Corticosteroids: medications in this class

Overview

Corticosteroids are synthetic versions of cortisol. Taken by mouth in short courses they settle asthma and COPD flares, severe allergic reactions, gout, inflammatory bowel disease and many other conditions; at low doses long term they control autoimmune diseases such as rheumatoid arthritis and polymyalgia. Inhaled steroids control asthma and COPD, nasal sprays treat allergic rhinitis, and creams treat eczema and other skin conditions, each with far less effect on the rest of the body.

Oral courses longer than a couple of weeks are tapered, because the adrenal glands reduce their own output while a steroid is taken. Long-term oral use raises blood sugar, blood pressure and infection risk and causes bone loss, weight gain and mood change, so prescribers use the lowest dose for the shortest time and add bone protection when courses are long.

Prednisone, prednisolone and methylprednisolone are interchangeable for most purposes at equivalent doses; dexamethasone is longer-acting and more potent.

How the drugs in this class differ when you pay cash

Prednisone and the other oral tablets are commodity generics costing pharmacies pennies; the cash price of a short course is the dispensing fee, and branded taper packs cost several times more than loose tablets with written instructions. Inhaled steroids and steroid-bronchodilator combinations are a different world: the device is part of the product, generics have arrived for only some, and the same prescription written by brand or generically can be quoted at very different prices. Nasal steroid sprays are cheap over the counter; some prescription creams, especially combinations and foams, are expensive.

For a long-term low-dose oral steroid, a ninety-day fill at a flat-price pharmacy is where the saving is. For inhalers, ask the pharmacy which generic devices it stocks.

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Should I take the oral dose in the morning with food?
• Do I need to taper, or can I stop when the course ends?
• If I am on it long term, do I need bone protection or blood sugar checks?
• For an inhaler, is there a generic device, and can you show me the technique?
• Would the over-the-counter nasal spray do for me?