Steroids and Surgery: Your Steroid Cover Plan

You may need cover if you have adrenal insufficiency, or if you take prednisolone 5 mg a day or more (or the equivalent dose of another steroid) for 4 weeks or longer. This applies to steroids by any route — tablets, inhalers, nasal sprays, strong skin creams, and joint injections — and to long courses finished recently. Many people do not think of inhalers or creams as steroids, so tell the team about all of them.

• Never stop your steroid suddenly.
• Tell every doctor, nurse, and dentist that you take steroids.
• Carry your steroid emergency card at all times, and show it whenever you are unwell.
• Tell the team about inhalers, nasal sprays, creams, and joint injections too.
• Never reduce your dose yourself before surgery; any change is made with the specialist who prescribed it.

Medicines such as methotrexate, biologic injections for arthritis or bowel disease, and transplant medicines also affect healing and infection risk. Each needs its own plan, made with the specialist who prescribes it: some are continued, and some are paused for one dosing cycle before planned surgery. Transplant medicines must never be stopped without the transplant team's advice.

Long-term steroids thin the skin, slow wound healing, and increase the chance of wound infection, so your wound will be checked closely. Extra steroid can also raise your blood sugar for a few days; this is expected and will be monitored.

• Fever, infection, or an illness that keeps you in bed: double your usual steroid dose and seek medical advice.
• Vomiting and unable to keep tablets down: go to the emergency department at once — you need a steroid injection. Show your emergency card.
• Feeling very unwell with dizziness, severe weakness, abdominal pain, or confusion can be an adrenal crisis: emergency treatment is a hydrocortisone injection given immediately, without waiting for tests.

• Do not fast while recovering from surgery or while unwell.
• If you take steroid replacement for adrenal insufficiency, fasting carries extra risk: discuss it with your endocrinologist first, as the timing or type of steroid may need to change.

Why do I need extra steroid for the operation?

Because you have taken steroids for some time, your body may not make enough of its own steroid under the stress of surgery. Extra steroid keeps your blood pressure safe.

Should I take my steroid on the morning of surgery?

Yes. Never miss it. The team will give you extra on the day.

I only use a steroid inhaler. Does that count?

It can, especially at higher doses. Tell the team about all inhalers, nasal sprays, creams, and joint injections.

Will steroids affect my wound?

They can slow healing and increase infection, so your wound is checked closely. Do not reduce your dose yourself.

What is a steroid emergency card?

A card that tells any doctor you take steroids and may need an urgent steroid injection if you become very unwell. Carry it at all times.