If you take steroid medicines such as prednisolone, your own adrenal glands may make less cortisol, the hormone your body needs when it is ill, injured or having surgery. Your doctor or pharmacist will decide whether you need the red NHS Steroid Emergency Card. If you have one, carry it all the time and show it to anyone treating you, so they know you may need extra steroids. Never stop steroid tablets suddenly.
Many people with rheumatoid arthritis, polymyalgia rheumatica and other inflammatory conditions take steroids for weeks, months or longer. This guide covers one job: understanding the steroid cards, knowing when to show them, and what to do on a sick day, especially if you are older, living with frailty or caring for someone. For infection warning signs on steroids, see our steroids and infection guide.
Why steroids can make illness more risky
The NHS explains that steroid medicines copy the stress hormones your adrenal glands make. When you take them in doses higher than your body's usual level, your adrenal glands may make less of their own cortisol. This is called adrenal insufficiency. The NHS says it is more likely if you take high doses for a long time, especially tablets and injections, or if you use more than one kind of steroid at the same time, such as a steroid inhaler and a nasal spray.
Most of the time this causes no problems, because your tablets supply what you need. The risk comes when your body needs more cortisol than usual: a bad infection, being sick or having diarrhoea, a fall or injury, or an operation. Without extra steroid, a small number of people can become seriously unwell very quickly. This is called an adrenal crisis, and it is an emergency.
The two steroid cards
- Red NHS Steroid Emergency Card: your doctor or pharmacist assesses your risk of adrenal insufficiency from the type and dose of steroids you take, and may recommend this card. It tells health professionals that you take steroids that should not be stopped suddenly, and sets out the first steps to take in an emergency. It is the size of a credit card
- Blue steroid treatment card: the NHS says you will be given this if you take prednisolone for longer than 3 weeks, or at a high dose of more than 40mg a day. It explains how to reduce the risk of side effects and records your doctor, your dose and how long treatment will last
The Society for Endocrinology says the blue card is not replaced by the red one, so keep both if your team has given you both. You can also download a PDF of the red card; some people save it as their phone's lock screen so emergency staff can see it.
Do I need a red card?
Only your own prescriber can say. Ask your GP, pharmacist or rheumatology team if any of these apply and nobody has mentioned a card:
- you have taken steroid tablets for a long time, or at a high dose
- you have repeated steroid injections into joints or muscles, as well as other steroids
- you use several kinds of steroid together, such as tablets plus an inhaler or nasal spray
- you are coming off steroids slowly after a long course
Bring a full list of your medicines, including inhalers, creams, nasal sprays and recent injections. Our steroid injections versus tablets guide explains the difference.
When to show your card
- at A&E, to paramedics, and if you are admitted to hospital for any reason
- before any operation, procedure or scan that involves fasting or sedation, such as a colonoscopy
- at the dentist, before dental treatment
- at a new GP, out-of-hours or NHS 111 contact, so they know about your steroids
- to carers and family, so they can show it for you if you cannot
Sick days: ask for your plan now, not when you are ill
- Do not stop, skip or lower your steroid dose yourself. The NHS says it can be dangerous to stop prednisolone suddenly, especially after a high dose for a long time
- When you are unwell, your body may need more steroid, not less. Ask your doctor whether sick day rules apply to you, what dose change (if any) they want, and for how long. Write it on your flare action plan
- If you are being sick and cannot keep your tablets down, or have severe diarrhoea, get urgent advice from your GP or NHS 111 the same day and tell them you take steroids
- Do not run out. Order repeat prescriptions early, especially before bank holidays and over Christmas
- Our winter viruses guide has a sick-day plan for your other arthritis medicines too
When it is an emergency
The NHS lists signs of adrenal crisis that need 999. Call 999 if someone who takes steroids becomes suddenly much worse and has any of these:
- feeling very dizzy or light-headed, especially when standing up
- being sick, or severe tummy pain or pain in the side
- a fast heart rate
- muscle weakness, pain or spasms, or a headache that will not go away
- being very drowsy, irritable or confused
- a seizure (fit) or passing out
Show the red card to the ambulance crew and take the person's medicines, or a list. If you have been given an emergency injection kit and trained to use it, the NHS says call 999 even after you have given the injection. Signs of sepsis, such as fast breathing, blotchy or blue skin and a rash that does not fade, also need 999.
Frailty and steroids: why carers matter
In older people, an adrenal crisis or a serious infection may look like going "off their legs", a fall, new confusion or not eating and drinking. These are reasons to ask for help early, not to wait. If you care for someone on steroids:
- keep the steroid cards, medicines list and rheumatology advice line number together
- know where their sick-day plan is written down
- check repeat prescriptions are ordered in time
- ask for a carer's assessment if you need more support
Long courses of steroids can also thin bones, so ask about bone protection. Our bone density guide explains the checks.
Frequently asked questions
Do steroid joint injections count?
They can. The Society for Endocrinology says steroids given by any route, including joint injections, inhalers, nasal sprays and creams, can lower your own cortisol, especially when they add up. Ask your team whether your injections change your risk.
I have stopped steroids. Do I still need the card?
Your adrenal glands can take time to recover after a long course. Ask your doctor how long you should keep carrying the card after your last dose.
Where do I get a card?
Your GP, hospital team or pharmacist can give you one. If you think you should have one and do not, ask at your next appointment or speak to your community pharmacist.
Sources and further reading
- NHS: Common questions about prednisolone (steroid cards)
- NHS: How and when to take prednisolone
- NHS: Steroids
- NHS: Addison's disease (adrenal crisis signs)
- Society for Endocrinology: Adrenal crisis and the NHS Steroid Emergency Card
- NHS: Sepsis
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Steroids and infection with rheumatoid arthritis — warning signs and who to call
- Steroids for arthritis — how steroids are used and why they are tapered
- Steroid injections or tablets — when each makes sense
- Printable flare action plan — write your sick-day steps down
- Winter viruses and arthritis medicines — a sick-day plan
- Chest infections and arthritis — self-care and warning signs
- Bone density — bone protection on steroids
- Polymyalgia rheumatica — condition hub
- Flare-up guide — flare or something more serious