Highlights
- Steroids are similar to hormones and work to reduce inflammation and lessen stress on the immune system.
- Steroids are prescribed for a variety of conditions, including inflammation, hormone therapy, prostate cancer, breast cancer, and as birth control.
- Different types of steroids include corticosteroids, anabolic steroids, antiandrogens, and contraceptive steroids.
- Synthetic steroids come in various forms, including oral tablets, gels, injections, liquid suspensions, and patches.
- Steroid use is generally safe for many patients; however, improper use of anabolic steroids can put users at risk of substance abuse and lead to serious health problems.
Inflammation is the body’s natural response to fighting infections or healing from injuries. It can be a good thing, but certain medical conditions and other factors can trigger this response when your body doesn’t need it. Over time, inflammation can lead to serious health conditions, including arthritis, depression, and even cancer. To help combat inflammation, doctors may prescribe steroids that will reduce your body’s inflammatory response.
Before taking steroids, it’s important to be informed about their uses, how they work, potential side effects, and warnings. Use this reference guide to learn more about steroids.
How Do Steroids Work?
Steroids mimic the body’s natural hormones. They work by binding to specific receptor sites within the cells to suppress certain natural responses.
Different steroids have different functions, depending on the condition or purpose for which they’re being used.
For example, corticosteroids work by suppressing the immune system’s response to inflammation caused by various triggers. By binding to specific receptor sites within cells, corticosteroids prevent inflammation from occurring, which helps to reduce swelling, redness, pain, and heat associated with various inflammatory conditions.
Steroids can also have non-inflammatory-related effects on the body. For example, they can balance salt and water content by increasing fluid secretion in sweat glands. They can also affect metabolism by promoting glucose production from protein stores and inhibiting insulin’s actions.
Steroids can be applied to a variety of use cases, including:
- Inflammation
- Hormone replacement therapy
- Hirsutism
- Birth control
- Hormonal disorders
- Prostate cancer
- Breast cancer
- Menopause symptoms
- Osteoporosis
- Muscle growth and development
Steroids can provide much-needed relief in some patients. However, it’s essential to use them judiciously and under a doctor’s supervision due to potential side effects, such as mood changes or an increased susceptibility to infections.
Types of Prescription Steroids
Steroids come in several common drug classes and types. Let’s take a closer look.
Corticosteroids
Corticosteroids are among the most commonly prescribed steroids. These steroids mimic the hormone cortisol (also called the stress hormone) and are used to treat inflammatory conditions, such as:
- Asthma
- Arthritis
- Lupus
- Multiple sclerosis
- Eczema
- Rashes
- Some types of cancer
Examples of corticosteroids include:
- Cortisone
- Prednisone
- Prednisolone
- Hydrocortisone
- Dexamethasone
- Betamethasone
These steroids can also come in various forms, such as:
- Oral tablets
- Liquids
- Injections
- Inhalers
- Eye drops
- Topicals, such as lotions, ointments, or creams
Warnings and Contraindications – Corticosteroids
Who Should Not Take Corticosteroids?
Warnings and contraindications can vary between corticosteroids. In general, according to FDA Prescribing Information, patients should not take corticosteroids if they are hypersensitive to the product or any of its ingredients.
Who Should Take Corticosteroids With Caution?
Again, according to FDA Prescribing Information, patients with any of the following conditions should proceed with caution:
- Systemic fungal infection
- Uncontrolled hyperglycemia
- Joint infection
- Glaucoma
- Osteoporosis
- Diabetes mellitus
- Diverticulitis
- Uncontrolled hypertension
- Herpes simplex keratitis
- Varicella infection
- Peptic ulcer disease
- Congestive heart failure
- Infections not controlled by medication
Check with your physician regarding personal concerns and specific drugs. Always read your medication’s insert regarding warnings and contraindications.
Side Effects – Corticosteroids
The following are possible side effects to be aware of while taking this medication:
- Weight gain
- Mood changes
- Increased blood sugar
- Elevated blood pressure
- Cataracts
- Skin changes
- Insomnia
- Stomach ulcers
- Muscle weakness
- Gastrointestinal bleeding
Rare but serious side effects include:
- Allergic reactions
- Cushing’s syndrome
- Psychosis or mania
Side effects can vary by drug. Refer to your medication’s insert for more information.
Drug Interactions – Corticosteroids
Drug interactions can vary. For example, according to Drugs.com, the corticosteroid prednisone lists 568 known drug interactions.
Major Drug Interactions
Drugs.com lists 68 major drug interactions with prednisone that can lead to life-threatening effects. They include:
- Influenza virus vaccine, live (and other vaccines). Depending on the dose, prednisone could increase your likelihood of developing an infection from the vaccine and/or reduce your response to the vaccine.
- Thalidomide. This drug taken with prednisone could increase your risk of developing blood clots.
- Cinoxacin. This drug and others in its class may cause tendinitis and tendon rupture, and combining it with prednisone may increase this risk.
- Cladribine. The use of this drug with prednisone may increase the risk of serious infections.
For the complete major interactions list, see prednisone Interactions Checker.
Other Drug Interactions
The complete interaction list for prednisone includes 461 moderate interactions and 39 minor ones. It’s a good idea to check this list before beginning this medication.
In addition to these drugs, prednisone and other corticosteroids may also interact with vitamins, herbal supplements, and over-the-counter drugs. Make sure your providers know all of the medications and supplements you take.
Anabolic Steroids
Anabolic steroids are synthetic versions of testosterone, which is responsible for muscle growth and male characteristics. These steroids are illicitly used by athletes to improve their performance since they enhance muscle development, but they can also pose serious health risks when taken incorrectly.
Common purposes of anabolic steroid use are:
- Hypogonadism in men
- Hormone therapy
- Anemia
- Delayed puberty
- Muscle-wasting diseases
- Breast cancer
- Hereditary angioedema
Examples of anabolic steroid prescriptions include:
- Danazol
- Fluoxymesterone
- Mesterolone
- Methyltestosterone
- Nandrolone decanoate
- Oxandrolone
- Oxymetholone
Synthetic testosterone can come in various forms, including:
- Patches
- Nasal gels
- Subcutaneous pellets
- Injections
- Oral capsules
- Topicals
Warnings and Contraindications – Anabolic Steroids
People who use anabolic steroids may be at risk of developing substance abuse. These medications can create severe and long-lasting damage and lead to:
- Early heart attacks
- Strokes
- Liver tumors
- Kidney failure
- Depression
- Psychiatric problems
Teenagers are at a heightened risk because their bodies are still developing.
Who Should Not Take Anabolic Steroids?
Contraindications can vary by prescription. For example, oxandrolone is contraindicated in patients with the following:
- Known or suspected carcinoma of the prostate or breast (males)
- Carcinoma of the breast in females with hypercalcemia
- Pregnancy or breastfeeding
- Hypercalcemia
- Nephrosis
Who Should Take Anabolic Steroids With Caution?
According to FDA Prescribing Information, oxandrolone may have adverse effects on some patients, including:
- Geriatric patients
- Patients with congestive heart failure
- Pre-existing cardiac, renal, or hepatic disease
- Children
- Patients taking warfarin
Side Effects – Anabolic Steroids
Side effects may also vary by medication. Regarding oxandrolone, the following adverse reactions may occur:
- Weight gain
- Acne
- Voice changes
- Menstrual cycle disturbances
- Sleep problems
- Breast swelling
- Feelings of excitement
- Changes in libido
Consult with your physician regarding side effects of specific medications.
Drug Interactions – Anabolic Steroids
According to Drugs.com, a total of 89 medications can interact with oxandrolone.
Major Drug Interactions
Drugs.com lists 12 major drug interactions with oxandrolone that can lead to life-threatening effects. They include:
- Anisindione. This combination may cause you to bleed more easily.
- Ketoconazole. This medication may injure your liver, and combining it with oxandrolone may increase the risk.
- Lomitapide. This medication combination may increase your risk of developing liver problems.
- Warfarin. This combination may cause you to bleed more easily.
For the complete major interactions list, see oxandrolone Interactions Checker.
Other Drug Interactions
The complete interaction list for oxandrolone includes 78 moderate interactions. It’s a good idea to check this list before beginning this medication.
In addition to these drugs, oxandrolone may also interact with vitamins, herbal supplements, and over-the-counter drugs. Make sure your providers know all of the medications and supplements you take.
Antiandrogens
Antiandrogen steroids belong to the class of drugs called androgen receptor inhibitors. They block the effects of androgens, like testosterone.
These steroids bind to androgens’ target receptors to reduce their activity. They’re often used to treat the following conditions:
- Prostate cancer (primary use case)
- Hirsutism
- Transgender hormone therapy
- Early puberty in boys
- Acne
Examples of antiandrogen steroids include:
- Cyproterone acetate
- Megestrol acetate
- Chlormadinone acetate
- Spironolactone
- Oxendolone
Antiandrogen steroids are available in several forms:
- Oral tablets
- Injections
- Liquids
Antiandrogens exist as non-steroidal options, too.
Warnings and Contraindications – Antiandrogen Steroids
Warnings and contraindications can vary by prescription. For example, cases of new onset diabetes and Cushing’s syndrome and exacerbation of existing diabetes have been reported with megestrol.
Who Should Not Take Megestrol?
According to FDA Prescribing Information, patients with a history of hypersensitivity to megestrol or its ingredients should not take this medication.
Pregnant women should not take megestrol as it can cause fetal harm.
Who Should Take Megestrol With Caution?
Again, according to FDA Prescribing Information, patients with diabetes or a history of thromboembolic disease should use this medication with caution.
Side Effects – Antiandrogen Steroids
Side effects may vary by medication. Related to megestrol acetate, patients may experience the following:
- Abdominal pain
- Constipation
- Nausea
- Gas
- Diarrhea
- Increased blood pressure
- Changes in libido
- Weakness
This is not an exhaustive list of side effects or adverse reactions. Consult your medication’s informational insert for more details.
Drug Interactions – Antiandrogen Steroids
According to Drugs.com, a total of 147 medications can interact with megestrol.
Major Drug Interactions
Drugs.com lists two major drug interactions with megestrol that can lead to life-threatening effects. They are:
- Thalidomide. This combination can increase the risk of blood clots, and this risk increases even more in patients who smoke or have high blood pressure or high cholesterol.
- Dofetilide. Using dofetilide in combination with megestrol may increase the level of dofetilide in the bloodstream which may lead to an irregular heartbeat that may be life-threatening.
For more information on major interactions, see megestrol Interactions Checker.
Other Drug Interactions
The complete interaction list for megestrol includes 142 moderate interactions and 3 minor ones. It’s a good idea to check this list before beginning this medication.
In addition to these drugs, megestrol may also interact with vitamins, herbal supplements, and over-the-counter drugs. Make sure your providers know all of the medications and supplements you take.
Contraceptive Steroids
Contraceptive steroids, also known as birth control, are medications used primarily by women to prevent pregnancy. These hormones mimic the effects of naturally occurring hormones to prevent ovulation.
Contraceptive steroids come in two types:
- Combination birth control. This option contains progestin (a synthetic form of progesterone) and estrogen. They inhibit ovulation while also thickening the cervical mucus, making it harder for sperm to travel to the egg, and thinning the uterine lining, making it less receptive to fertilized eggs.
- Progestin-only birth control. This option does not contain estrogen but works in a similar way to combination birth control.
Birth control steroids can be delivered in several methods:
- Oral pills
- Implants
- Patches
- Injections
- Contraceptive intrauterine devices (IUDs)
Examples of contraceptive steroid prescriptions include:
- Norethindrone
- Ethynodiol/ethinyl estradiol
- Levonorgestrel/ethinyl estradiol
- Norethindrone/ethinyl estradiol
- Norgestimate/ethinyl estradiol
- Desogestrel/ethinyl estradiol
Warnings and Contraindications – Contraceptive Steroids
Warnings and contraindications can vary by birth control prescription. For example, the progestin-only medication norethindrone may increase fluid retention, which may affect conditions like epilepsy, migraine headaches, or renal dysfunction.
Patients should discontinue use if they experience a sudden partial or complete loss of vision or have a sudden onset of proptosis, diplopia, or migraine.
Who Should Not Take Norethindrone?
According to FDA Prescribing Information, individuals should not take norethindrone under these conditions:
- Known or suspected pregnancy
- Undiagnosed vaginal bleeding
- Active or a history of deep vein thrombosis
- History of pulmonary embolism
- Impaired liver function
- Hypersensitivity to the drug or any of its components
Contraindications for other contraceptive steroids may vary.
Who Should Take Norethindrone With Caution?
Again, according to FDA Prescribing Information, patients with the following should use norethindrone with caution:
- Cardiovascular disorders
- A history of clinical depression
- Hyperlipidemias
- Diabetes
Consult with your physician regarding specific precautions with your medication.
Side Effects – Contraceptive Steroids
As with all medications, norethindrone may create some side effects and adverse reactions, including:
- Mood changes
- Acne
- Spotting
- Changes in menstrual flow
- Edema
- Rash
- Melasma
- Clinical depression
- Breast enlargement
- Breast tenderness
- Headache/migraine
- Nausea
- Insomnia
Drug Interactions – Contraceptive Steroids
Some drugs and supplements may interact with contraceptive steroids, making them less effective. According to Drugs.com, a total of 246 medications can interact with norethindrone.
Major Drug Interactions
Drugs.com lists 36 major drug interactions with norethindrone that can make birth control less effective. They include:
- Carbamazepine. This medication may reduce the blood levels and effects of norethindrone.
- Phenytoin. This medication may increase the risk of breakthrough bleeding and unintended pregnancy.
- Rifapentine. Using these medications together could make birth control less effective.
- Phenobarbital. This medication has a similar interaction as other medications in this life.
For the complete major interactions list, see norethindrone Interactions Checker.
Other Drug Interactions
The complete interaction list for norethindrone includes 197 moderate interactions and 13 minor ones. It is a good idea to check this list before beginning this medication.
In addition to these drugs, norethindrone may also interact with vitamins, herbal supplements, and over-the-counter drugs. Make sure your providers know all of the medications and supplements you take.
Conclusion
Steroids are powerful medications that can have potential side effects and contraindications. However, because they can reduce the body’s natural immune response, it’s essential to take steroids only as needed and as directed by your physician.
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