Steroids (dexamethasone, prednisolone, methyl prednisolone)

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

• Prednisolone
• Methylprednisolone
• Dexamethasone

You may have heard of anabolic steroids, which body builders and athletes use to build up their muscles. Anabolic steroids are an artificial form of testosterone. They are not used to treat cancer but are occasionally used to treat a type of anaemia called aplastic anaemia.

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.

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 a week, you should have a 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 doctors need to treat you in an emergency, so they 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 – you must 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 low for a while after you stop taking them
• Difficulty sleeping – taking your tablets first thing in the morning may help
• Steroids may be harmful to a baby that is developing in your womb so it is not advisable to become pregnant or father a child if you are taking steroids. Talk about contraception with your doctor before having the treatment if you are concerned that you or your partner could become pregnant

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, 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.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.