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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Methylprednisolone (Medrol, Solu-Medrol), prednisone (Deltasone, Orasone), and prednisolone (Pediapred) may need to be prescribed when inhaled medications fail to control asthma. Examples of such situations include after an acute asthma attack or when a respiratory infection or allergy aggravates asthma symptoms.

How corticosteroids work

Corticosteroids decrease the inflammation within the airway passages that contributes to asthma symptoms and acute attacks.

Who should not use these medications

• Individuals who are allergic to corticosteroids should not use these drugs.



• Individuals with systemic fungal infections or active tuberculosis should not use these drugs without medical supervision.

Use

• Dosage varies depending on the situation for which corticosteroids are being used.



• Corticosteroids may be given as an intravenous (IV) injection for an acute asthma attack in the emergency room.



• The frequency of initial oral use may be as often as three to four times per day for one to two days following an acute asthma attack, which is then slowly decreased over one week.



• When corticosteroids are taken regularly, they should be taken once daily upon awakening (usually in the morning) to coincide with your body's normal biological rhythm. The smallest possible dose should be given to avoid long-term side effects. Some individuals can control their asthma symptoms with every-other-day dosing.



• Your doctor may try other medications to control your asthma to avoid long-term use of oral corticosteroids.



• Take these drugs with food or milk to avoid stomach upset.

Drug or food interactions

Use caution with other drugs that suppress the immune system, such as cyclosporine (Sandimmune, Neoral). Phenobarbital (Luminol), phenytoin (Dilantin), or rifampin (Rifadin) may decrease the effectiveness of corticosteroids. Some drugs, such as ketoconazole (Nizoral) or erythromycin (E-Mycin, E.E.S.), may increase blood levels and toxicity of corticosteroids. An increased risk of stomach bleeding (bleeding ulcer) may occur when taken with high-dose aspirin or with blood thinners such as warfarin (Coumadin). Corticosteroids tend to increase blood glucose levels in individuals with diabetes, so diabetic therapy, such as insulin or oral medicines, may need to be adjusted. Talk to your doctor or pharmacist before taking other medications with oral corticosteroids.

Side effects

Do not suddenly stop taking oral corticosteroids if you have used them for more than a week. Doses must be gradually decreased with precise directions from your doctor. These drugs may decrease growth in children, so the lowest dose possible must be used. Long-term use may cause mood changes, osteoporosis, sleep irregularities, increased hair growth, cataracts, increased eye pressures (risk for glaucoma), roundness of the face, or thinning skin. Call your doctor if you experience any of the following:

• Itching or hives, swollen face or hands, chest tightness, breathing troubles, tingling in mouth or throat



• Headache, eye pain, or visual troubles



• Increased urination or thirst



• Seizures or dizziness



• Stomach problems, stomach pain, bloody or black stools



• Sudden pain, swelling, or loss of movement in the lower leg



• Sudden fluid retention or weight gain

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