What are steroids?
Steroids are hormones produced by the adrenal glands that are used to reduce brain
swelling. Steroids belong to a class of drugs called corticosteroids. The steroids used to
treat brain tumors are not the same as those used by athletes. The most common steroid is
Dexamethasone (Decadron). Prednisone may also be used.
When are steroids used?
Steroids are used when a person is having symptoms of brain edema. Steroids can be
- Before, during, or after surgery.
- During or after radiation therapy.
- During or after chemotherapy.
- When edema is noted on an MRI scan, even if the person is not having symptoms.
How are steroids given?
Steroids can be given through an IV (intravenous) line, into a muscle (IM), or as a pill
(oral). Most brain tumor patients will take their steroids as a pill. Your doctor will order
your dose based either on your symptoms or the amount of edema present on the MRI
scan. The dose will be adjusted up or down. This depends on how your body responds.
Steroids should always be taken with food to protect your stomach. Your doctor may
also prescribe a medicine (Ranitidine® or Zantac®) to protect your stomach. Steroids
can also affect the normal bacteria in your mouth, making you more likely to have a yeast
infection called “thrush”. Therefore, your doctor may also prescribe a medicine to
prevent the yeast infection. Mycelex® troches or Nystatin® are often prescribed.
Over time your doctor will try to decrease your steroid dose. Sometimes this is very easy
to do, and other times it is a very slow process. Don’t be surprised if your steroids dose
needs to be increased along the way. The brain is very sensitive to edema. Your doctor
will work on finding the lowest dose of steroids to keep the symptoms of brain edema to
Never stop your steroids without talking to your doctor. Steroids must be decreased
slowly over time or “tapered”. The longer you are on the steroids, the slower this taper
What are the side effects of steroids, and how do I manage them? Although steroids cause a range of side effects, the benefits usually outweigh the side
effects. If you have questions about the use of steroids, please talk with your doctor or
Weight gain/increased hunger
- After a few weeks or months on steroids, many people notice weight gain
and a fullness or puffiness in their face or neck and the upper part of their
- Although steroids increase appetite, the weight gain most people see is
related to the way the body processes and stores fats.
- To deal with the weight gain: - avoid empty calories such as candy,
cookies, sweets, and sodas. Try to eat fruits and vegetables.
- If you have questions or concerns about a diet, talk with your doctor or
nurse, or ask to speak with a dietician.
- Since steroids can increase the acid in your stomach, steroids should
always be taken with food. A medicine to protect your stomach may be
- Avoid non-steroidal anti-inflammatory drugs (NSAIDs, Motrin®, Advil®,
Aleve®, and aspirin).
- If you have stomach pains, notice blood in your stool, or become
constipated, call your doctor.
Increased blood sugar levels
- If you have diabetes, steroids can increase blood sugar levels. Call your
diabetes doctor to have your blood sugar levels followed more closely.
Steroids may mean your diabetes medicines need to be adjusted. You
may also need to watch your diet more closely.
- If you do not have diabetes, your body will usually adjust to the increased
blood sugar levels. If you notice you are drinking and urinating a lot, call
your doctor. This may be an early sign of increased blood sugar levels.
Muscle weakness in thighs, hips, and shoulders
- Muscle weakness from steroids can be seen when you try to get out of a
chair, up from the toilet, climb a set of stairs, or walk a long distance.
- Steroids weaken the large muscles of the hips, thighs, and shoulders.
- Safety should always be of primary concern. You should walk with others
if there is a risk of stumbling or falling. Grab bars may be installed in the
bathroom near the toilet or tub. If you require devices, such as a walker,
cane, or wheelchair, please discuss this with your doctor or nurse.
- Exercises that focus on the hip and thigh muscles are available. Please ask
your nurse for a copy if you are interested.
- Some people are able to do these exercises at home and maintain leg
strength, while others may need the help of physical therapy (PT) or
occupational therapy (OT). These services may be covered by your
insurance plan. Please discuss these issues with your health care team.
Increased risk of infections
- Increased risk of infections
o Steroids can “mask” the early signs of an infection. Be alert for subtle
signs of infections, especially in the mouth.
- You can notice a yeast infection in your mouth called “thrush”. Your
doctor may prescribe medicines to help prevent thrush. Even if you take
the medicines as directed, you can still get thrush. If you notice a “white”
coating on your tongue, food develops a foul or metallic taste, or you
notice bad breath, call your doctor.
- Good oral care is important. Look at your tongue each time you brush
Insomnia or trouble sleeping
- Trouble sleeping is a common side effect of steroids. Some people
combat this by taking their steroids earlier in the day. If you are taking
steroids four times a day, this may not be possible.
- If insomnia is an issue for you, discuss this with your doctor.
Depression, mood changes, or agitation
- While taking steroids, you may have any or all of these symptoms due to
the effect on hormone levels.
- Discuss these symptoms with your doctor. Sometimes the steroid can be
changed or other medicines prescribed to deal with these symptoms.
Thinning of skin or changes in your skin
- You may notice the skin appears “thinner”, stretch marks on the abdomen,
or small red “dots” on the arms.
- Avoid exposure to sun. Try to minimize weight gain. Avoid activities
where the skin may get rubbed or torn.
Interaction with other medicines
- Talk with your health care team (oncologists, primary care doctors and
nurses, and pharmacists) about all of the medicines you take. To avoid
drug interactions, be sure to include over-the-counter drugs, herbals, and
vitamins on your medication list.
- Avoid non-steroidal anti-inflammatory drugs (NSAIDs, Motrin®, Advil®,
Aleve®, and aspirin) while taking steroids.
The information provided should not be used during any medical emergency or
for the diagnosis or treatment of any medical condition. A licensed physician
should be consulted for diagnosis and treatment of any and all medical conditions.
Call 911 for all medical emergencies. Any duplication or distribution of the
information contained herein is strictly prohibited
What is cortisone?
Cortisone is a type of steroid that is produced naturally by a gland in your body called the
adrenal gland. Cortisone is released from the adrenal gland when your body is under
stress. Natural cortisone is released into the blood stream and is relatively short-acting.
Injectable cortisone is synthetically produced and has many different trade names (e.g.
Celestone, Kenalog, etc.), but is a close derivative of your body's own product. The most
significant differences are that synthetic cortisone is not injected into the blood stream,
but into a particular area of inflammation. Also, the synthetic cortisone is designed to act
more potently and for a longer period of time (days instead of minutes).
How does the cortisone injection help?
Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving
medication, it only treats the inflammation. When pain is decreased from cortisone it is
because the inflammation is diminished. By injecting the cortisone into a particular area
of inflammation, very high concentrations of the medication can be given while keeping
potential side-effects to a minimum.
Seroids: are there safe & effective alternatives?
Doctors tell you that steroids (cortisone, prednisone) only cause side effects after
many years. But new research shows that permanent damage is immediate and
devastating. Studies show that steroids can cause permanent, debilitating effects
after a single dosage.
"...the treatment of a patient with prednisone at 60 mg per day for about
three months can actually cause AIDS. This treatment and doses often
given to patients suffering from lung fibrosis, thrombocytopenia, or other
chemically induced chronic illnesses." "...AIDS is caused by the heavy use
of corticosteroids and/or cytotoxic drugs to treat many health problems.
Fauci described in detail the effects of corticosteroids on the immune
system. These effects resemble the immune abnormalities that are found in
patients suffering from AIDS or Idiopathic CD4 T cells lymphocytopnea
(ICL) which are also described by Fauci et al" Dr. Mercola
Steroids The Sleaziest of Drugs
Steroids are fast catching up with antibiotics as the most abused class of drugs in your
doctor's black bag. There's no doubt that the discovery of steroids a half century ago was
a major advance in medicine-a life-saver for those like the late President John F
Kennedy, who suffered from Addison's disease, a disease of the adrenal glands causing
insufficient hormone production. Steroids mimic the action of the adrenal glands, the
body's most powerful regulator of general metabolism. John Stirling, director of the
vitamin company Biocare, credits a very short course (three injections) of steroids with
jump-starting his failing adrenal system after anaphylactic shock and saving his life. The
problem is, like antibiotics, steroids appear to be a miracle 'cure'. Patients with crippling
arthritis or asthma seem to be instantly better on steroids.The wheeze, the swelling, the
pain go away. So doctors turn to steroids as the first, rather than last, line of attack for
their anti-inflammatory and anti-allergic effects.
As with antibiotics, what was once reserved for the extreme emergency is now being
used on the most trivial of conditions. Steroids are now handed out as readily as
antibiotics, even to babies, at the first sign of inflammation of any sort. The latest drug set
to replace gripe water for babies with croup is a steroid (budesonide); hydrocortisone is
included in the latest over-the-counter medication for piles. Steroids make up many OTC
skin drugs, and are considered the drug of choice for asthma, eczema, arthritis, back
problems, bowel problems like ulcerative colitis-indeed, for any and all inflammations or
allergic reactions and new uses are still being invented. The sole exceptionis Addison's
Disease, where steroids act as a replacement therapy of cortisone, much as insulin is
given to diabetics.
Far from being a wonder drug 'cure all', steroids cannot cure one single condition. All
they do is suppress your body's ability to express a normal response. In a few instances,
this type of suppression will give the body a chance to heal itself. But more often, the
effect is immediate, devastating and permanent damage. And we are only now realizing
just how quickly damage can occur. Despite what doctors say, that steroids only have
side effects after many years of use, there is no such thing as a safe dose.
Studies show that steroids cause permanent, debilitating effects after a single dosage.
With long-term use, some of the more common side effects of steroids include changes
in appearance, such as acne, development of a round or moon-shaped face and an
increased appetite leading to weight gain. Steroids may also cause a redistribution of
fat, leading to a swollen face and abdomen, but thin arms and legs. In some cases, the
skin becomes more fragile, which leads to easy bruising. These take weeks to begin
Psychological side effects of steroids include irritability, agitation, euphoria or
depression. Insomnia can also be a side effect. These changes in appearance and mood
are often more apparent with high doses of steroids, and may begin within days. Injected
Triamcinalone (see above), or oral dexamethasone seem to cause these changes less, but
as they stay in the body an undesirably long time, rendering them second choices.
An increase in susceptibility to infections may occur with very high doses of steroids.
Prednisone may also aggravate diabetes, glaucoma, and high blood pressure, and
often increases cholesterol and triglyceride levels in the blood. In children, steroids
can suppress growth. These effects are reversed once the steroids are stopped.
Long-term damage: quick and dirty
Steroids don't take years to damage your system, as doctors maintain. Permanent,
crippling damage can occur weeks after you've begun treatment.
- Osteoporosis can occur within a matter of months. Steroids cause 8 per
cent reduction in bone mass after four months (Ann Int Med, November
15, 1993), the equivalent of the effect on your bones of having your
ovaries removed. Even low doses of inhaled steroids (400 micrograms per
day) reduce bone formation (The Lancet, July 6, 1991).
- Low doses (10-15 mg prednisone) for a year can cause cataracts (Surv
Ophthalmol, 1986; 31: 260-2).
- Topical steroids may begin to cause eye damage or raise pressure after
two weeks. Extensive visual loss can be caused by a 1 per cent
hydrocortisone ointment, which is available OTC (BMJ, August 20-27,
- Rub-on steroids have caused Cushing's syndrome in children as soon as a
month after treatment has begun (Arch Dis Child, 1982; 57: 204-7).
- Inhaled steroids slowth growth in children after six weeks (Acta Ped,
1993; 82: 636-40. See also, The Lancet, December 14, 1991).
Side effects that may be caused by the long-term use of steroids include cataracts,
muscle weakness, avascular necrosis of bone and osteoporosis. These usually do not
occur with less than four weeks of treatment.
Avascular necrosis of bone, usually associated with high doses of prednisone over long
periods of time, produces hip pain and an abnormal MRI scan. It occurs most often in
the hip, but it can also affect the shoulders, knees and other joints. Caught early, the joint
can be saved by "decompression" by an orthopedic surgeon. Once full developed,
Avascular necrosis is painful and often requires surgical joint replacement for pain relief.
Steroids reduce calcium absorption through the gastrointestinal tract which may result
in osteoporosis, or thinning of the bones. Osteoporosis can lead to bone fractures,
especially compression fractures of the vertebrae, causing severe back pain. Calcium, at
least 1500 mg of the calcium carbonate form or equivalent, should be taken. There are
new medications (Fosamax in particular) that also may help to prevent osteoporosis.
There is also a relationship between steroids and premature arteriosclerosis, which is a
narrowing of the blood vessels by fat (cholesterol) deposits. In general, there is a close
relationship between the side effects of steroids and the dose and duration of their use.
Thus, a high dose of steroids given over a long period of time is more likely to cause side
effects than a lower dosage given over a shorter period of time.
"Furthermore, my investigation revealed that the majority of AIDS patients suffer from
metabolic and endocrine abnormalities . The high prevalence of adrenal insufficiency
observed among AIDS patients provides strong evidence that AIDS in these patients is
caused by the use of corticosteroids" Mohammed Ali Al-Bayati Ph.D. Toxicologist, and
Pathologist Toxi-Health International, 150 Bloom Dr., Dixon, California 95620, USA
"Dr. Al-Bayati, discovered that the steroid treatments, Prednisone and Azathioprine
had completely destroyed my immune system and were the culprits that were not
allowing my bodily systems to repair themselves. In essence my HMO gave me the
appearance of medication induced "Aids." Larry J. Boyd, Suisun City, California
Topical corticosteroids are often prescribed intermittently for short-term reactive
treatment of acute flares and supplemented by emollients. Reactive treatment with
corticosteroids offers rapid and effective symptomatic relief for acute flares. However,
there are considerable safety concerns associated with their use, particularly when they
are applied continuously. Potential adverse events are primarily cutaneous (principally
skin atrophy, but also telangiectasia, hypopigmentation, steroid acne, increased hair
growth and rosacea-like eruptions), but there may be systemic effects (suppression of
the hypothalamicpituitary- adrenal (HPA) axis, growth retardation, increased risk of
glaucoma cataract and Cushing’s syndrome).16–20