What is classed as long-term steroids?

October 6, 2025 •

4 min read

While there is no single official definition for long-term steroid use, oral corticosteroid therapy lasting more than 30 days is widely considered prolonged and increases the risk of side effects. Defining what is classed as long-term steroids varies depending on the specific medication, dosage, and route of administration, making it a critical consideration for both patients and healthcare providers.

Quick Summary

The classification of long-term steroid use lacks a universal definition, varying significantly by medication type, dose, and duration. For oral forms, use beyond a month is typically considered long-term, while thresholds for topical and inhaled steroids differ. The potential for serious side effects increases with longer exposure.

Key Points

Varied Definitions: The classification of long-term steroid use lacks a single standard and differs based on the type of steroid (oral, topical, inhaled) and cumulative dosage.
Oral Thresholds: For oral corticosteroids, use exceeding 30 cumulative days is often considered long-term, with risks of adverse events increasing significantly after 90 cumulative days within a year.
Systemic vs. Localized Risks: Systemic (oral) steroids carry higher risks of serious side effects throughout the body compared to localized inhaled or topical steroids, which typically have fewer systemic effects.
Significant Health Risks: Prolonged systemic steroid therapy is associated with serious side effects including osteoporosis, weight gain, increased blood sugar, elevated blood pressure, and increased risk of infection.
Adrenal Suppression and Tapering: Long-term use can suppress the body's natural hormone production, requiring a slow and carefully managed tapering process to prevent adrenal insufficiency and withdrawal symptoms.
Risk Management is Crucial: Effective management involves using the lowest possible dose, considering alternate-day therapy, and implementing monitoring and supportive care strategies.

What Defines Long-Term Steroid Use?

Because the term 'long-term' is not officially standardized across all medical fields, its definition often depends on the specific type of steroid and the clinical context. A short course might last only a few days or weeks, such as a steroid burst for an acute flare-up of a condition like asthma. In contrast, chronic conditions like rheumatoid arthritis or lupus may require therapy lasting months or even years. The key determining factors are the duration, dose, and route of administration.

Oral Corticosteroids

For oral corticosteroids like prednisone, the threshold for long-term use is typically considered to be more than 30 days. Some studies have focused on cumulative use, suggesting that adverse effects may become statistically significant when a patient receives oral corticosteroids for more than 90 days within a year. This highlights that even intermittent courses can add up to a significant cumulative exposure over time.

Topical and Inhaled Steroids

For topical steroids, which are applied to the skin, the duration defining long-term use can vary by potency. Stronger, ultra-high-potency topical steroids are generally not recommended for continuous use for more than three weeks. For lower-to-high potency versions, continuous use beyond three months is often considered long-term. Inhaled steroids used for respiratory conditions like asthma and COPD are often prescribed as daily maintenance medications for the long term. Unlike oral steroids, standard daily doses of inhaled corticosteroids have a lower risk of systemic side effects.

The Critical Differences: Systemic vs. Localized Effects

Understanding the distinction between systemic and localized steroid effects is crucial for grasping why the definition of 'long-term' varies. Systemic corticosteroids, particularly oral tablets, affect the entire body, leading to a broader range of potential side effects than localized treatments like inhalers or topical creams.

Oral Corticosteroids (e.g., Prednisone): These are absorbed into the bloodstream and impact the body's entire system. The potency and duration of oral therapy directly correlate with the risk of systemic side effects.
Inhaled Steroids (e.g., Fluticasone): Primarily act on the airways to reduce inflammation. While some medication can be absorbed systemically, the dose is much lower, and the side effects are generally mild and localized to the mouth and throat.
Topical Steroids (e.g., Clobetasol): Applied to the skin, these are designed to act locally. However, prolonged or widespread use, particularly of high-potency formulations, can lead to systemic absorption and side effects.

Key Health Risks of Long-Term Steroid Use

Prolonged use of systemic corticosteroids is associated with a wide array of adverse health events, which is the primary reason why short-term usage is generally preferred when possible. The risks increase with both higher doses and longer duration.

Common Adverse Effects of Prolonged Corticosteroid Therapy

Osteoporosis: Long-term steroid use can significantly weaken bones, increasing the risk of fractures.
Weight Gain and Metabolic Changes: Steroids can increase appetite and affect metabolism, leading to weight gain and fat deposits, especially in the face, neck, and abdomen.
Diabetes: Corticosteroids can raise blood sugar levels, which may cause or worsen diabetes.
Increased Risk of Infection: By suppressing the immune system, steroids make the body more vulnerable to infections.
Cardiovascular Risks: Long-term use can contribute to high blood pressure and increase the risk of heart disease.
Eye Problems: Glaucoma and cataracts are potential complications.
Mental Health Issues: Mood swings, anxiety, depression, and other psychiatric disturbances can occur.
Skin Changes: The skin can become thinner, more fragile, and bruise more easily.
Adrenal Suppression: The body's natural production of corticosteroids by the adrenal glands is suppressed, making it critical to taper off the medication slowly to avoid withdrawal symptoms.

Managing Long-Term Steroid Therapy

Effective management of long-term steroid therapy aims to maximize therapeutic benefits while minimizing adverse effects. A healthcare provider will carefully monitor a patient's health and make adjustments as needed.

Strategies for Managing Long-Term Use

Alternate-Day Therapy: For some conditions, taking the medication every other day can help minimize side effects while still providing therapeutic benefits.
Lowest Effective Dose: The goal is always to use the minimum dose necessary to control the condition.
Tapering: When discontinuing treatment after long-term use, the dose must be slowly reduced to allow the adrenal glands to recover normal function.
Supportive Care: Supplementing with calcium and vitamin D can help combat osteoporosis, and dietary changes can help manage weight gain and blood sugar levels.

Comparison of Short-Term and Long-Term Effects


Characteristic	Short-Term Steroid Use	Long-Term Steroid Use
Duration	Few days to a few weeks (often <30 days)	Over 30 cumulative days, potentially months or years
Adrenal Function	Minimal or temporary impact	Potential for significant suppression of the hypothalamic-pituitary-adrenal (HPA) axis
Primary Risks	Often mild, potentially reversible side effects like mood changes, appetite increase	Increased risk of serious, systemic adverse effects
Side Effects	Sleep disturbance, increased appetite, temporary mood changes, stomach irritation	Weight gain, osteoporosis, increased blood sugar, high blood pressure, cataracts, glaucoma, Cushing's syndrome
Tapering	Usually not required for short, low-dose courses	Essential for safe discontinuation to prevent withdrawal symptoms and adrenal insufficiency

Conclusion

Understanding what is classed as long-term steroids is essential for both patients and healthcare providers to manage risks effectively. The definition is not fixed but rather depends on the type of steroid and the duration of therapy, with oral corticosteroids generally considered long-term after 30 days of cumulative use. The potential for serious side effects, particularly for systemic (oral) steroids, escalates with duration and dose, making careful monitoring and patient education vital. Patients on long-term therapy should be managed with the lowest effective dose, with a gradual tapering plan for discontinuation, and appropriate supportive measures to mitigate adverse effects.

For more information on managing steroid use and potential side effects, consult reliable resources like the Hospital for Special Surgery health library.

Frequently Asked Questions

While there is no single official definition, oral steroid use lasting more than 30 days is widely considered long-term. Some studies indicate that the risk of adverse events increases significantly after 90 cumulative days of use in a year.

Short-term steroid use typically involves few risks and mild, reversible side effects. In contrast, long-term use significantly increases the risk of serious systemic adverse effects like osteoporosis, diabetes, and increased susceptibility to infections.

Yes, the definition varies. While oral steroids are considered long-term after about a month, topical steroids may be considered long-term after 3 months, and daily inhaled steroids are often used for chronic management with a different risk profile.

Stopping long-term systemic steroids abruptly can lead to adrenal insufficiency, a condition caused by the body's inability to produce enough natural cortisol. This can cause severe symptoms like fatigue, low blood pressure, and joint pain.

Side effects can be managed by using the lowest effective dose, exploring alternate-day therapy, monitoring for specific complications, and supplementing with nutrients like calcium and vitamin D to support bone health.

No, generally they are not. Inhaled steroids are designed to act locally in the lungs, with minimal systemic absorption. As a result, the risk of serious, systemic side effects is much lower compared to oral corticosteroids.

Adrenal suppression is a condition where the body's adrenal glands reduce their natural production of cortisol in response to long-term systemic steroid use. It can lead to a state of dependency and requires careful tapering of the medication.