According to the National Multiple Sclerosis Society, when a person with relapsing-remitting multiple sclerosis (MS) has an acute symptom flare-up, they are frequently prescribed a short course of high-dose steroids (NMSS). Steroids are usually administered intravenously or orally for three to five days.
According to Matthew McCoyd, MD, an associate professor and residency program head of neurology at Loyola University Medical Center in Maywood, Illinois, “high-dose steroids are utilized to hasten recovery” following an MS relapse.
Corticosteroids, which mimic natural hormones generated by the adrenal gland and disrupt inflammation, are the steroids used to treat MS symptoms.
“We only use them for brief periods of time, and we rarely use them more than once or twice a year,” Dr. McCoyd explains, citing long-term risks like as bruising, skin abnormalities, and bone alterations.
However, even in the short run, steroid-usa can have negative effects – although, according to McCoyd, most unwanted effects will fade as you begin to reduce the medicine.
“Steroids are generally well tolerated,” says Tamara B. Kaplan, MD, a doctor at Brigham and Women’s Hospital in Boston’s Brigham Multiple Sclerosis Center. “And you should never let these side effects prevent you from receiving effective treatment.”
However, knowing what you’re in for can help, so here are six potential side effects to be wary of:
1. Sleep Issues Associated with High-Dose Steroids
“Sleep disturbance is one of the most prevalent side effects of the initial high dose of steroids,” McCoyd explains.
Dr. Kaplan shows how steroids can help you feel more energized. She recommends that her patients schedule their infusions early in the day so that they do not disrupt their sleep.
If you’re having difficulties falling asleep, having bad nightmares, or feeling sleepy or tired during the day, try the following suggestions:
Take the steroids first thing in the morning and avoid dosing in the afternoon or evening.
Request a prescription for sleep medicine from your doctor.
Take sedating medications, such as antidepressants, before bedtime if you need them.
2. It’s possible that you’ll have a bad taste and an upset stomach.
When taking steroids, some people have a strange, metallic taste in their tongue. It may be relieved by sucking on mints or hard candies.
Stomach trouble, nausea, and vomiting are also frequent steroid adverse effects. If you have indigestion or heartburn, ask your doctor for a prescription for an over-the-counter antacid.
Proton pump inhibitors, such as Prilosec (omeprazole) or Prevacid (lansoprazole), are also used to treat stomach symptoms, and your doctor may prescribe them to prevent stomach problems, according to Barbara Giesser, MD, a multiple sclerosis specialist at Pacific Neuroscience Institute in Santa Monica, California, and professor emeritus of clinical neurology at the David Geffen UCLA School of Medicine in Los Angeles.
3. Mood Disorders: Anger, Irritability, and Mood Swings
You may feel restless, anxious, and irritated when taking steroids.
“For some folks, agitation is a common symptom,” McCoyd explains. “Patients with a mood condition may be treated in the hospital to ensure that they do not have a significant spell of depression or anxiety,” says the article.
Mood swings caused by steroid medication can be minor to severe. If you have a history of depression, anxiety, or bipolar disorder, be sure to notify your doctor.
Simply being aware that steroids can impact your mood can help you cope with this side effect, but if it becomes severe, tell your doctor.
It’s also crucial to inform loved ones about this potential side effect so they can grasp what’s going on. “I always tell my partner, ‘She might be a little irritable in the coming days.’ “It’s the drug, not her,” Kaplan observes.
4. Retention of Water Embarrassing, but only for a short time
Swollen ankles, as well as an overall swollen and bloated feeling throughout your body, may occur after the initial dose of steroids. Because steroids cause your body to retain more water, urine frequency is typical, according to Kaplan.
Knowing that something like this could happen — and that it will pass quickly — can be comforting.
“It’s nothing to be concerned about,” she says. “It’s not a long-term symptom; it should go away in a few days.”
5. Steroid Use Increases Infection Risk
A steroid’s job is to suppress your body’s immune system, putting you at greater danger of infection.
If you experience any infection symptoms while taking a steroid, such as a fever, chills, cough, or sore throat, tell your doctor, McCoyd advises.
You can reduce your risk of infection by washing your hands frequently and staying away from persons who have cold or flu symptoms.
While persons with MS are normally advised to have an annual (non-live) flu vaccine as well as other vaccines, the NMSS advises against getting any vaccines during an MS relapse, whether or not you’re on steroids.
Vaccines that are live or live-attenuated are also not indicated for patients with MS who are on any disease-modifying therapy (DMT). If you are using certain MS drugs, you may be unable to get some non-live vaccines.
6. Diabetes Patients Should Be Concerned About Elevated Blood Sugar
High blood sugar levels are one of the most serious adverse effects of steroids. This is normally not a concern unless you have diabetes, but if you do, you’ll probably observe higher numbers when checking your blood glucose level.
“People with diabetes should be warned that their blood sugar levels will rise and that they should talk to their doctor about changing their insulin [or other diabetic treatment] while on the steroid,” Kaplan says.
During steroid treatment, people who do not have diabetes can acquire steroid-induced diabetes. While taking steroids, report any unusual thirst, dry mouth, frequent urination, blurred vision, or excessive weakness and weariness to your doctor.
Steroid Treatment Alternatives
According to the NMSS, when someone cannot tolerate steroids or does not respond satisfactorily to steroid treatment, the following options should be considered:
Gel Acthar According to the Multiple Sclerosis Association of America, Acthar Gel activates the outer layer of cells in the adrenal gland, which helps your body create natural hormones that reduce inflammation. It contains a gelatin capsule containing a highly purified form of the hormone adrenocorticotropin (ACTH), which is injected into the muscle or under the skin. Injection site response, lethargy, fluid retention, sleeplessness, headache, and elevated blood sugar are all common adverse effects.
Plasmapheresis This procedure, also known as plasma exchange, can be used to treat severe flares.