Key Terms: Autoimmune disease.
Definition
Corticosteroids are a group of related drugs used in cancer treatment to reduce the growth of tumors, stimulate the appetite, and treat skin rashes, nausea and vomiting, allergic reactions, inflammation, accumulation of fluid in the brain, and autoimmune disease.
Purpose
Corticosteroids have broad use in cancer treatment. Some are used to treat adult leukemias, adult lymphomas, acute childhood leukemia, multiple myeloma, and advanced prostate cancer. Others are used in creams to treat skin rashes from radiation therapy. Corticosteroids are also used to reduce swelling, especially in the brain and spinal column, reduce nausea and vomiting, and improve appetite.
Description
Corticosteroids occur naturally in the body. They are produced by the cortex of the adrenal glands, a small, pea-sized pair of glands that are located in the lower back, just above the kidney. Some corticosteroids regulate fluid balance in the body. Others influence fat and sugar (glucose) usage. Corticosteroids are chemically related to the sex hormones estrogen and testosterone.
Many different corticosteroids are produced artificially to use as drugs. They are administered as creams, tablets, liquids, or intravenously (or injection directly into a vein). Many people are already familiar with hydrocortisone, a corticosteroid found in low doses in over-the-counter creams.
The most common corticosteroids used in cancer treatment are:
- dexamethasone (Decadron)
- hydrocortisone
- methylprednisolone (Medrol)
- prednisone
- cortisone
- betamethasone
- prednisolone There are many trade names for drugs containing these corticosteroids.
Recommended Dosage
Corticosteroids come in tablets, liquids, intravenous solutions, and creams. Because of their wide variety of uses and forms, there is no standard recommended dose. Dosage is individualized, and depends on the type of cancer, the patient's body weight and general health, the goal of the treatment, the other drugs being given, and the way a patient's cancer responds to the drug. Corticosteroids should be stored away from heat.
Precautions
People taking corticosteroids may want to go on a low-salt, high-potassium diet in order to reduce water retention. They may also want to watch their calorie intake unless corticosteroids are being given to improve appetite. Patients taking large doses of corticosteroids are more susceptible to infection and should try to avoid contact with crowds or any individuals that may have an infection. Patients should seek immediate medical advice if they are exposed to chicken pox or measles.
Side Effects
Corticosteroids have several side effects. Not every side effect is seen in every patient. The most serious, although rare, side effect is an allergic reaction to corticosteroids when given intravenously (IV). Other side effects can include:
- salt and water retention
- excessive potassium loss
- high blood pressure
- other fluid and electrolyte imbalances
- loss of muscle tissue
- loss of bone strength (osteoporosis)
- easily fractured bones
- heartburn and ulcers
- thin, fragile skin
- slow wound healing
- skin rashes
- masking of infection
- convulsions
- headache
- dizziness
- reproductive irregularities
- strong mood changes
- changes in the functioning of the adrenal gland
- increased pressure in the eye
- glaucoma, cataracts, and blindness (rare)
- nausea
- fatigue
- increased appetite
- weight gain
- increased urination
Interactions
Many drugs interact with nonprescription (over-thecounter) drugs and herbal remedies. Patients should always tell their health care providers about these remedies, as well as any prescription drugs they are taking. Patients should also notify their physician if they are on a special diet.
Corticosteroids can also interact with anticoagulants (blood thinners such as Coumadin), cyclosporine, phenobarbitol, and antidepressants.
—Tish Davidson, A.M.
