Corticosteroids given for a long time

What are corticosteroids?

A corticosteroid medicine is a steroid hormone that may be used to treat many different problems or conditions. Corticosteroid medicines are not the same type of steroids that some athletes use to make them better in sports. Your child's body naturally makes corticosteroids, but in smaller amounts than are given as medicine.

Corticosteroids may be used to treat problems caused by inflammation (e.g., Crohn's disease, asthma, allergic reactions) and to decrease the body's immune response (after an organ or bone marrow transplant). Corticosteroids are also used in the treatment of some cancers. These drugs may also help prevent problems such as allergic reactions or nausea caused by some cancer medicines.

You may hear corticosteroids called steroids or by one of their brand names such as Solu-Cortef, Solu-Medrol, Depo-Medrol, Pediapred, or Decadron. Corticosteroids come in tablet, liquid, and injection forms.

Before giving corticosteroids to your child

Tell your doctor if your child has ever reacted badly to a steroid or any other medication.

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• infection or recent exposure to infection (such as chickenpox)
• diabetes or problems with blood sugar
• stomach or intestine problems
• eye problems such as glaucoma
  
• any heart, kidney, or liver problems
• high blood pressure
• bone problems such as bone weakening or thinning
• behaviour problems

How should you give your child corticosteroids?

Your child may receive corticosteroids by a needle from a nurse or by liquid or tablets that they swallow. If your child is getting corticosteroids by mouth:

• Give your child corticosteroids exactly as the doctor or pharmacist told you to do, even if your child seems better.
• Talk to your child's doctor before you stop giving this medicine for any reason. Your doctor may want to gradually reduce the amount your child gets before completely stopping the medicine.
• Give your child corticosteroids at the same time each day. Give in the morning if your child is taking only one dose per day.
• Have your child take corticosteroids with food or milk to prevent them from getting an upset stomach.
• If your child is not able to swallow the tablets whole, speak to your pharmacist about other options.
• Shake the bottle well before you give your child the medicine. Measure the dose with the special spoon or oral syringe that the pharmacist gives you.

What should you do if your child misses a dose of corticosteroids?

If your child takes this medicine once a day:

• Give the missed dose as soon as you remember if it is the same day as the missed dose. If you do not remember until the next day, skip the missed dose and return to the normal dose times.

If your child takes this medicine more than once a day:

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, it is fine to give two doses together unless your doctor has told you otherwise.
• Give the missed dose, then the regularly scheduled dose, and then go back to your usual schedule.

What are the possible side effects of corticosteroids?

The risk of side effects with corticosteroids depends on how long your child has treatment with corticosteroids, how often your child takes corticosteroids, and how big a dose your child needs to take.

Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• increased appetite
• weight gain
• indigestion (heartburn)
• trouble sleeping
• nervousness or changes in mood
• nausea (upset stomach) or vomiting (throwing up)
• headache
• filling or rounding out of the face (called moon faces)
• acne
• increase in hair growth
• stretch marks on skin
• unusual tiredness or weakness
• changes in eyesight
• slowing of growth

Call your child's doctor during office hours if your child has any of these side effects:

• signs of infection (e.g. fever, chills, sore throat, cough)
• frequent need to pass urine
• more thirsty than usual
• muscle weakness or pain
• pain in back, ribs, arms, legs, hip, or shoulder
• swelling of the feet or lower legs
• redness, pain, swelling, or sores on any area of the body
• stomach or throat pain or burning
• for girls, changes in menstrual periods
• for children with diabetes, uncontrolled blood sugars

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• pain or burning when urinating
• black, tarry stools, or blood in stools
• vomiting blood or material that looks like coffee grounds

For injections:

• burning, numbness, pain, or tingling at or near injection site
• hives (raised, red bumps on skin)
• shortness of breath, trouble breathing or wheezing
• swelling of face or eyes
• tightness in chest
• flushing of face or cheeks
• seizures

If your child has been taking steroids for an extended period, the doctor may tell you to slowly reduce the amount of steroids over a period of time before stopping. This is called tapering. If you taper too fast, or stop altogether, your child may show some signs of withdrawal syndrome. Call your child's doctor if your child has any of these signs:

• frequent or unexplained headaches that do not go away
• low-grade fever
• muscle or joint pain
• nausea
• prolonged loss of appetite
• rapid weight loss
• reappearance of disease symptoms
• shortness of breath
• unusual tiredness or weakness

What safety measures should you take when your child is using corticosteroids?

Check with your doctor if your child's condition reappears or gets worse when the dose has been lowered or when treatment has stopped.

Your doctor should check your child's progress at regular visits. Also, your child's progress may have to be checked after stopping corticosteroids since some of the effects may continue.

Tell the doctor or dentist that your child is getting corticosteroids and after your child stops taking corticosteroids:

• before having skin tests
• before having any kind of surgery (including dental surgery) or emergency treatment
• if your child gets sick or hurt

If your child will be using corticosteroids for a long time (more than three months):

• Your doctor may suggest changing your child's diet.
• Your doctor may have your child take a medicine to help prevent bone problems while getting a corticosteroid.
• Your doctor may want your child to have their eyes checked by an ophthalmologist (eye doctor) before, and also sometime later during treatment.
• Your doctor may want your child to carry a medical identification card stating that your child is using this medicine.

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with steroids. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine.

While your child is getting this medicine and for some time after stopping treatment, your child may not be able to fight infection well. Corticosteroids may also mask or hide some of the usual symptoms of infection. Your child can take the following precautions to prevent infections:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are very crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse, or dentist may suggest different ways to clean your child's mouth and teeth.
• You or child your child should not touch your child's eyes or inside their nose without washing you/your child's hands first.
• Your child's nurse will review with you what to do in case of fever.

There are some medicines that should not be taken together with corticosteroids or in some cases the dose of corticosteroids or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medications (prescription, over the counter, or herbal) including: cyclosporine, antifungals (including ketoconazole), medicines used to control epilepsy, and some antibiotics.

What other important information should you know about corticosteroids?

• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Make sure you always have enough corticosteroids to last through weekends, holidays, and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Keep corticosteroid tablets at room temperature in a cool, dry place away from sunlight. Do NOT store in the bathroom or kitchen.
• Check with your pharmacist how to store corticosteroid liquid. Storage will depend on the type of corticosteroid your child is taking.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep corticosteroids out of your child’s sight and reach and locked up in a safe place. If your child takes too much corticosteroids, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.