What are corticosteroids?
Corticoid is the name used to designate a certain group of steroid hormones . These hormones are produced by the adrenal glands or by synthetic derivatives, that is, a combination of substances produced through a chemical process.
These hormones, also known by the names of corticosteroids , cortisone and cortisol , perform several actions within our body, such as providing an electrolyte balance in our body (balance of ions and water) and regulation of metabolism.
Although these hormones are produced naturally by our body, they are also present in some medications.
Due to its anti-inflammatory action, it is highly recommended in cases of chronic diseases, such as allergy , asthma , rheumatoid arthritis , lupus and by people who have undergone kidney transplant surgery.
However, we need to have control over the production of these hormones by our body. This production happens and is regulated by the hypothalamus. It occurs due to various stimuli. Even the heartbeat and stimuli of pain and stress can influence this process.
Therefore, when altered, this production of corticosteroids can trigger pathologies such as Cushing’s Syndrome and Addison’s disease.
Corticosteroids, despite contributing to the treatment of many diseases, even in some types of cancer , present health risks and enable serious complications when the use is mistaken.
For this or any medication, it is necessary to consult with a doctor to understand all possible side effects of the use and when it is necessary or not.
Steroid hormones are responsible for the formation of corticosteroids. These hormones, or hormones, are derived from cholesterol. They develop in the adrenal (endocrine) glands and are surrounded by a fibrous capsule, above the kidneys.
Corticosteroids are divided into two classes, according to the types of steroid hormones that the adrenal gland produces: glucocorticoids and mineralocorticoids.
In addition to corticosteroids, this gland is also responsible for the production of sex hormones such as progesterone :
Glucocorticoids, often referred to as a corticosteroid, are the most important cortisol in the human body.
Cortisol is a hormone naturally produced by the human body. It is known as the stress hormone . The name is not for nothing: every time we find ourselves in a situation of high physical stress, such as trauma, surgery and infections, its production increases.
It is responsible for raising blood pressure, providing more glucose and energy so that our bodies are able to face these physical stresses.
Therefore, its presence is essential to regulate and support various actions of the organism such as metabolic, cardiovascular, immunological and homeostatic functions.
It differs from mineralocorticoids and sex steroids because it contains specific receptors, target cells and differentiated effects. These receptors are present in the cells of almost all vertebrate tissues.
It is in this class of corticosteroids that the drugs used as immunosuppressants and anti-inflammatory drugs are concentrated, thus being of great importance for the treatment of autoimmune diseases , such as Lupus.
Mineralocorticoids are part of the second class of steroid hormones, responsible for the formation of corticosteroids.
The main function of these hormones is due to the hormone aldosterone . They have a great influence on the electrolytic balance (ions and water).
It is also responsible for sodium balance, as it acts directly on the kidneys, helping with the proper functioning of these organs.
Consequently, it also contributes to regulating the water balance, since it follows the osmotic gradient (osmosis process) that is formed in the face of sodium reabsorption.
It is possible to find corticosteroids in various medications and in different types, as it is used according to the pathology to be treated.
Some options are:
- Oral corticosteroids : tablets, generally used to treat chronic inflammatory diseases, such as hepatitis, Crohn’s disease, arthritis and bronchitis;
- Injectable corticosteroids : must be prescribed and administered by a doctor. Used to treat diseases like lupus, keloids and rheumatoid arthritis;
- Nasal corticosteroids : sprays recommended for patients in the treatment of asthma, allergic rhinitis and other respiratory diseases;
- Corticosteroids in eye drops : in cases of ophthalmic diseases, it is possible to find corticosteroids in eye drops. Recommended in the treatment of diseases such as conjunctivitis and uveitis. Helps to reduce symptoms such as irritation and redness;
- Corticosteroids in creams : indicated in cases of allergic reactions or skin diseases, such as eczema and hives.
There is also, in relation to the types of corticosteroids, a division according to the levels of cortisol present in the medication.
For example, the glucocorticoids used and prescribed by doctors are synthetic versions of the corticosteroids that our bodies produce in the adrenal glands. There are several of these versions of cortisol, produced in the laboratory. The most used are:
- Prednisone ;
- Hydrocortisone ;
- Dexamethasone ;
- Deflazacorte ;
- Beclometasona (via nasal);
The vast majority of these synthetic versions are stronger than the hormone naturally produced by our body. Check out the potency of these synthetic drugs in relation to natural cortisol:
- Hydrocortisone – Similar potency;
- Deflazacorte – 3 times more powerful;
- Prednisolone – 4 to 5 times more potent;
- Prednisone – 4 to 5 times more potent;
- Triamcinolone – 5 times more potent;
- Methylprednisolone – 5 to 7.5 times more potent;
- Betamethasone – 25 to 30 times more potent;
- Dexamethasone – 25 to 30 times more potent;
This high level of cortisol in synthetic corticosteroid medications contributes to making it possible to treat some diseases that require a greater potency of these hormones.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
It is interesting to understand that the anti-inflammatory action of the use of corticosteroid drugs is related to the way the hormone cortisol behaves in the body.
When the patient has some inflammation, his body responds to this aggression by releasing substances to help the site recover. However, this natural process of the immune system ends up causing quite uncomfortable symptoms, such as pain and swelling.
Corticosteroids, in these cases, help to slow the release of these substances, preventing effects like these from happening.
It is also for this reason that the body becomes more susceptible to infections, since the immune system has its action suppressed with the use of these drugs.
Patients who are taking any medication based on corticosteroids should also strictly follow medical guidelines and, especially, medication schedules. This is because these hormones exhibit certain behaviors in our body.
It should be considered that the release of cortisol acts in different ways throughout the day, undergoing changes, according to the period. For example, in the morning, the release is higher. While at night, it is very low.
What most doctors recommend is that the patient take corticosteroid medications early in the morning, depending on the case, as this would be a way to match the natural release of the hormone by the body.
This recommendation is an attempt to try to avoid the side effects that drugs can cause.
The absorption of corticosteroids by our body also varies according to their shape. For example, the vast majority of side effects related to extended time of use are associated with corticosteroids used orally or intravenously (injections).
However, drugs administered via the nasal route or in ointments, even though they show less absorption by the body, are also capable of causing the same side effects.
The use of corticosteroids on the skin (ointments) and their absorption also takes into account factors such as the region of the body in which it was used. Areas with skin folds, forehead and scalp hair show greater absorption of these hormones.
In children, care must be taken with areas where there is some inflammation or peeling of the skin (wounds), as absorption is greater. If the use is prolonged, the risks of side effects will also be greater.
Corticosteroids are used to treat various chronic diseases and their main benefits are related to their anti-inflammatory and immunosuppressive functions.
What makes corticosteroids so good for the health and defense of our body, when used correctly, is the fact that it provides a great energy load for our body. With a stronger body, it is easier to fight inflammation.
In addition, these hormones are also responsible for the production or degradation of nutrients such as proteins , fats and sugars. Thus, they contribute to the balance of these nutrients in our body.
Works as anti-inflammatory
The use of corticosteroids is very welcome in cases of inflammatory diseases. This is one of the main benefits contained in corticosteroid medications.
It is immunosuppressive
Our immune system aims to protect our body from everything it identifies as foreign or a risk. However, not every foreign body means danger. This is the case for people who have had a transplant.
The immunosuppressive function of corticosteroids is found in these cases, specifically in cases of kidney transplantation. In order that the patient’s organism does not reject the transplanted organ, the use of corticosteroids is necessary.
Maintains fluid and electrolyte balance
Its application involves a change in the metabolism of carbohydrates , proteins and lipids. It maintains the balance of liquids and electrolytes, in addition to preserving the normal function of the cardiovascular and immune system, kidney, skeletal muscle and endocrine and nervous systems.
Yes, overuse of corticosteroids can make you fat . Using corticosteroids for more than 30 days can cause the patient to end up gaining weight.
This is because the drug directly affects the conversion of glucose (sugar) into energy for our body. In addition, it alters the metabolism, preventing the body from spending that accumulated energy.
Another important point is that corticosteroids end up increasing appetite. Adding all these factors together, it unfortunately causes a leap in the balance pointer
It is very common, in these cases, for people to have an increase in localized fat in the belly, neck and back region. It is also possible that they feel bloated, due to the accumulation of water and sodium, caused by the prolonged use of the medication.
The risks go beyond a few more numbers in clothing. The increase in glucose, for example, can even trigger a condition of diabetes .
Many diseases benefit from the anti-inflammatory and immunological actions of corticosteroids. Among the diseases that use corticosteroids in the treatment are:
- Multiple sclerosis;
- Chronic Obstructive Pulmonary Disease (COPD);
- Allergies such as anaphylaxis;
- Autoimmune hepatitis;
- Herpes Zoster;
- Rheumatoid arthritis;
- Multiple myeloma;
- Brain edema;
- Allergic rhinitis;
- Wegener’s granulomatose;
- Addison’s disease (adrenal insufficiency);
- Inflammatory and autoimmune skin diseases.
Excessive use of corticosteroids can result in several side effects, but suddenly stopping a treatment is also not right.
One of the most important steps in treatment with corticosteroid medications is to stop using them.
The patient should stop taking the medications slowly and gradually, according to medical advice. This process is known as weaning , the same name given to the moment when babies stop breastfeeding the mother.
Ceasing use, immediately, can cause serious complications and even cause a rebound effect. Cortisol is essential for health and withdrawing the daily doses from the body that the body has been receiving can leave the patient in serious condition.
The main symptoms that can arise with the withdrawal of corticosteroids are:
- Loss of appetite and weight loss;
- Dejected appearance;
- Body pain;
- Emergence of nodules;
- Steroid pseudo-rheumatism: syndrome that presents as symptoms anorexia, nausea, pain and muscle weakness.
It is common to overdose illicit drugs, but we must not ignore that the drugs, although beneficial in the treatment of diseases, offer this risk. And yes , excess corticosteroids can cause an overdose.
This attitude is extremely dangerous and can lead to death. There are some symptoms that may indicate the presence of an overdose of corticosteroids, such as nervousness, increased appetite, problems with digestion, insomnia and excessive sleepiness.
When using corticosteroids and if any of these symptoms develop, see a doctor.
There is no need to be terrified or run from these remedies. If you are using it consciously and with medical supervision, there is nothing to fear.
Corticosteroids can have some side effects for patients who are using this medication. Although not related to indiscriminate use, there is a risk of some symptoms appearing. The most common ones involve:
- Increased sweating (sweat);
- Redness of the skin;
- Thin skin;
- Weight gain.
If your treatment includes the use of corticosteroids and these side effects have manifested, see a doctor. You should not stop using the medicine abruptly.
Corticosteroids, despite contributing to the treatment of many diseases and being a group of hormones that the body itself produces, can pose many health risks. After all, it is a medicine and its use must be done responsibly.
In general, its side effects are related to the prolonged or overuse of the medication.
When the patient uses corticosteroids for a short period, the risks of having side effects are less, even if the doses are high.
In the face of the appearance of side effects, see a doctor. The patient should not interrupt the use of medications, as this action can further aggravate his condition.
One of the factors that make corticosteroids a risk is precisely the fact that they do not need a prescription, in certain cases. With free access, the responsibility rests with the patient, who can prolong or shorten the use of the medication.
Better understand the risks and side effects:
The rebound effect is one of the main side effects related to the indiscriminate use of corticosteroids. This means that after the treatment of a certain disease, the effects return. Or even become more intense.
In the same way that the accordion effect is the terror of people who seek to lose weight, the rebound effect is a nightmare for anyone who is suffering from some pathology. However, this is not standard and will not happen to everyone who uses the drug.
There is no need to be afraid of using corticosteroids, after all, they are of great help. However, it is essential to strictly follow medical guidelines.
This risk of the rebound effect is related to a confusion that corticosteroid hormones can cause in our body, “deceiving” the immune system in the long run.
The drugs use substances that are synthesized based on cortisol, a fundamental hormone for life and naturally produced by our body. Suspending use may result in a condition called adrenal insufficiency .
People within the framework of adrenal insufficiency may experience circulatory shock, coma and even be at risk of life, when not treated urgently.
Therefore, with the use of medications for more than a month, the body can understand that it no longer needs to produce the quota of this hormone, causing an imbalance and opening space for the disease to manifest itself again, with even more intensity.
Knowing this, respect the time indicated for the use of corticosteroids, according to what the specialist doctor deemed necessary. Thus, you prevent the disease from returning, since your immune system becomes more balanced with weaning after prolonged use.
Weakened immune system
What is a benefit in the use of corticosteroids, can also become a health risk. The fact of being immunosuppressive contributes to the treatment of many diseases, but by decreasing the body’s defense, they can increase the risk of infections.
For presenting this drop in defense, it is possible that diseases such as ulcers and gastritis arise, due to the fragile situation of the stomach, in relation to its immunity.
May cause hyperglycemia
The hyperglycemia means the increase in blood sugar levels and is a common condition of people suffering with diabetes, type 1 and type 2.
This is a side effect that can bring serious complications to the patient’s health. Among the symptoms that hyperglycemia causes are headaches, excessive thirst, fatigue and blurred vision.
When left untreated, it can manifest signs such as weight loss, nausea, vomiting, tiredness , confusion and even bring the patient into a coma. The patient is also susceptible to developing diabetes.
Corticosteroids can cause this side effect due to the fact that it helps in the production of some nutrients for our body, such as, in this case, sugar. What makes it a risk is its improper use, in quantity or for longer than necessary.
Delay in child development
Excessive use of corticosteroids can cause growth retardation in children receiving this medication. Hormones can cause a delay in the development of the child’s skeleton, as it decreases the absorption of calcium in the intestine.
Another action of corticosteroids that interferes with the growth of children is related to the inhibition of the secretion of GH, the growth hormone, caused by medications.
They interfere directly – and in a negative way – in the development of the child who is using it. In addition, it has an anti-anabolic and catabolic effect on proteins in peripheral tissues (brain, spinal cord and nerves).
This means that the body of the child who is in high use of corticosteroids will not be able to reconstruct the muscle tissues and proteins of these tissues, a process that occurs during rest periods.
When our body is healthy and with all functions in order, this state known as anabolism works perfectly. This is not the case here, as what is manifested is the anti-anabolic effect.
In relation to catabolism, the body will make use of its own energy reserves to try to supply the wear and tear that these muscles are suffering. The consequence is a decrease in lean mass and, in some cases, a reduction in performance.
One of the main side effects of the wrong use of corticosteroids is weight gain. This happens when the patient uses the medication in excess, which facilitates the accumulation of abdominal fat and, consequently, a few kilos – or many kilos – appear more.
This weight gain is related to the fact that corticosteroids contribute to the increase of bad cholesterol, which makes weight loss difficult.
From this, it also allows red streaks to appear in the belly area of the individual using hormones. It is necessary to pay attention to these signs, as it may mean not only weight gain, but that they may be symptoms of Cushing’s Syndrome.
The Cushing’s syndrome is a disease that manifests itself in people using steroids in excess and its symptoms weight gain in the abdomen region, and presented the more rounded face, legs, thin fingers, in addition to acne on his face.
Acnes appears because of the high amount of cortisol in the blood. If you are using any corticosteroid medication and notice the presence of any of the symptoms, see a doctor.
Increased blood pressure
The use of corticosteroids can cause sodium and water retention in our body. These two elements in abundance can lead to increased blood pressure.
It can be very dangerous not to have control over this function of our organism. The high pressure , if left untreated, may result in complications such as stroke, infarction and issues the proper functioning of the kidneys.
It can cause osteoporosis
The osteoporosis is a disease related to wear of the bones or accelerated loss of bone mass. It is a pathology associated with the aging process of our body, however, there are some risk factors that may be the cause.
Corticosteroids are part of these risk factors. Because it hinders the absorption of calcium, it becomes dangerous to the health of our bones. Thus, the skeleton becomes more fragile, at greater risk of suffering fractures.
May increase eye pressure
The use of corticosteroids can lead to increased eye pressure and, therefore, be a serious risk to eye health. One of the diseases that this side effect can develop is glaucoma .
Eye pressure is one of the main symptoms that causes glaucoma to develop, as it causes damage to the optic nerve. This is a very serious ophthalmic pathology, and can even lead to blindness, when left untreated.
In some cases where corticosteroids cause this eye pressure, the patient improves after ceasing use. In rarer cases, the pressure may become even higher after the abandonment of corticosteroid medications.
In addition to glaucoma, cataracts also become a risk. Be it tablets, spray, eye drops or nasal, all types of corticosteroids can pose the risk of increased eye pressure.
Although it is a risk, it should not be generalized. Side effects are manifested differently in each patient, as it involves many particular factors. What should be taken as a general rule is the conscious use and medical monitoring.
Aesthetic side effects
Corticosteroids can cause some aesthetic side effects. Although they do not present major health risks, having them can become a great discomfort, in addition to making the individual’s self – esteem more fragile.
Among these effects are the appearance of acne, stretch marks, swelling, increased hair on the arms and legs and bruises on the skin.
It can also make the skin thinner, as it inhibits fibroblasts, responsible for the synthesis of collagen, an essential protein for the firmness and rejuvenation of the skin.
Reduces muscle mass
Excessive use of corticosteroids can cause a loss of muscle mass, since these hormones are able to inhibit the protein synthesis of the human body, increasing the burning of muscle mass (catabolism).
It damages the central nervous system
Although corticosteroids provide a feeling of well-being and euphoria in patients, in the long run the effect is the opposite.
Thus, it acts directly on the central nervous system, causing such side effects.
Corticosteroid remedies are not indicated for some specific groups. For people who can and do use it, some precautions must be taken to avoid possible complications. Know the existing contraindications:
It is not recommended that people with any type of infection use corticosteroid medications, regardless of whether they are infected by bacteria, fungi or viruses.
What is known is that corticosteroids can cause the body to weaken in response to infection. Thus, an infection that could be treated properly according to your need, in an effective and more simplified way, ends up becoming a much bigger problem. Only by the presence of the wrong medication.
Like a snowball, your initial infection, in the presence of these hormones, can become much more serious and even lethal. If you are suspected of having an infection, see a doctor.
Contact with infected people
Due to the fact that corticosteroids make the body weaker in relation to infections, it is recommended that patients who are being treated with these drugs avoid contact with those people who are suffering from an infection.
There is a heightened alert regarding measles and smallpox. If you have never had these diseases or have not received the vaccine, care should be taken. If contact with these diseases occurs, seek medical attention.
Research on the use of corticosteroids by pregnant women is not 100% conclusive. However, it is necessary to be careful. If you are pregnant or intend to become pregnant, talk to your doctor about the risks of using these medications.
Women who are breastfeeding are part of the specific group of contraindications. This is because corticosteroids can be passed into breast milk. Therefore, care must be taken that the baby does not suffer from any side effects.
Possible consequences brought by the use of corticosteroids during breastfeeding include delays in the child’s growth and development. In such cases, consult with the doctor about the possibility of suspending treatment or ways to avoid complications for the baby.
The use of corticosteroids, in any age group, should be done under medical guidance. However, the use of these drugs by children should be avoided, as it is not safe to say that the use is entirely safe and effective for children.
In addition, problems related to child growth are one of the side effects that corticosteroids can provide.
Corticosteroids increase the level of sugar in the blood and therefore can be a risk for people who suffer from some type of diabetes.
Consult with a doctor if it will be safe. In cases where corticosteroids are indispensable, what will be feasible is to test the glucose level more frequently and change the dosage of diabetes medications.
The use of corticosteroids is not indicated for people who suffer from psychiatric disorders. It is also not recommended for people who suffer from seizures .
It is possible that these drugs interfere with the patient’s condition and even suffer drug interactions with the drugs used to treat the disorders, as corticosteroids cause side effects on the central nervous system.
People suffering from high blood pressure
Corticosteroid medications should be avoided by people with high blood pressure or heart problems, precisely because these drugs contribute to the increase in blood pressure, which can aggravate even more sensitized cardiac conditions.
People with glaucoma and other eye diseases
People with glaucoma or any other serious eye disease should be careful about using corticosteroids. They can increase eye pressure, in addition to increasing the risk of infections.
People with intestinal problems
It is possible that the use of corticosteroids will make the condition of people who already suffer from a problem in the intestine or stomach even worse, as it causes irritation.
People with liver problems
Using corticosteroid medications when you suffer from a liver problem can be a risk, as these hormones can intensify this liver failure.
The ideal is to consult with the doctor about possible complications, as each organism responds differently.
People with kidney problems
People who have kidney problems should check with their doctor about the risks of using corticosteroids to treat other conditions. They can mean a worsening in your current condition.
Pulsotherapy is a medical procedure widely used in cases of autoimmune diseases, such as lupus, rheumatoid arthritis and multiple sclerosis. It is an urgent method, used in crises or outbreaks, because very high doses of medication are used for a short period.
In the case of pulse therapy with the use of corticosteroids, generally, what you have is the use for a maximum of 3 to 5 days, with a dose of approximately 1000 mg / day. This treatment is used when there has been a failure in the usual treatment, in cases of extreme severity or when the patient is at risk of life.
Before starting pulse therapy, it is necessary for doctors to understand that the risk of the method must be less than the risk of life that the patient suffers.
Corticosteroids, especially pills, can suffer interactions with other medications, vitamins or even herbs that are consumed in tea.
When an interaction occurs, it means that a substance changes the way the drug works. This can cause side effects or even cut the medicine’s actions.
To prevent the combination of corticosteroids and other medications from happening, talk to your doctor about all the medications or supplements you use.
When using corticosteroids, it is recommended that certain medications be avoided:
Live vaccines are produced from the microorganism responsible for causing the disease to be treated. Usually, it is a virus or bacteria.
This process occurs through a sample of this microorganism, from a person or animal already infected. After several laboratory processes, starting from cell culture, an attenuation is reached that decreases the infectious power of the bacteria or virus. At the end of it all, we have the vaccine.
Due to the immunosuppressive action of corticosteroids, it is dangerous to receive these vaccines because the body may not be able to increase the resistance to the virus of these diseases, which could cause side effects or the symptoms of the disease you are trying to fight.
Contraceptives can suffer drug interactions with the simultaneous use of corticosteroids. It is necessary to check with your gynecologist the possible risks of having a failure in the contraceptive action of the medicine when there is the treatment of any disease with the use of corticosteroids.
Faced with the risk of an unwanted pregnancy, talk to the doctor and look for other contraceptive alternatives that do not present risks of drug interaction .
At the time of the consultation, do not forget to have both drugs in hand, as some corticosteroids, such as prednisolone and prednisone, do not demonstrate to cut the effect of contraceptives. Having the exact name of the remedies helps to have more accurate information.
However, together with the use of pills, they can trigger potential side effects. Either way, they can become a risk.
There are some basic precautions that must be considered by those who use corticosteroid medications, which involve items such as when to take it, storage and purchase. Check out some essential tips:
How to use?
Corticosteroid drugs are sold in several forms. You may find them as ointment, spray, pills and eye drops. Each type requires specific care, but in general, some steps can be taken as a rule.
For example, if it is a possibility, prefer to take the pills together with the meal or a glass of water. This helps to prevent stomach pain related to pills from occurring.
It is also recommended, with the exception of specific cases, that you take the medication in the morning, and in the case of pills, you can break or crush them.
How to store?
Corticosteroid medications should be stored at room temperature and away from light. They should also not be placed in damp environments, such as bathroom cabinets.
Do not leave medicines stored in hot places, such as in a car glove compartment. Or in the car itself, all day.
When traveling, look for an option so that medications are not left in bad environmental conditions. Not too humid, too hot or too cold.
Are you going to travel? Don’t forget the medicine!
Treatment does not go on vacation. So if you are traveling, take your medicines with you. Remember that stopping the use can cause serious complications.
When traveling by air, take your medicine in your handbag. So they will be stored correctly. There is also no need to worry about airport x-ray machines , they should not interfere with your medication.
Monitor your health
Are you suffering from a health problem that requires the use of corticosteroids and have you ever visited a doctor to find out what treatment should be like? This is great, but it is not enough.
A common mistake of people is to believe that just visiting to investigate the problem and treatment is enough, but monitoring your health is just as important.
While taking corticosteroids, make frequent visits to the doctor and check if everything is OK with your health, report possible side effects and ask questions.
The use of corticosteroids should be done in a very responsible way. Patients who need medications based on these steroid hormones must be aware of the risks and how strict they must be in relation to conscious use.
Access, even if there is no mandatory medical prescription, requires the monitoring of a professional. Self-medicating or prolonging the use of these remedies are behaviors that should be avoided.
However, we cannot have corticosteroids as a villain. After all, they are responsible for collaborating in the treatment of many diseases. Side effects do exist and can trigger serious complications, but this is a risk that comes with any exaggeration.
Always keep in mind that the use must be made with medical supervision and that the withdrawal, in this case, must be done slowly and gradually.
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