Corticosteroids side effects
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Corticosteroids Side Effects: A Comprehensive Overview
Introduction to Corticosteroids and Their Uses
Corticosteroids are powerful anti-inflammatory drugs commonly prescribed for a variety of conditions, including allergic reactions, autoimmune diseases, and joint pain . Despite their effectiveness, corticosteroids are associated with a range of side effects that can impact both physical and mental health .
Psychiatric Side Effects of Corticosteroids
Mood Disturbances and Psychiatric Symptoms
Corticosteroids can induce significant psychiatric side effects, including mania, depression, and mood disturbances. These symptoms often appear within the first two weeks of therapy and are typically dose-related . In pediatric patients, corticosteroid use has been linked to cognitive disorders, behavioral changes, and psychiatric diseases, particularly in those treated for acute lymphoblastic leukemia. Both antipsychotic medications and benzodiazepines have been used to manage corticosteroid-induced psychiatric symptoms, although no unified treatment strategy has emerged.
Case Reports and Clinical Trials
Numerous case reports and clinical trials have documented the psychiatric complications of corticosteroid treatment, ranging from anxiety and insomnia to severe mood and psychotic disorders, delirium, and dementia. These adverse effects are not rare and often require psychotropic medications for management due to the medical necessity of continuing corticosteroid therapy.
Physical Side Effects of Corticosteroids
Short-Term Side Effects
Short-term use of corticosteroids is generally associated with mild side effects, such as cutaneous effects, electrolyte abnormalities, hypertension, hyperglycemia, and pancreatitis. However, even short courses of high doses can occasionally lead to significant side effects like psychosis .
Long-Term Side Effects
Long-term corticosteroid use is more problematic and can lead to serious and irreversible issues. These include osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal and hepatic effects, hyperlipidemia, growth suppression, and possible congenital malformations . Additionally, systemic side effects such as increased blood glucose levels, reduced immune function, and an increased risk of infections are common.
Hypersensitivity Reactions
Hypersensitivity reactions to corticosteroids are rare but can occur, especially in patients who receive repeated doses. These reactions are divided into immediate reactions, occurring within an hour of administration, and non-immediate reactions, which manifest later. Allergic contact dermatitis is the most commonly reported non-immediate hypersensitivity reaction, particularly following topical corticosteroid application.
Patient-Reported Side Effects and Adherence
A significant proportion of patients report side effects from corticosteroid use, which can impact treatment adherence. For instance, 64% of asthma patients using inhaled corticosteroids (ICS) and 88% using oral corticosteroids (OCS) reported experiencing side effects. There is often a disparity between clinician estimates and patient-reported side effects, highlighting the need for better communication and management strategies to improve adherence and treatment outcomes.
Conclusion
Corticosteroids are highly effective but come with a range of potential side effects that can affect both mental and physical health. Short-term use is generally associated with mild side effects, while long-term use can lead to more serious complications. Psychiatric side effects are particularly concerning and require careful monitoring and management. Understanding these risks and communicating them effectively to patients is crucial for optimizing treatment outcomes and adherence.
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