When an individual with relapsing-remitting multiple sclerosis (MS) has an acute symptom flare, or exacerbation, they are commonly prescribed a short course of high-dose steroids. Typically, steroids are administered intravenously for three to five days, sometimes followed by a tapering dose of oral steroids over one to two weeks.
“High-dose steroids are good to accelerate recovery” after an MS relapse, says Matthew McCoyd, MD, an assistant professor and residency program director of neurology at the Loyola University Medical Center in Maywood, Illinois.
The steroids used for MS flares are known as corticosteroids, which behaves like natural hormones produced in the cortex of the adrenal gland and which interrupt inflammation.
“Because of long-term complications, like bruising, skin changes, and bone changes, we only use them for short periods, and it is rare to use them more than once or twice a year,” Dr. McCoyd says.
But even in the short term, steroids can have side effects — although, says McCoyd, once you start to taper the drug, most side effects will subside.
“In general, steroids are very well tolerated,” says Tamara B. Kaplan MD, a neurologist at Partners Multiple Sclerosis Center at Brigham and Women’s Hospital in Boston. “And these side effects should never deter you from getting proper treatment.”
But it helps to know what you may be in for, so here are six possible side effects to be aware of:\
1. Mood Disturbances: Agitation, Irritability, Mood Swings
Being on a steroid can make you restless, agitated, and irritable.
“Agitation is a common symptom for some people,” McCoyd says. In addition, “Patients who have a mood disorder may be treated in the hospital to make sure they do not have a serious bout of depression or anxiety.”
Mood swings with steroid treatment can range from mild to serious. Be sure to tell your doctor if you have a history of depression, anxiety disorder, or bipolar disorder.
Simply being aware that steroids can affect your moods may make this side effect easier to tolerate, but let your doctor know if it feels intolerable.
It’s also important to let loved ones know about this possible side effect so they understand what’s going on with you. “I always warn the partner: ‘She might be a little more irritable over the next few days. It’s the medicine; it’s not her,’” notes Kaplan.
2. Elevated Blood Sugar a Concern for Those With Diabetes
One of the most important side effects of steroids is high blood sugar levels. This is usually not a problem unless you have diabetes, but if you do have diabetes, you are likely to see higher numbers when you check your blood glucose level.
“People with diabetes should be warned that their blood sugar will go up and that they need to talk to their doctor about adjusting their insulin [or other diabetes medication] while they are on the steroid,” says Kaplan.
People without diabetes sometimes develop steroid-induced diabetes during steroid treatment. If you notice unusual thirst, dry mouth, frequent urination, blurred vision, or extreme weakness and fatigue while on steroids, let your doctor know.
3. Trouble Sleeping Linked With High-Dose Steroids
“One of the most common side effects from the initial high dose of steroid is sleep disturbance,” McCoyd says.
Steroids can give you an extra boost of energy, explains Dr. Kaplan. She advises her patients to schedule their infusions for early in the day so they don’t interfere with sleep.
If you do have trouble falling asleep, experience unpleasant dreams, or feel sleepy or fatigued during the day, the following tips may help:
- Ask your doctor for a prescription sleep medication.
- If you also take drugs with sedating effects, such as antidepressants, take them at bedtime.
4. Water Retention Annoying but Temporary
After the initial dose of steroids, you may experience swollen ankles as well as a general swollen and bloated feeling throughout your body. Since steroids cause your body to retain more water, it’s also common to experience urinary frequency, says Kaplan.
Just knowing that this can potentially happen — and that it will soon pass — can help.
“It’s not something to worry about,” she says. “It’s not a long-lasting symptom; it will improve within a few days.”
5. Bad Taste, Upset Stomach a Possibility
Some people notice a funny, metallic taste in their mouth when undergoing steroid treatment. Sucking on mints or hard candies may help alleviate it.
Other common side effects of steroids include upset stomach, nausea, and vomiting.
If you experience indigestion or heartburn, ask your doctor to suggest an over-the-counter antacid to help control it.
6. Infection Risk Rises With Steroid Use
One of the functions of a steroid is to suppress your body’s immune system, which places you at higher risk of infections.
“It is a good idea to do a blood and urine test to look for any sign of infection before starting treatment,” McCoyd says. And if you develop any symptoms of infection while taking a steroid — such as a fever, chills, cough, or sore throat — let your doctor know.
You can lower your risk of infection with frequent hand-washing and by keeping your distance from people with cold or flu symptoms.
While people with MS are generally encouraged to get an annual flu shot, as well as certain other vaccines, the National Multiple Sclerosis Society cautions against getting any vaccines during a serious MS relapse — whether or not you’re receiving steroids.
People on long-term corticosteroid therapy or any other immunosuppressive therapy should talk to their neurologist before receiving any live virus vaccine, such as the measles, mumps, and rubella (MMR) vaccine and the varicella (chickenpox) vaccine.