Side Effects of Injected and Oral Steroids

From Flushed Face to Obesity

Corticosteroids (steroid drugs) are often necessary and sometimes even life-saving treatments, but they can have short-term side effects. For instance, steroids can sometimes cause a flushed face for a few days. They also can lead to long-term side effects, some of them serious.

Steroids come in both topical (applied to the skin) and systemic forms. Systemic steroids are taken by mouth or injected, and are used for treating a wide range of diseases, like arthritis. "Systemic" means they affect the entire body, not just the skin, and can lead to broader complications.

This article explains why you might be prescribed a systemic steroid, what to know about short-term and long-term side effects, and how to manage them.

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What Are Systemic Steroids?

Systemic steroids are a synthetic (manufactured) version of cortisol, a hormone produced by the adrenal glands that plays many important roles in the body. Systemic steroids mimic the anti-inflammatory effects of cortisol.

Types of Systemic Steroids

Systemic steroids are also called glucocorticoids or cortisones. They include:

  • Prednisone
  • Prednisolone
  • Methylprednisolone
  • Beclomethasone
  • Betamethasone
  • Dexamethasone
  • Hydrocortisone
  • Triamcinolone

Prednisone is the most commonly prescribed oral steroid.

Steroids commonly given via an injection (sometimes called "cortisone shots") include triamcinolone, methylprednisolone, and betamethasone.

When Systemic Steroids Are Prescribed 

Systemic steroids are typically prescribed for diseases and conditions that cause inflammation in the body. Conditions that may be treated with oral steroids include:

Short term uses:

  • Allergic rhinitis
  • Acute bronchitis
  • Connective tissue and joint disorders
  • Asthma
  • Skin disorders (such as eczema)
  • Bell's palsy
  • Acute gout

Long-term uses:

Injectable steroids are used to relieve acute pain from low back pain, arthritis, cervical radiculopathy, bursitis, tendonitis, and carpal tunnel syndrome. They're typically given only three to four times a year.

Systemic Steroid Side Effects

Steroids can cause different side effects depending on how long they are used.

Short-Term Side Effects of Steroids

Side effects are usually temporary in people prescribed systemic steroids for short periods (a month or less). Most effects resolve within a few days after stopping the medication.

If you are otherwise healthy, the most common side effects you can expect are:

  • Insomnia
  • Changes in mood or behavior
  • Flushing of your face
  • Increased appetite
  • Short-term weight gain due to increased water retention

Certain underlying medical conditions can worsen when you take steroids. For example, your blood sugar levels can increase if you have type 2 diabetes.

Similarly, your blood pressure can become elevated if you already have high blood pressure. And if you have glaucoma, taking steroids might increase your eye pressure. You can also retain water if you have congestive heart failure.

Some studies suggest steroid injections are safe for pregnant people, but their use should be determined on a case-by-case basis.

Reports of facial flushing tend to happen more in people assigned female at birth. It's a short-term side effect that may last a few days, but it can occur again with future steroid injections.

Long-Term Side Effects of Steroids

If you use systemic steroids for a long period of time (more than three months) or take them on multiple occasions, you may experience more serious side effects. For this reason, healthcare providers tend to prescribe the lowest dose for the shortest period of time.

The risk of certain side effects may be reduced by taking a steroid every other day rather than daily, even if the total dose winds up being the same.

Side effects of long-term steroid use include:

  • Glaucoma
  • Cataracts
  • High blood pressure
  • Heart disease
  • Diabetes mellitus
  • Obesity
  • Osteoporosis
  • Redistribution of body fat
  • Myopathy
  • Increase in certain types of infections
  • Cushing syndrome

Long-term side effects often go away once you stop taking a steroid, but sometimes they can be permanent. 

Managing Side Effects

With most cases, the discomfort of a flushed face or other steroid side effects will pass within a few hours or days. You also can make lifestyle changes to reduce the impact of steroids on a flushed face, such as limiting alcohol use or avoiding smoking.

Contact your healthcare provider if, after a week, you still experience symptoms from your shot that include:

  • Fever
  • Pain (a "cortisone flare" of pain is not uncommon)
  • Swelling

Regardless of your overall health, it's important that you are closely monitored for long-term side effects if you are taking a systemic steroid.

Your blood pressure, weight, and blood sugar levels will be checked regularly. Because of the risk of osteoporosis, bone density scans are usually recommended for people who take steroids for three months or longer.

Sometimes a bisphosphonate drug such as Fosamax (alendronate) or Boniva (ibandronate) is prescribed to prevent osteoporosis.

Patients on prednisone may also be advised to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Indocin (indomethacin).

In some cases, prevention is the best way to avoid complications from a corticosteroid shot. For example, if you take blood thinner drugs, there's a chance it may raise the risk of bleeding within a joint treated by injection. Be sure to let your healthcare provider know about medications and other health conditions that may contribute to side effects.

Adults of either sex who use (or have taken) corticosteroids have a higher risk of fractures associated with bone density loss, with between 9% and 40% of people diagnosed with bone tissue death due to long-term use. Some experts suggest extra caution for use in people who are postmenopausal. Even children and teens can be affected, though.

Alternatives to Systemic Steroids

When systemic steroids are not effective, or side effects are too severe, your healthcare provider may start by lowering your dose to see if that helps.

If lowering the dose does not reduce side effects, there are other options in the case of some diseases, though these alternatives may not be as effective in controlling symptoms of the disease.

In patients with multiple sclerosis who cannot tolerate steroids, injections of the protein corticotropin may be used.

A 2020 study found that in some cases, patients with rheumatoid arthritis, lupus, or vasculitis who could not tolerate steroids might experience similar effects with drugs including Prograf (tacrolimus), Tavneos (avacopan), and disease-modifying antirheumatic drugs (DMARDs) like Plaquenil.

People diagnosed with eczema or psoriasis, may experience a rebound effect of their symptoms (sometimes severely) if they suddenly stop using even a strong topical steroid. Symptoms that rebound also can occur with a number of conditions, including sciatica treated with steroid injections.

Summary

Systemic corticosteroids are drugs that control inflammation in a wide variety of diseases, including asthma, some skin disorders, lupus, and rheumatoid arthritis. They are taken orally for these conditions. They can also be given via an injection for acute back pain and tendinitis.

Oral corticosteroids may be given for short or long periods of time, depending on the situation. It is common to experience side effects from these medications. Side effects that may occur with short-term use are typically less severe than those that occur with long-term use.

A Word From Verywell

Systemic steroids can be very effective in controlling symptoms. If they're prescribed, be sure to ask your healthcare provider how long you'll need to take them and the side effects you can expect. They can suggest ways to minimize the effects or perhaps even switch to a different drug.

Frequently Asked Questions

  • Is it safe to take systemic steroids long-term?

    Long-term use of systemic steroids can have a wide range of side effects, some of which can be serious. These include osteoporosis, effects on mood, weight gain, high blood sugar, high blood pressure, and Cushing syndrome.

  • How long do systemic steroids stay in your system?

    It depends on which steroid you are taking, what the dosage is, and for how long you've been taking them. Different people also process steroids differently. Steroids taken long-term will take more time to clear from your system.


  • What are the signs of too much steroids?

    If you overdose on corticosteroids, you may experience altered mental status, burning or itching skin, seizures, and heart rhythm disturbances (rapid pulse, irregular pulse).

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and formerly practiced at Central Coast Allergy and Asthma in Salinas, California.