A more extensive guide to steroids is planned and see also fact sheet on  drug treatments in uveitis - an overview. in the mean time this is a good fact sheet used in a uveitis clinic.

Steroids

BEFORE USING YOUR MEDICINE

1. Do you suspect that you have had an allergic reaction to, or been upset by any of the ingredients in your steroid tablet ( itching, reddening of the skin or difficulty in breathing, or any other problems when taking the tablets previously)
2. Have you had an allergic reaction to azo dyes (food colourings) in the past? This may have been itching, reddening of the skin or difficulty in breathing. An azo dye is the colouring agent in the 5mg tablets enteric coated tablets.
3. Are you suffering from an untreated widespread (systemic) infection?
4. While you are taking steroids, you are more likely to develop illnesses due to infection. Also any existing infections may become worse resulting in septicaemia. This is especially so during periods of stress. Certain infections can be serious if not controlled.
5. Are you suffering from herpes infection of the eye?
6. It is important to be aware that contracting chickenpox during treatment or for a period afterwards can be dangerous.
7. If you or anyone in your family or regular contacts catches CHICKENPOX it is important to contact your doctor IMMEDIATELY.
   DO NOT STOP your treatment.
   It is also IMPORTANT that you contact your doctor if you contract CHICKENPOX within a 3 month period after stopping treatment.
8. Have you taken Deltacortril `Enteric' (or similar medicine) before and had muscular problems (steroid myopathy)?
9. Do you suffer from any heart condition?
10. Do you suffer from kidney problems?
11. Do you suffer from liver problems?
12. Do you suffer from stomach ulcers?
13. Do you suffer from glaucoma or does glaucoma run in your family?
14. Do you suffer from diabetes or does diabetes run in your family?
15. Do you suffer from thyroid problems?
16. Do you suffer from epilepsy (fits)?
17. Are you suffering from, or have you been treated for tuberculosis (TB)?
18. Are you past the menopause (the change of life) and suffering from osteoporosis (thinning of the bones)?
19. Have you suffered from severe affective disorders (mania or depression)?
20. Have you taken Deltacortril `Enteric' (or similar medicine) before and suffered from serious mental illness (psychoses)?
21. If the answer to any of these questions is yes, tell your doctor before you start treatment. Your doctor may still want you to take the tablets.
22. If you are pregnant or trying to become pregnant, you must tell your doctor before you start the treatment.
23. Small amounts of steroids are present in breast milk. If you are breast feeding your doctor will want to examine your baby during your time of treatment.
24. Treatment of children: The use of steroids can slow down normal growth of children and adolescents. In order to lessen this effect the tablets are often taken in a single dose every other day.
25. Treatment of the elderly: When steroids are taken by elderly patients some of the unwanted effects can be more serious especially thinning of the bones, diabetes, high blood pressure, infections and thinning of the skin.

Are you taking any other medicines (either bought or prescribed)?

If you are taking any other medicines it is important to tell your doctor before you start the treatment, these include: antiepileptic drugs, antiarthritis drugs, analgesics (such as aspirin and ibuprofen) oestrogens, antihypertensives, diuretics, drugs used to treat myasthenia gravis and certain cancers, anticoagulants, antidiabetic drugs including insulin and vaccines.

STEROID TREATMENT CARD

Make sure that you have been given a STEROID TREATMENT CARD by your doctor which you should always keep with you.

TAKING YOUR MEDICINE

1. The tablets should only be taken by mouth and can be swallowed with water.
2. They can be taken before or after a meal.
3. Treatment with Deltacortril `Enteric' is tailored to each individual. It is important to follow your doctor's instructions.
4. Once your condition starts to get better, your doctor may change your dosage to a lower one. Your doctor may also reduce your dosage before stopping treatment completely. This may depend on your illness, your dosage and how long you have been taking this medicine. In all cases you should be careful to follow any changes.
5. Withdrawal symptoms. Sudden stopping of treatment can cause the following symptoms: fever, painful muscles and joints, inflammation of the eyes and nasal passages, painful and itchy skin lumps, loss of weight.

MISSED DOSE

Take that tablet as soon as you realise and take the next dose at the correct time.

OVERDOSE

Too many tablets can make you unwell. Contact your doctor or nearest hospital accident and emergency department.

AFTER TAKING YOUR MEDICINE

Most people benefit from taking this medicine, but a few people can be upset by it

First few weeks

1. It is not uncommon to get indigestion in the form of heartburn or epigastric pain. This requires treatment from your doctor to prevent you getting an ulcer.
2. Gastro-intestinal: indigestion, stomach ulcers with bleeding or perforation, bloating, oesophageal (gullet) ulcers, or candidiasis (thrush) and inflammation of the pancreas.
3. Steroids may make you euphoric (feeling high), feeling of dependency on treatment, depression, sleeplessness, pressure on the nerve to the eye (sometimes in children after stopping treatment), worsening of schizophrenia, worsening of epilepsy.

After the first few weeks

1. Weight gain is common but is usually delayed, resulting in most weight gain appearing to occur later on, often whilst on the smaller doses.
2. Fluid retention may occur leading to high blood pressure or swollen ankles and occasionally breathlessness.
3. Diabetes may be precipitated leading to increased thirst and production of large amounts of urine as a result of too much sugar in the blood. This is treated initially by avoiding all sugary foods.

In the long run

1. Thinning of the bones may occur (osteoporosis). For this reason all patients on long term treatment undergo a special (DEXA) scan to see if treatment is required. Regular weight bearing exercise, stopping smoking, moderating alcohol and taking plenty of calcium helps prevent this problem
2. Wasting of the muscles may occur leading to difficulty getting out of chairs.
3. Ocasionally tendons may rupture.
4. The skin becomes thinner, stretch marks may occur and acne may develop.
5. Growth hormone production is affected which can result in children stopping growing
6. The risk of contracting infection is increased, existing infections can worsen, signs of infection can be masked, dormant infections (such as TB) can reappear.
7. General: increased number of white blood cells, allergy, thrombosis, sickness, tiredness.

Stopping your tablets

1. Never stop your tablets without discussing your treatment with your doctor before stopping treatment.
2. If you are ill then your tablets may need to be increased.
3. If you are vomiting then you will require steroid injections
4. Although there is a risk that you may experience one or more of the above side-effects, your doctor will have chosen this treatment bearing in mind these risks and the risks to you from your illness. If you suffer from any of these or other undesirable effects they should be reported to your doctor or pharmacist.

STORING YOUR MEDICINE

Keep your medicine in a dry place, below 25 ° C

Keep all medicines out of the reach of children

Uveitis Information Group is a charity registered in Scotland, no. SCO28439