All about Corticosteroids

What are they

Under the name of corticosteroid drugs are grouped several molecules united by the fact that they are structurally similar to cortisol, a steroid hormone physiologically produced by the adrenal glands.

How they work

Corticosteroid drugs have been synthesized using natural cortisol as a model, in order to reproduce in particular one of the functions of this hormone: its ability to modulate inflammatory reactions and overall the activity of the immune system.

For this reason, they are often also referred to as “steroidal anti-inflammatories” – and as such distinct in the classification of anti-inflammatories from NSAIDs (non-steroidal anti-inflammatory drugs).

If you want to know more about Fans, read this tab.

The mechanism through which corticosteroids exert their anti-inflammatory and immunosuppressive action is very articulated and involves the different biochemical processes that cells put in place in response to potentially harmful stimuli (infectious agents, allergens, foreign substances, abnormal cells, etc.).

This mechanism has the function of triggering the immune response, maintaining it until the danger is eliminated and then dampening it so that it does not become harmful in turn (as happens for example in chronic inflammation or autoimmune diseases).

In this case, corticosteroids inhibit those cellular processes that lead to the synthesis of proinflammatory and immunostimulant substances and vice versa activate those cellular processes that lead to the synthesis of anti-inflammatory and immunosuppressive substances.

The end result of this chain of chemical reactions is the containment of all those events that in localized inflammation or generalized immune responses are responsible for the symptoms of the disease.

What are they?

Currently, numerous synthetic corticosteroids are available (produced from molecules of animal or plant origin) with anti-inflammatory and immunosuppressive properties, which differ from each other for the greater or lesser intensity and specificity of the anti-inflammatory action and for the more or less long duration of action.

Among the various molecules we can mention: cortisone, prednisone, prednisolone, methylprednisolone, meprednisone, beclomethasone, triamcinolone, paramethasone, mometasone, budesonide, fluocinonide, alcinonide, flumethasone, flunisolide, fluticasone, betamethasone, dexamethasone, hydrocortisone, fluocortolone.

Directions

As anti-inflammatories, corticosteroids can be used practically whenever an inflammatory process is taking place in any district of the body regardless of its origin.

If you want to know more about inflammatory processes read this sheet.

Their effect is in fact symptomatic, as they serve to alleviate the disorders and damage related to inflammation and not to treat its cause. Let’s see in detail the inflammatory pathologies for which the use of these substances can be indicated.

As immunosuppressants they are used, generally in combination with other immunomodulators, in the treatment of tumors of the hematopoietic system (leukemias, lymphomas, myelomas) and in anti-rejection therapy following organ or bone marrow transplantation.

Corticosteroids are available for virtually any route of administration (intravenous, intramuscular, subcutaneous, intraarticular, inhalation, oral, cutaneous topical, ocular topical, rectal).

The route of administration is chosen according to the type of disease to be treated, the speed of action required and the duration of treatment.

Effects

The side effects of synthetic corticosteroids depend mostly on the fact that, in addition to the anti-inflammatory/immunosuppressive effect, they also share to varying degrees the other biological effects of the natural hormone, which concern in particular: glucose metabolism; protein metabolism; lipid metabolism; metabolism of bone tissue; renal excretion of sodium and potassium; gastric acid secretion; blood crasis (balance between the various cells and the various components of the blood); the mood.

Due to interference with these homeostasis systems of the body, corticosteroids can cause: hypertension; water retention; hyperglycaemia; loss of potassium; osteoporosis; muscle hypotrophy; capillary fragility; delayed wound healing; hyperlipidemia; accumulation of adipose tissue at the level of the face, neck and abdomen; gastroduodenal ulcer; increased blood coagulability; hematological abnormalities; euphoria and insomnia.

In prolonged treatment, moreover, these drugs tend to inhibit the production of natural analogous hormones by the adrenal glands, thus causing a picture of adrenal insufficiency, which manifests itself with serious consequences especially at the suspension of therapy.

Another important side effect of prolonged use of corticosteroids is related to their immunosuppressive action (unless required as in the case of anti-rejection or anticancer therapy), which increases susceptibility to infections.

In view of the many potentially harmful side effects, the use of corticosteroids should be:

• reserved for cases where other anti-inflammatories are not effective enough;
• limited as much as possible in terms of doses and duration of treatment;
• prescribed locally, rather than systemically, whenever indicated;
• discontinued gradually (never overnight) at the end of therapy.