Steroid tablets – what to know before and during a course
Very effective, and with real consequences when taken long or stopped suddenly. What to expect from a short course and what changes with a long one.
What they are, and what they are not
Corticosteroids suppress inflammation and immune activity. They are used for asthma and COPD flare-ups, severe allergic reactions, autoimmune conditions, some cancers and a range of inflammatory diseases. They work well, sometimes dramatically.
They are not the anabolic steroids used for muscle building — different drugs, different effects.
The common oral steroids in South Africa:
Prednisone — Trolic, Meticorten, Adco-Prednisone, Panafcort
Asthma exacerbations; COPD exacerbations; inflammatory and autoimmune conditions
Prednisolone (Oral) — Prelone
Acute asthma; COPD exacerbation; autoimmune conditions; allergic reactions; croup
Dexamethasone — Decadron, Kortizone-Dexa
Severe inflammation; cerebral oedema; croup; anti-emetic (chemo); adrenal insufficiency crisis; COVID-19 (hospitalised)
Hydrocortisone (Oral) — Cortef
Adrenal insufficiency (Addison's disease); congenital adrenal hyperplasia
A short course
A few days to a couple of weeks is generally well tolerated. Common effects while taking it:
- Increased appetite, and some fluid retention.
- Difficulty sleeping — take the dose in the morning where possible.
- Mood changes: often energised or irritable, occasionally markedly so.
- Raised blood sugar, which matters if you have diabetes and needs closer monitoring during the course.
- Indigestion — take with food.
- Take the whole course as prescribed rather than stopping when you feel better.
Longer courses change the calculation
Beyond a few weeks, and especially over months, additional considerations apply and should be actively managed rather than discovered later.
- Bone thinning. Bone protection should be discussed for anyone on longer-term steroids.
- Increased infection risk, and infections that present less obviously because the usual inflammatory signs are suppressed.
- Weight gain and changes in body and facial shape.
- Raised blood pressure and blood sugar, and a risk of developing diabetes.
- Cataracts and glaucoma with prolonged use.
- Muscle weakness, thinning skin and easy bruising.
- In South Africa specifically: steroids can allow latent TB to reactivate, which is why TB status matters before a long course.
The rule about stopping
- Carry a steroid card or note if you are on long-term treatment, so anyone treating you in an emergency knows.
- You may need a temporarily higher dose during serious illness, injury or surgery — ask about sick-day rules.
- Seek medical advice promptly for any infection, and for chickenpox or measles exposure if you have not had them.
- Report severe mood changes, visual problems, severe abdominal pain or black stools without delay.
Common questions
- Will a short course make me gain weight permanently?
- A few days to a couple of weeks typically causes appetite increase and some fluid retention that settle afterwards. Sustained weight gain is a feature of longer courses.
- Can I drink alcohol on steroids?
- Moderate alcohol is usually acceptable on a short course, but both irritate the stomach and the combination raises the risk of bleeding — more so alongside an anti-inflammatory. Ask about your specific situation.
- Are steroid creams and inhalers the same risk?
- No. Inhaled and topical steroids deliver far less into the bloodstream and are much safer for long-term use, though strong creams on thin skin and very high inhaled doses carry their own considerations. The warnings here are about tablets.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Medicines regulation, safety communications and adverse event reportingSAHPRA
Last reviewed 4 August 2026.