Steroids (dexamethasone, prednisolone, methylprednisolone and hydrocortisone)

What are steroids?

Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system, reducing inflammation and blood pressure.

Steroids can also be made in the laboratory (manufactured). You usually have a type of steroids called corticosteroids. These are manufactured versions of the hormones produced by the ​adrenal glands​.

Steroids used in cancer treatment include the drugs in the list below. Next to each drug name we have added how you pronounce it:

• prednisolone (pred-nis-oh-lone)

• methylprednisolone (meeth-ul-pred-nis-oh-lone)

• dexamethasone (deks-uh-meth-uh-zone)

• hydrocortisone (hi-dro-kort-uh-zone)

• budesonide (bew-dess-oh-nide)

What do steroids do?

Steroids help control many body functions including:

• how your body uses food to produce energy (metabolism)

• keeping the balance of salt and water in your body

• regulating blood pressure

• reducing allergies and inflammation

• controlling mood and behaviour

Why are steroids used in cancer treatment?

There are a number of reasons you might have steroids as part of your cancer treatment. Some of these reasons include:

• treating the cancer

• reducing inflammation

• helping prevent an allergic reaction to cancer treatments

• reducing your body’s immune response, for example after a bone marrow transplant or immunotherapy such as checkpoint inhibitors

• helping reduce sickness when having cancer treatment

• improve your appetite

How do you have steroids?

Steroids come in many different preparations. The following is the most common way of having steroids during cancer treatment. You might have them as:

• tablets or liquid, you take them just after a meal or with milk as they can irritate your stomach

• an injection into a vein (intravenous)

• drops that go into the eye (eye drops)

• a cream that you put on the affected area

Your doctor, nurse or pharmacist will explain the way you have your steroids.

Make sure you take your steroids according to the instructions your doctor, nurse or pharmacist gives you. Take the right dose, not more or less.

You should not stop taking steroids without talking to your specialist first.

Find out more about taking medicines safely

How often do you have steroids?

The amount (dose) and length of steroid treatment is different depending on why you're having steroids. 

For example, if you are having steroids to treat myeloma you usually have them as part of a combination of drugs. In this case you usually take the steroids in cycles. A cycle means that you have the combination of drugs and then have a rest to allow your body to recover.

If you’re having steroids to help reduce sickness, you usually have them before treatment and you may continue them for a few days after.

If you are having steroids to treat a side effect of immunotherapy treatment, you could have a long course of steroids. The dose is then slowly lowered over a number of weeks to come off them.

Your doctor, nurse and pharmacist will explain how often you need them and for how long.

Steroid safety cards

Your healthcare team may give you a small card to carry with you while you are taking steroids. This is so that anyone else treating you, such as your dentist or in an emergency, knows that you are on steroids.

There are 2 types of card:

Steroid Treatment Card (blue card)

You should have a steroid treatment card if you take steroids for more than 3 to 4 weeks.

NHS Steroid Emergency Card (red card)

You should have this card if you are dependant on daily steroid use. This means your body has problems making enough of a ​hormone​ called cortisol. It is made by the adrenal glands. The ​pituitary gland​ controls how much cortisol is made. Having this problem can affect your body’s ability to cope with stress. This might be from an infection, surgery or injury for example. Knowing this allows the healthcare team to give you prompt medical treatment.

Some of the conditions which make you at risk include:

• Addison's disease

• Congenital Adrenal Hyperplasia (CAH)

• having had both your adrenal glands removed (bilateral adrenalectomy)

• your pituitary gland not making enough hormones (hypopituitarism)

What are the side effects of steroids?

We haven't listed all the side effects. You may get some of them, but it is very unlikely that you will have all of them. You might have some of the side effects at the same time.

How often and how severe the side effects are can vary from person to person. We’re unable to give an idea of the frequency of these side effects because it depends on:

• what other treatment you are having. For example, your side effects could be worse if you are also having other medicines or radiotherapy

• the aim of the steroid treatment, for example to treat your cancer or to help with symptoms

• if you’re taking steroids short or longer term

• the dose of steroids

• how you have your steroids, such as by mouth, as an injection into a vein (intravenous) or as eye drops

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

You might have one or more of these side effects. They include:

Increased risk of infection

Steroids can hide or change the signs and symptoms of some infections. They might also make it harder for your body to deal with an infection. This means infections are more difficult to diagnose at an early stage.

Symptoms of an infection include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.

Chicken pox, shingles and measles

Keep away from people who have chicken pox or shingles whilst taking steroids if you have never had these illnesses or been vaccinated against them. You should also stay away from people who have measles whilst taking steroids if you have never been vaccinated against it.

These conditions could make you very ill as steroids can lower your immune system.

If you do come into contact with someone who has them, tell your healthcare team straight away.

Mood and behaviour changes

Your mood and how you behave might change while taking steroids. You might be feeling:

• anxious

• more emotional than usual

• irritable

• confused or finding it difficult to think or concentrate

• high (mania) or extreme moods swings

• forgetful or feel as though you are losing your memory

Around 5 out of every 100 people (around 5%) experience serious mental health problems when they take steroids. This includes depression. Let your healthcare team know if you notice any changes in your emotional or psychological wellbeing. Also let them know if you or any family members have ever had depression or manic depression (bipolar disorder).

Steroids can cause a reaction called steroid induced psychosis. People can become excited, confused and imagine things that aren’t real. This can be frightening, but it goes away when you stop taking the steroids.

Changes in blood sugar levels

You might have regular blood and urine tests to check this. Some people develop ​diabetes​. You might need to have blood sugar lowering treatment. But your sugar levels usually go back to normal shortly after you stop taking steroids.

If you have diabetes already, you might need to check your blood sugar levels more often than usual.

Let your healthcare team know if you get headaches, feel thirsty and have blurred vision.

Follow the advice of your healthcare team about when to best take your steroids.

Indigestion or heartburn

You might have indigestion or heartburn. Tell your doctor or nurse if you have a gnawing or burning pain in your tummy (abdomen), feel bloated and are burping.

Steroids can irritate your stomach. So it’s best to take them just after a meal or with milk.

Digestive system problems

Steroids can affect different parts of the digestive system. You might feel sick. They can cause sores and ulcers in the stomach, top part of the small bowel which connects to the stomach (duodenum) and food pipe (oesophagus).

Some of these sores and ulcers can bleed. Some people can get a bad taste in their mouth if they have steroids as an injection into a vein.

Steroids can also cause a hole in the bowel wall (perforation). Symptoms of this can include sudden and severe abdominal pain, high temperature, feeling or being sick.

Changes to your face and appearance (Cushing's syndrome)

You might develop:

• a swollen or puffy face

• stretch marks

• acne

• increased facial hair

You might put on weight around your tummy (abdomen).

This can be quite upsetting. Talk to your doctor or nurse about any of these side effects.

Eye problems

Steroids can cause a number of eye problems including clouding of the lens of the eye (cataract), damage to the optic nerve (glaucoma) or eye infections. Your eyes might bulge or protrude. These conditions can cause changes with your vision, such as blurred or double vision, pain, headaches, seeing rings (halos) around lights or reddening of the eye.

Fluid can build up under the part of the eye called the retina. Symptoms can include central vision changes such as blurred vision or things may appear misshapen. It may be darker than normal. Straight lines may look bent or whatever you are looking at may look smaller or further away.

Skin changes

Some of the skin changes might include:

• rashes, spots or lumps

• thinning of the skin

• bruising

• stretch marks

• redness and inflammation

• changes in skin colour such as areas becoming lighter or darker

• itching

• seeing small blood vessels on the skin also known as spider veins

Wounds might take longer to heal than usual.

Weaker bones

You might have weaker bones due to bone loss (osteoporosis). This can increase your risk of breaking (fracturing) bones.

Dizziness and loss of balance (vertigo)

You might feel dizzy and you may feel as though the room is spinning. This is vertigo. Let your doctor or nurse know if this happens.

Increased numbers of white blood cells

Steroids can increase the number of white blood cells in your blood. Your doctor might see this on a full blood count test.

Hair changes

You might have more body hair than usual. Your head hair may thin. This is usually not noticeable by other people but can be upsetting.

Heart problems

Your heart might not be able to pump the blood properly (heart failure). Symptoms can include swollen ankles, difficulty in breathing, palpitations, irregular, fast or slow heartbeat.

Steroids can cause severe heart problems such as a heart attack or a tear in the heart muscle after a recent heart attack.

Muscle and joint problems

You may have aches and pains in your muscles and joints.

You might get muscle cramps, spasms or stiffness. You may feel weaker and lack strength. So for example walking or climbing stairs may be more difficult.

Steroids can cause damage to the nerves which can cause loss of sensation in your foot and ankle. Because of this you can develop breaks or damage to your joints in these areas.

Some people develop a condition that causes your muscles to breakdown. This is called rhabdomyolysis. This can be serious if not treated quickly. Symptoms include muscle pain or weakness, dark urine, tiredness, dehydration and confusion.

Growth problems in babies, children and teenagers

Steroids might cause growth problems in babies, children and teenagers. Your child’s doctor will look at the benefits and risks of prescribing high doses of steroids for your child.

Changes to salt levels in your blood

You might have a high level of sodium in the blood. Or a low level of potassium in the blood is called hypokalaemia. You have blood tests during cancer treatment to check your salt levels.

Burning or tingling around your bottom

You might have a burning or tingling sensation around your genitals or bottom during a steroid injection into a vein. It usually goes once the injection finishes. Your nurse will give the injection slowly to try and prevent this.

Epilepsy becoming worse

If you have epilepsy this could become worse when taking steroids.

Inflammation of the pancreas

This drug can cause inflammation of the pancreas (pancreatitis). Tell your doctor straight away if you have sudden and severe pain in your abdomen. Other symptoms can include feeling or being sick, a high temperature or diarrhoea.

Changes to your periods

Women might have irregular periods, or they stop altogether (amenorrhoea).

Hiccups

You might get the hiccups with steroids.

Seizures (fits)

Tell your doctor if you have any fits, twitching or jerking of your limbs.

Kaposi's sarcoma

A cancer of the cells that line the walls of the blood vessels (endothelial cells). Tumours can develop on the skin, in the mouth, lymph nodes and internal organs such as the lung, liver and spleen.

It usually goes away if steroids are stopped.

Allergic reaction

Some people have an allergic reaction while having steroid treatment. Symptoms can include a rash, shortness of breath, redness or swelling of the face, feeling hot, dizziness, and a sudden need to pass urine.

Tell your doctor or nurse immediately if you have any of these symptoms or feel unwell at all while you are having the treatment or shortly afterwards.

What else do you need to know?

Pregnancy and contraception

This treatment might harm a baby developing in the womb. Talk to your doctor or nurse about effective contraception before starting your cancer treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding

There is evidence that steroid drugs may come through into your breast milk. Talk about breastfeeding with your doctor. You can make a decision together based on the benefits to you and the possible risks to your baby.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention that you are taking steroids. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You might be able to have other vaccinations if you have had:

• small doses of steroids for a short period of time (less than 2 weeks)

• local steroid treatment, such as eye drops or creams

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened.