How to Take Oral Steroids

What are oral steroids?

Oral steroids (corticosteroids) are prescription pills that reduce inflammation throughout the body. Common examples are prednisone, prednisolone, methylprednisolone (Medrol, often as a 6-day dose pack) and dexamethasone. They are related to cortisol, a hormone your body makes on its own.

They are not the anabolic steroids some people misuse to build muscle. They are also different from a steroid nasal spray or a budesonide sinus rinse, which work mainly where they are applied, with very little reaching the rest of the body.

Why did we prescribe them?

We use short courses, usually a few days to a few weeks, when swelling or inflammation needs to come down quickly. Common reasons include:

• Nasal polyps. Steroid pills shrink polyps and improve congestion and smell within days, but the benefit fades over the following months. That is why we pair them with longer-term care, such as a steroid spray or rinse, or a biologic medicine.
• After sinus surgery for nasal polyps, to calm swelling while the sinuses heal.
• Sudden hearing loss in one ear, ideally started within 2 weeks. See sudden hearing loss in one ear.
• Other severe swelling, such as a bad allergic flare or swelling in the throat or voice box, when other treatments are not enough.

How do I take them?

1. Follow your label or dose pack

   Many courses are a taper: the dose goes down a step every day or every few days. If you have a dose pack, such as a Medrol Dosepak, start with day 1 and take the pills in the order printed on the card. Mark off each dose so you do not lose your place.

2. Take them in the morning, with food

   If your label says once a day, take the whole dose with breakfast. Food protects your stomach, and a morning dose is less likely to keep you awake. If your label spreads the doses through the day, follow the times on the label and take each one with food or a snack.

3. Finish the course

   Keep taking them exactly as prescribed, even after you feel better. Stopping a higher dose suddenly can cause its own symptoms. If you want or need to stop early, call us first.

4. If you miss a dose

   Take it as soon as you remember. If it is almost time for your next dose, skip the missed one and go on as scheduled. Do not take two doses to catch up.

5. Tell us what else you take

   Including other prescriptions, supplements and herbal products. Ask us before taking ibuprofen (Advil, Motrin) or naproxen (Aleve) along with your steroid, especially if you have had a stomach ulcer. Acetaminophen (Tylenol) is fine for aches or pain.

What side effects do steroid pills cause?

Many people have no side effects from a short course of prednisone or another steroid pill. When they happen, they usually go away within a few days after the last dose. What helps:

Are there serious risks?

Serious problems are uncommon with a short course, but they are not zero. In the month after starting a short course of steroid pills, the chance of a serious infection, a blood clot or a broken bone is higher than usual, then falls again. That is why we prescribe them only when the benefit is worth it, at the lowest dose and for the shortest time that works.

Repeated or long courses carry more risk, including thinner bones, cataracts and glaucoma, and changes in the body’s own hormone production. If you have needed more than 2 courses in a year, tell us, so we can talk about other ways to keep the inflammation under control.

Who should talk to us first?

Tell us before you start if you have:

• Diabetes
• High blood pressure or heart failure
• Glaucoma or cataracts
• Osteoporosis
• A stomach ulcer or gastritis
• Depression, bipolar disorder or another mental health condition
• Tuberculosis, now or in the past, or a current infection
• Pregnancy, plans to become pregnant, or breastfeeding

Steroids may still be the right choice, but we may change the dose, plan extra checks such as watching your blood sugar, or choose another treatment.

When should I call?