Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Glucocorticoids

Last updated: April 18, 2021

Summarytoggle arrow icon

Synthetic glucocorticoids are a group of drugs with anti-inflammatory, immunosuppressant, metabolic, and endocrine effects. These drugs are structurally and functionally similar to the endogenous glucocorticoid hormone cortisol. Glucocorticoids have immediate effects (e.g., vasoconstriction) that do not depend on DNA interaction. However, they exert their main antiinflammatory and immunosuppressive actions by binding to glucocorticoid receptors, which causes complex changes in gene transcription. These genomic effects only begin to manifest after several hours. Similarly, glucocorticoids bind to mineralocorticoid receptors, but, for most glucocorticoid drugs, high doses are required for a significant mineralocorticoid effect. Systemic glucocorticoids are used for hormone replacement therapy (e.g., in Addison disease), for acute or chronic inflammatory diseases (e.g., rheumatoid arthritis), and for immunosuppression (e.g., after organ transplants). Local glucocorticoids are used to treat conditions like dermatoses, asthma, and anterior uveitis. Side effects include metabolic and endocrine disturbances, weight gain, skin reactions, hypertension, and psychiatric disorders. Contraindications for systemic glucocorticoids include systemic fungal infections and, in the case of dexamethasone, cerebral malaria. Status asthmaticus is a contraindication for inhaled glucocorticoids. Topical and ophthalmic glucocorticoids are usually contraindicated if there are preexisting local infections.

This article describes the pharmacology of synthetic glucocorticoids in detail; accordingly, glucocorticoids refer here to the drug class rather than the endogenous hormone.

Relative potency of systemic corticosteroids [1][3]
Duration of action

Drug

Common routes
of administration
Equivalent
doses
Relative
glucocorticoid
potency
Relative
mineralocorticoid
potency
Systemic glucocorticoids
Short-acting
(8–12 hours)
Hydrocortisone
  • Oral
  • Injectable
  • Topical
  • 20 mg
  • 1
  • 1
Cortisone
  • Oral
  • Injectable
  • 25 mg
  • 0.8
  • 0.8
Intermediate-acting
(12–36 hours)

Prednisolone

  • 5 mg
  • 4
  • 0.8
Prednisone
Methylprednisolone
  • Oral
  • Injectable
  • 4 mg
  • 5
  • 0.5
Triamcinolone
  • Injectable [5][6][7]
  • Topical
  • 4 mg
  • 5
  • 0
Long-acting
36–72 hours

Dexamethasone

  • Oral
  • Injectable
  • Topical
  • 0.75 mg
  • 30
  • 0
Betamethasone
  • Oral
  • Injectable
  • Topical
  • 0.6 mg
  • 30
  • 0
Systemic mineralocorticoid

Intermediate-acting
12–36 hours

Fludrocortisone
  • Oral
  • 0.1 mg
  • 10–15
  • 125–150

Fludrocortisone is not used for glucocorticoid activity but as a mineralocorticoid substitute in the management of adrenal insufficiency. [3][8]

  1. Anti-inflammatory and immunosuppressive
  2. Mineralocorticoid properties
    • Cortisol can bind to mineralocorticoid receptors at high concentrations [9]
    • Effects include, e.g., reduced sodium excretion, increased potassium excretion
  3. Antiproliferative: triggers cell apoptosis, and inhibits fibroblast proliferation [10]
  4. Anabolic-androgenic effects with steroid abuse: : increase in muscle mass and strength

Both acute and long-term effects of glucocorticoids lead to inhibition of inflammatory processes and to immunosuppression.

References:[11][12][13][14][15]

Systemic glucocorticoids

Glucocorticoid toxicity depends on the dose that is administered over a certain period of time. Therefore, even low doses can have toxic effects if administered long-term. If glucocorticoids are administered once or only briefly (e.g., for treatment of anaphylactic shock), there are usually no significant adverse effects even at high doses.

Organ/System of organs Effects
Skin
Cardiovascular system
Metabolism, electrolytes and endocrine system
GI system
CNS and psyche
Eyes
Other

Many of the adverse effects listed above are also features of iatrogenic Cushing syndrome.

The tibia is BIGgA than the FIBula: cortisol increases Blood pressure, Insulin resistance, Gluconeogenesis, and Appetite; and decreases Fibroblast activity, Immune response, and Bone formation.

Local glucocorticoids [20]

Topical glucocorticoids Inhaled glucocorticoids
Local effects
Eyes
  • Ocular reactions
Other

-

Local side-effects of inhaled glucocorticoids can be avoided by reducing the dose to the lowest effective amount, rinsing with mouthwash after each puff, improving the inhalation technique and compliance, and keeping vaccinations up to date.

We list the most important adverse effects. The selection is not exhaustive.

References:[22]

We list the most important contraindications. The selection is not exhaustive.

  • Systemic administration
    • Tapering to avoid toxicity
      • Short-term administration (≤ 3 weeks): no tapering necessary
      • Long-term administration (> 3 weeks): tapering regimen based on patient age and condition and on duration/dose of prior glucocorticoid administration → e.g., tapering over 2 months
    • Sudden discontinuation after chronic use should be avoided because of the risk of adrenal insufficiency (adrenal crisis) secondary to long-term hypothalamic-pituitary-adrenal axis suppression.
    • IM application

If the Cushing threshold is exceeded over a longer period of treatment, the glucocorticoid dose should be gradually decreased to minimize the risk of adrenocortical insufficiency.

An intratendinous injection carries the risk of bacterial spread and iatrogenic bacterial arthritis.

References:[2][23]

Interested in the newest medical research, distilled down to just one minute? Sign up for the One-Minute Telegram in “Tips and links” below.

  1. Brunton L. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition. McGraw-Hill Education / Medical ; 2017
  2. Zoorob RJ, Cender D. A Different Look at Corticosteroids. Am Fam Physician. 1998; 58 (2): p.443-450.
  3. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma & Clinical Immunology. 2013; 9 (1): p.30. doi: 10.1186/1710-1492-9-30 . | Open in Read by QxMD
  4. Barnes PJ. Inhaled Corticosteroids.. Pharmaceuticals (Basel, Switzerland). 2010; 3 (3): p.514-540. doi: 10.3390/ph3030514 . | Open in Read by QxMD
  5. Pandey S, Pandey AK. Intra-articular & Allied Injections. JP Medical Ltd ; 2017
  6. Premanshu B, Prateek M, Swarn L. Intralesional steroid injections: look before you leap!. Indian J Dermatol. 2014; 59 (4): p.410-1. doi: 10.4103/0019-5154.135506 . | Open in Read by QxMD
  7. Jonas JB. Effects of triamcinolone acetonide injections with and without preservative.. Br J Ophthalmol. 2007; 91 (9): p.1099-101. doi: 10.1136/bjo.2007.117432 . | Open in Read by QxMD
  8. Bennett PN, Brown MJ, Sharma P. Clinical Pharmacology. Churchill Livingstone ; 2012
  9. Editors: Donald W Kufe, MD, Raphael E Pollock, MD, PhD, Ralph R Weichselbaum, MD, Robert C Bast, Jr, MD, Ted S Gansler, MD, MBA, James F Holland, MD, ScD (hc), and Emil Frei, III, MD. Holland-Frei Cancer Medicine. BC Decker ; 2003
  10. Ramalingam A, Hirai A, Thompson EA. Glucocorticoid inhibition of fibroblast proliferation and regulation of the cyclin kinase inhibitor p21Cip1.. Mol Endocrinol. 1997; 11 (5): p.577-86. doi: 10.1210/mend.11.5.9923 . | Open in Read by QxMD
  11. Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011; 335 (1): p.2-13. doi: 10.1016/j.mce.2010.04.005 . | Open in Read by QxMD
  12. Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond). 1998; 94 (6): p.557-572.
  13. Van Der Goes MC, Jacobs JW, Bijlsma JW. The value of glucocorticoid co-therapy in different rheumatic diseases - positive and adverse effects. Arthritis Res Ther. 2014; 16 (Suppl 2): p.S2. doi: 10.1186/ar4686 . | Open in Read by QxMD
  14. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004; 34 (8): p.513-554.
  15. Gomez-Sanchez E, Gomez-Sanchez CE. The multifaceted mineralocorticoid receptor. Compr Physiol. 2014; 4 (3): p.965-994. doi: 10.1002/cphy.c130044 . | Open in Read by QxMD
  16. Nango D, Nakashima H, Hirose Y, Shiina M, Echizen H. Causal relationship between acute pancreatitis and methylprednisolone pulse therapy for fulminant autoimmune hepatitis: a case report and review of literature. Journal of Pharmaceutical Health Care and Sciences. 2018; 4 (1). doi: 10.1186/s40780-018-0111-5 . | Open in Read by QxMD
  17. Chan KL, Mok CC. Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management. Open Orthop J. 2012; 6 : p.449-457. doi: 10.2174/1874325001206010449 . | Open in Read by QxMD
  18. Rehman Q, Lane NE. Effect of glucocorticoids on bone density. Med Pediatr Oncol. 2003; 41 (3): p.212-216. doi: 10.1002/mpo.10339 . | Open in Read by QxMD
  19. Dardevet D, Sornet C, Savary I, Debras E, Patureau-Mirand P, Grizard J. Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging.. J Endocrinol. 1998; 156 (1): p.83-9. doi: 10.1677/joe.0.1560083 . | Open in Read by QxMD
  20. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014; 5 (4): p.416-425. doi: 10.4103/2229-5178.142483 . | Open in Read by QxMD
  21. Jantz MA, Sahn SA. Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med. 1999; 160 (4): p.1079-1100. doi: 10.1164/ajrccm.160.4.9901075 . | Open in Read by QxMD
  22. Triamcinolone (ophthalmic). https://www.drugs.com/mtm/triamcinolone-ophthalmic.html. Updated: December 15, 2010. Accessed: February 14, 2018.
  23. Chung S, Son GH, Kim K. Circadian rhythm of adrenal glucocorticoid: Its regulation and clinical implications. Biochim Biophys Acta. 2011; 1812 (5): p.581-591. doi: 10.1016/j.bbadis.2011.02.003 . | Open in Read by QxMD
  24. Herold G. Internal Medicine. Herold G ; 2014
  25. . Triamcinolone (Rx). Triamcinolone (Rx). New York, NY: WebMD. http://reference.medscape.com/drug/kenalog-iv-aristospan-triamcinolone-342748. Updated: February 20, 2017. Accessed: February 20, 2017.
  26. Shatsky M. Evidence for the Use of Intramuscular Injections in Outpatient Practice. Am Fam Physician. 2009; 79 (4): p.297-300.
  27. Steroid hormone. https://en.wikipedia.org/wiki/Steroid_hormone. Updated: February 11, 2017. Accessed: February 20, 2017.
  28. UpToDate. Cortisone acetate: Drug information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cortisone-acetate-drug-information.Last updated: January 1, 2017. Accessed: March 30, 2017.
  29. Quick Reference For the Most Common Symptoms of Adrenal Hormone Replacement Excess and Deficiency. http://www.nadf.us/tools-for-life/adrenal-hormone-replacements/. Updated: March 30, 2017. Accessed: March 30, 2017.
  30. Corneal abrasions. https://bestpractice.bmj.com/topics/en-us/500. Updated: January 1, 2019. Accessed: February 25, 2019.
  31. Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology. 2010; 49 (8): p.1594-1597. doi: 10.1093/rheumatology/keq039a . | Open in Read by QxMD
  32. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008; 372 (9634): p.234-245. doi: 10.1016/s0140-6736(08)61077-6 . | Open in Read by QxMD
  33. Buckley L, et al.. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis & Rheumatology. 2017; 69 (8): p.1521-1537. doi: 10.1002/art.40137 . | Open in Read by QxMD
  34. Moghadam-Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010; 49 (3): p.239-248. doi: 10.1111/j.1365-4632.2009.04322.x . | Open in Read by QxMD
  35. Munson JC, Wahl PM, Daniel G, Kimmel SE, Hennessy S. Factors associated with the initiation of proton pump inhibitors in corticosteroid users. Pharmacoepidemiol Drug Saf. 2012; 21 (4): p.366-374. doi: 10.1002/pds.2350 . | Open in Read by QxMD
  36. Bibbins-Domingo K, Grossman DC, et al. Screening for Latent Tuberculosis Infection in Adults. JAMA. 2016; 316 (9): p.962. doi: 10.1001/jama.2016.11046 . | Open in Read by QxMD
  37. Vozoris NT, Seemangal J, Batt J. Prevalence, screening and treatment of latent tuberculosis among oral corticosteroid recipients. European Respiratory Journal. 2014; 44 (5): p.1373-1375. doi: 10.1183/09031936.00076714 . | Open in Read by QxMD
  38. Papp KA, Haraoui B, Kumar D, et al. Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg. 2018; 23 (1): p.50-74. doi: 10.1177/1203475418811335 . | Open in Read by QxMD
  39. Dineen R, Thompson CJ, Sherlock M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. 2019; 10 : p.204201881984821. doi: 10.1177/2042018819848218 . | Open in Read by QxMD
  40. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: A comprehensive review. J Am Acad Dermatol. 2017; 76 (1): p.1-9. doi: 10.1016/j.jaad.2016.01.062 . | Open in Read by QxMD