Oral corticosteroids

Oral corticosteroids, also known as steroid tablets, are the most powerful type of steroid medication because they can affect the whole body. Corticosteroids that are given by injection or inhaler usually affect a specific area of the body.

Due to their strength, restrictions about who can safely take oral corticosteroids are tighter than those for other types of corticosteroid. For example, someone with an active infection should not usually start using oral corticosteroids because they could make the infection more severe. However, someone who develops an infection while already being treated should continue to take corticosteroids. Suddenly stopping medication could make them very ill.

Oral corticosteroids may also not be suitable if you:

• have had liver disease – they could damage your liver further
• have mental health or behavioural problems, such as depression or alcohol dependence – corticosteroids can have unpredictable effects on behaviour and mood
• have a wound – oral corticosteroids can delay wound healing

If you have any of these, you will probably only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks.

Several health conditions can be made worse by taking oral corticosteroids, including:

• heart failure
• a recent heart attack
• high blood pressure 
• type 1 diabetes and type 2 diabetes
• epilepsy
• glaucoma
• underactive thyroid gland
• osteoporosis
• obesity
• psychosis
• stomach ulcers

If you have been diagnosed with any of the above conditions, you will probably only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks.

Intravenous corticosteroids

Most people can safely have corticosteroid injections, also known as intravenous corticosteroids.

However, intravenous corticosteroids are not recommended for people with an active infection, unless they have a potentially life-threatening condition that requires urgent treatment.

Inhalers and sprays

Corticosteroid inhalers and sprays are generally safe for most people to use. However, you should not use them if you have ever had an allergic reaction to the ingredients in them.

Pregnancy

Corticosteroids are generally safe to use during pregnancy. However, they are not usually recommended unless the potential benefits of treatment outweigh any potential risk to the baby.

For example, oral corticosteroids may be recommended because some conditions, such as severe asthma, may pose a bigger risk than the medication itself.

The benefits of using inhaled corticosteroids during pregnancy for conditions such as asthma are thought to far outweigh any potential risk.

There is no evidence that a single injection of corticosteroids during pregnancy poses any threat to the baby, although repeated injections may cause low birth weight.

Breastfeeding

If oral corticosteroids are required during breastfeeding, prednisolone is usually recommended because it is thought to have the least chance of causing the baby any adverse effects. However, as a precaution, it is recommended that you wait three to four hours after taking a tablet before feeding your baby.

Corticosteroid injections, inhalers or sprays are not thought to pose a threat to babies being breastfed. However, as a precaution, they should only be used if the benefits to the mother outweigh any potential risk.