6 Side Effects of MS Steroid Treatment
Steroids can help with an MS relapse, but they come with the risk of side effects. Here’s what to watch out for.
When a person with relapsing-remitting?multiple sclerosis (MS)?has an acute symptom flare-up, they are often prescribed a short course of high-dose steroids,?according to the National Multiple Sclerosis Society (NMSS). Typically, steroids are given intravenously or orally for three to five days.
“High-dose steroids are used to speed recovery” after an?MS relapse, says?Matthew McCoyd, MD, an associate 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 mimic natural?hormones?produced in the adrenal gland that interrupt inflammation.
MS Tips From the Red Carpet
“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 clinician at Brigham Multiple Sclerosis Center at Brigham and Women’s Hospital in Boston. “And these side effects should never deter you from getting proper treatment.”
However, it helps to know what you may be in for, so here are six possible side effects to be aware of:
1. Sleep Problems Common From High-Dose Steroids
“One of the most common side effects from the initial high dose of steroids 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:
- Take the steroids early in the morning, and avoid afternoon or evening dosing.
- Ask your doctor for prescription sleep medication.
- If you also take drugs with sedating effects, such as?antidepressants, take them at bedtime.
RELATED:?Getting a Good Night’s Sleep When You Have MS
2.?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.
Medications called?proton pump inhibitors, such as omeprazole (Prilosec) or lansoprazole (Prevacid), are also used to help with stomach symptoms, and your doctor may prescribe them to prevent stomach issues, says Barbara Giesser, MD, a multiple sclerosis specialist with Pacific Neuroscience Institute in Santa Monica, California, and a professor emeritus of clinical neurology at the David Geffen UCLA School of Medicine in Los Angeles.
RELATED:?11 Lifestyle Tips to Help You Manage MS Symptoms
3.?Mood Disturbances: Agitation, Irritability, Mood Swings
Being on a steroid can make you feel 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.
4. Water Retention Can Be 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. 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.
If you develop any symptoms of infection while taking a steroid — such as a?fever, chills,?cough, or?sore throat?— let your doctor know, says McCoyd.
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 (nonlive) flu vaccine, as well as certain other vaccines, the NMSS cautions against getting any vaccines during an MS relapse — whether or not you’re taking steroids. Also, live and live-attenuated vaccines are not recommended for people who have MS who are taking any disease-modifying therapy (DMT). There are also some restrictions on receiving some nonlive vaccines if you are taking certain medications for MS.
RELATED:?What You Need to Know About the COVID-19 Vaccine if You Have MS
6. 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.
Alternatives to Steroid Treatment
When someone cannot tolerate steroids or does not adequately respond to steroid treatment, the following alternatives may be considered,?according to the?NMSS:
- Acthar Gel Acthar Gel stimulates the outer layer of cells of the adrenal gland, which helps your body produce natural hormones that reduce inflammation, according to the Multiple Sclerosis Association of America. It contains a highly purified preparation of the hormone adrenocorticotropin (ACTH) in gelatin, which is injected either into the muscle or under the skin. Commonly reported side effects include injection site reaction, fatigue, fluid retention, insomnia, headache, and high blood sugar.
- Plasmapheresis?Also known as?plasma exchange, this treatment may be used to treat severe flares.
RELATED: Understanding and Coping With MS Relapses
Additional reported by Susan Jara.
The Takeaway
High-dose steroids are often prescribed to speed up recovery from MS flare-ups. While effective, these medications can lead to uncomfortable temporary side effects such as sleep disturbances, mood swings, and water retention. Scheduling steroid infusions early in the day can help manage some of these effects.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Managing Relapses.?National Multiple Sclerosis Society.
- Vaccinations.?National Multiple Sclerosis Society.
- Courtney SW. Acthar Gel.?Multiple Sclerosis Association of America.
- Plasmapheresis.?National Multiple Sclerosis Society.
Jason Paul Chua, MD, PhD
Medical Reviewer
Chris Iliades, MD
Author
Chris Iliades, MD, is a full-time freelance writer based in Boothbay Harbor, Maine. His work appears regularly on many health and medicine websites including Clinical Advisor, Healthgrades, Bottom Line Health, HeathDay, and University Health News. Iliades also writes a regular blog for The Pulse, a website for fetal health and pregnancy.
Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery. He practiced clinical medicine for 15 years and has also been a medical director for diagnostic research and a principal investigator for clinical research before he turned to full-time medical writing.