Cortisone side effects

Since cortisone as a drug only works in doses that are above the natural hormone level, the body reacts to the hormone excess. The side effects are therefore quasi-normal reactions to the corticoid stimuli – since these are increased, the effects are also increased. Side effects occur mainly with long-term treatment, while short-term use is rarely problematic.

Desirable effects of cortisone treatment

Some of the side effects are sometimes also desired effects: The suppression of the immune system (immunosuppression) can be intentional, for example in the therapy of the excessive defense in the context of an allergic reaction, but it can also be a serious side effect that leads to an increased susceptibility to infection.

Typical side effects of cortisone

Undesirable side effects  as a result of direct hormone action are:

• the so-called  Cushing’s syndrome  with full moon face, bull neck, facial redness and brittle skin vessels
• rise in blood pressure
• blood sugar increase
• increase in blood lipid levels
• increased susceptibility to infection
• weight gain
• water retention in the tissue
• Osteoporosis : While cortisone doesn’t seem to be the sole trigger, it can increase the risk if you’re prone to it. It is therefore necessary to determine the risk of osteoporosis ( bone density measurement ) before prolonged cortisone therapy and, if necessary,  to initiate preventive measures such as calcium supplements or the intake of  vitamin D  and  fluoride .

Cortisone influences the control circuit of the hormones

Another group of side effects affects the regulatory circuit of the hormones. By supplying the glucocorticoid from the outside, the own hormone production falls asleep and can even lead to atrophy of the adrenal cortex.

This condition becomes problematic when the therapy is terminated because it takes some time before the patient’s own production gets going again. In stressful situations, such a patient is in danger because the adrenal cortex cannot provide the hormone in sufficient quantities quickly enough.

Conversely, a so-called  rebound effect  can occur – the increased recurrence of the symptoms of the disease if the drug is stopped too quickly instead of being gradually tapered off.

Guidelines for correct dosing

Die inzwischen gut erforschten Konsequenzen der Kortison-Therapie haben auch dazu geführt, dass das Medikament heute anders eingesetzt wird als noch zu Zeiten seiner Entdeckung. Die Dosierung richtet sich dabei nach der Schwere des individuellen Krankheitsbildes und der Reaktion des Patienten.

Akute Erkrankungen werden in der Regel nur kurzfristig, chronische Erkrankungen meist langfristig therapiert. Dabei bemüht man sich, chronisch Kranken mit der kleinsten, eben noch wirksamen Dosis zu helfen.

Dieser Prozess ist langwierig und schwierig, weil man nach einer erfolgreichen Anfangsbehandlung mit einer relativ hohen Dosierung versucht, die Wirkstoff-Dosierung immer weiter zu verringern. Bei sehr niedrigen Dosierungen kann dieser Vorgang jedoch nur sehr langsam und in ganz kleinen Schritten vollzogen werden.

Auch auf den Patienten kommt es an

The aim is always to keep the undesirable side effects as low as possible. To achieve this, doctor and patient must work together. The patient should deal intensively with his cortisone treatment himself and get as much information as possible in order to actively participate in the therapy.

This includes, among other things, a low-salt, balanced diet in which low-fat dairy products as well as  fruit  and  vegetables  play an important role. Sport and exercise also contribute to fewer symptoms and side effects.