Corticosteroids are powerful medications used in short-term and long-term treatment of many conditions. They are used systemically, topically and locally. Systemic use is by either ingesting the medication orally or having it injected intravenously or less commonly by intramuscular injection. Topically is when the drug is used as a cream, ointment or lotion, or is inhaled or used as a nasal spray to treat lung or nasal conditions. Local use is when the medication is injected directly into or near the area it is needed, like in tendonitis or bursitis as well as in epidural injections for back or neck problems.
Some patients are poor candidates for corticosteroid systemic or locally injected corticosteroid therapy because of conditions that may be made worse by the drugs. The most common of these are discussed in this article:
- Diabetes: These drugs are called glucocorticoids because of their effect on blood sugar. Use of systemic or locally injected glucocorticoids like prednisone causes a rise in blood sugar levels. This can be in patients with known diabetes or in patients with pre-diabetes. It is not uncommon in hospitalized patients to find quite high blood sugars in people not previously diagnosed with diabetes when they are getting high dose prednisone as therapy. This can sometimes require insulin therapy. In general physicians tend to try to avoid systemic use of glucocorticoids in patients with diabetes.
- Tuberculosis: Latent TB, namely a positive skin test for TB, even in patients who have received a course of therapy with anti-tubercular drugs, can lead to reactivation of the TB, and is a strong contraindication to systemic therapy.
- Psychiatric disease: A common side effect of high dose systemic corticosteroid therapy is some degree of anxiety, insomnia and in children hyperactivity. More serious psychosis and severe depression are less common but do occur more often in patients with prior serious psychiatric problems.
Other less common reasons to be cautious in taking or prescribing corticosteroids include previous adverse effects of these drugs and acid dyspeptic stomach problems.