Steroids (dexamethasone, prednisolone, methyl prednisolone)
This page tells you about steroids in cancer treatment. You can find information about
Steroids are substances made naturally by our bodies. The term steroid includes sex hormones, which are made by the reproductive system. But steroids to treat cancer are generally a type called corticosteroids, and we talk about these on this page.
Corticosteroids are made by small glands found just above the kidneys, called the adrenal glands. They help to control many functions in the body, including
- How your body uses food to produce energy (your metabolism)
- Keeping the balance of salt and water in your body
- Regulating blood pressure
- Reducing inflammation and allergies
- Controlling your mood and behaviour
Steroids can be man made to treat many different diseases and conditions, including cancer. Steroids used to treat cancer include
There are a number of reasons why you may need to take steroids for cancer. You might have them
- To treat the cancer itself, often alongside chemotherapy treatment
- To reduce inflammation
- To reduce your immune response, for example, after a transplant
- To help relieve sickness when having chemotherapy
- To help boost your appetite
Most people who have steroids as part of cancer treatment only need to take them for a few days or weeks (short term). But you may need treatment for longer after a bone marrow transplant or stem cell transplant.
You can have steroids in different ways
- As tablets that you swallow – you need to take your tablets after a meal, or with milk, as they can irritate your stomach
- As a syrup or tablets that dissolve – this is easier if you find swallowing tablets difficult
- As an injection into a muscle – normally your leg or buttock muscle
- As an injection into a vein (intravenously)
The dose and length of steroid treatment varies depending on why you are having steroid treatment. You may need to take them every other day, once a day or several times a day.
If you miss a dose of steroids, don’t take a double dose. Let your nurse or doctor know and ask them what you should do.
If you are taking steroids for more than 3 weeks, you should have a blue steroid card to carry with you all the time. Or your doctor or pharmacist may suggest that you wear a medical alert bracelet. This is just in case you need treatment in an emergency, so the doctor will know you are taking steroids. You should also tell your dentist you are having steroids if you need any dental work done.
You should only stop taking steroids if your doctor or nurse tell you to. If you take steroids for more than a few days, your body will produce less steroids naturally. So when you stop taking the steroids, your body has to readjust. Your doctor may gradually reduce your dose of steroids, rather than stopping them suddenly.
Any side effects you may have from taking steroids will depend on the dose you take and how long you have them for. Some common side effects include
- Indigestion or heartburn – you need to take your tablets after a meal or with milk, as they can irritate your stomach
- Increased appetite and weight gain – feeling hungrier can make it difficult to keep your weight down. Your appetite will go back to normal when you stop steroids, but some people need to diet to lose the extra weight
- Swollen hands, feet or ankles from water retention – if you have swollen ankles, avoid standing for long periods of time and put your feet up when you are sitting down
- Increased risk of infection – tell your nurse or doctor straight away if you think you might have an infection, as you may need to take antibiotics
- Changes in blood sugar levels with high dose or long term treatment – tell your doctor if you feel thirstier or if you are passing urine more often, as these can be symptoms of high blood sugar. You will have regular blood tests and may need to learn how to check your blood sugar. Diabetic people may need to adjust their tablets or insulin dose.
- Changes in mood and behaviour – you may feel more anxious and emotional than usual when you take steroids and can be a bit tired and feel sad for a while after you stop taking them. Let your doctor know if you or any family members have ever had depression or manic depression (bipolar disorder)
- Difficulty sleeping – taking your tablets first thing in the morning may help
These side effects only occur if you take long term steroids (more than a few months). They include
- Eye problems such as cataracts, infections or glaucoma
- Changes to your face (Cushings syndrome) – you may develop a swollen or puffy face, dark marks, acne or facial hair. If you notice any of these changes talk to your doctor
- Muscle wasting – your legs may feel weaker and walking or climbing stairs may be more difficult. You may have aching muscles for a short while after stopping treatment
- Weaker bones due to bone loss (osteoporosis)
- Raised blood pressure – your blood pressure should be checked regularly
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
Talk to your doctor about side effects
Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You should have a contact number for your chemotherapy nurse, clinic or ward nurse. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.
Taking other medicines
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together. Medicines that may react with steroids include
- Medicines for sleep problems and epilepsy
- Some drugs used to clear a blocked nose
- Tuberculosis drugs
- Some blood thinning drugs
- Insulin and other diabetes medicines
- Some anti inflammation drugs
- Medicines that make you pass more urine
- Some stomach ulcer medicines
- Some heart medicines
- Some medicines used to treat high blood pressure
Contraception, pregnancy and breastfeeding
Steroids may slow the growth of a baby in the womb so it is not advisable to become pregnant or father a child if you are taking steroids. Talk about contraception with your doctor or nurse before having the treatment if you are concerned that you or your partner could become pregnant. You will need to use reliable contraception while you are having steroid treatment.
Breastfeeding is not advisable while having steroid treatment as the drug can come through in the breast milk. It may slow the baby's growth or cause other side effects.
Chicken pox and shingles
Keep away from people who have chicken pox or shingles if you have never had these illnesses. They could make you very ill. If you do come into contact with someone who has them tell your doctor or nurse straight away.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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