Inhaled and intranasal corticosteroids

Risk of psychological and behavioural side effects.

Article date: September 2010

Inhaled corticosteroids are used for the prevention of asthma. Intranasal corticosteroids are used in the management of hayfever, allergy, and some nasal conditions.

We have previously reminded healthcare professionals that psychiatric side effects can occur with all systemic steroids (See Drug Safety Update September 2007).

A review of data for inhaled and intranasal corticosteroids suggests that in addition to the known systemic effects of these medicines, a range of psychological or behavioural effects may also occur. These include:

  • psychomotor hyperactivity
  • sleep disorders
  • anxiety
  • depression
  • aggression (particularly in children).

Affective disorders may be more frequently reported in patients with asthma or allergy than in patients without these conditions; however, treatment with inhaled and intranasal corticosteroids is also widespread in these patient groups, as is treatment with some substances known to be associated with behavioural and sleep disorders (such as β-receptor agonists).

Advice for healthcare professionals:

  • all patients (or their carers) should be informed of the important benefits of steroid treatment, and should be advised of these safety issues
  • all patients (or their carers) who receive steroids should receive a Patient Information Leaflet and be encouraged to read it
  • patients should keep using their steroid medication, but should seek medical advice in the event of worrying symptoms or illness while taking steroids

  Article citation: Drug Safety Update Sept 2010, vol 4 issue 2: A4.

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