rated at least one adverse event as very bothersome. Weight gain was the most common problem. More than 60% of the highest-dose group experienced bruising or thinning of skin or disturbed sleep. Among the more serious adverse events, 15% of the participants had developed cataracts, and 12% had suffered a fracture.

Even low-dose corticosteroids can cause significant side effects. But if the benefits of taking the drugs outweigh the risks, doctors can minimize side effects by prescribing preventive therapies.