Corticosteroid drugs (also known as glucocorticoids) act like the naturally occurring adrenal hormone cortisone in the body. They are strong anti-inflammatory and immune-suppressant medications used in many inflammatory and autoimmune conditions, such as rheumatoid arthritis , asthma , inflammatory bowel disease , and systemic lupus erythematosus . Corticosteroids are also prescribed to suppress transplant rejection.
Drugs in this family include:
- Betamethasone (Celestone)
- Cortisone acetate (Cortone Acetate)
- Dexamethasone (Decadron, Dexameth, Dexone, Hexadrol)
- Hydrocortisone (Cortef, Hydrocortone)
- Methylprednisolone (Medrol)
- Prednisolone (Delta-Cortef, Pediapred, Prelone)
- Prednisone (Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred DS)
- Triamcinolone (Aristocort, Atolone, Kenacort)
- And others
One of the most serious side effects of long-term corticosteroid use is accelerated osteoporosis. Although we don't fully understand how this works, corticosteroid interference with calcium and vitamin D is known to play a major role.
Calcium and vitamin D supplements are definitely beneficial for fighting ordinary osteoporosis ; in addition, there is good evidence that they also protect against osteoporosis brought on by corticosteroids. 1 A review of 5 trials enrolling a total of 274 participants found that calcium and vitamin D supplementation significantly prevented bone loss at the lumbar spine and forearm in corticosteroid-treated individuals. 2 For example, in a 2-year double-blind placebo-controlled study of 130 individuals, supplementation with 1,000 mg of calcium and 500 IU of vitamin D daily actually reversed steroid-induced bone loss, causing a net bone gain. 3
Aloe and licorice are two herbs sometimes used topically for skin problems. Preliminary evidence suggests that each one might help topical corticosteroids, such as hydrocortisone, work better. 4,5
There are theoretical reasons (but little direct evidence) to believe that individuals taking corticosteroids, such as prednisone, might be protected from some side effects by taking DHEA at the same time. 9,10
Long-term, high-dose corticosteroid treatment can cause diabetes. This may be at least partly caused by chromium deficiency. A very preliminary study found treatment with corticosteroids caused increased loss of chromium in the urine. 11 Another preliminary study found that individuals with corticosteroid-induced diabetes could improve blood sugar control by taking chromium supplements. 12
Long-term use of corticosteroids, whether orally, or possibly, by inhalation, can slow a child’s growth. One animal study suggests that use of the supplement creatine may help prevent this side effect. 15
The supplement ipriflavone is used to treat osteoporosis. A 3-year, double-blind trial of almost 500 women, as well as a small study, found worrisome evidence that ipriflavone can reduce white blood cell count in some people. 13,14 For this reason, anyone taking medications that suppress the immune system should avoid using ipriflavone except under physician supervision.
When taken by mouth, the herb licorice appears to enhance some actions of oral corticosteroids, but interfere with others. 6-8 Because of the unpredictable nature of this interaction, individuals using oral corticosteroids should avoid licorice.
References
REF1 Reid IR and Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr. 1986;44:287-290.
REF2 Homik J, Suarez-Almazor ME, Shea B, et al. Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Database Syst Rev. 1998;(1). DOI: 10.1002/14651858.CD000952.
REF3 Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D 3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 125: 961-968, 1996.
REF4 Davis RH, Parker WL, and Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc. 1991;81:1-9.
REF5 Teelucksingh S, Mackie ADR, Burt D, et al. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet. 1990;335:1060-1063.
REF6 Tamura Y, Nishikawa T, Yamada K, et al. Effects of glycyrrhetinic acid and its derivatives on delta-4-5-alpha- and 5-beta-reductase in rat liver. Arzneimittelforschung. 1979;29:647-649.
REF7 Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Endocrinol Jpn. 1190;37:331-341.
REF8 Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on thymolytic and immunosuppressive action of cortisone. Endocrinol Jpn. 1967;14:39-42.
REF9 Robinzon B and Cutulo M. Should dehydroepiandrosterone replacement therapy be provided with glucocorticoids? Rheumatology. 1999;38:488-495.
REF10 van Vollenhoven RF, Park JL, Genovese MC, et al. A double-blind, placebo-controlled, clinical trial of dehydroepianodrosterone in severe systemic lupus erythematosus. Lupus. 1999;8:181-187.
REF11 Ravina A, Slezak L, Mirsky N, et al. Reversal of corticosteroid-induced diabetes mellitis with supplemental chromium. Diabet Med. 1999;16:164-167.
REF12 Ravina A, Slezak L, Mirsky N, et al. Control of steroid-induced diabetes with supplemental chromium. J Trace Elem Exp Med. 1999;12:375-378.
REF13 Agnusdei D and Bufalino L. Efficacy of ipriflavone in established osteoporosis and long-term safety. Calcif Tissue Int. 1997;61(suppl 1):S23-S27.
REF14 Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA. 2001;285:1482-1488.
REF15 Roy BD, Bourgeois JM, Mahoney DJ, et al. Dietary supplementation with creatine monohydrate prevents corticosteroid-induced attenuation of growth in young rats. Can J Physiol Pharmacol . 2002;80:1008-1014.