Prednisone - 10 Things You Should Know

Proper Use of Prednisone Is Essential to Avoid Adverse Events

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Prednisone is a potent anti-inflammatory medication used to treat inflammatory types of arthritis and other conditions by suppressing immune system activity. It is available in tablet form, liquid, or concentrated solution to take by mouth.

Misuse can lead to undesirable side effects. Prednisone must be taken according to directions and safety warnings should be followed. If you're going to start taking prednisone, here are some facts about the drug you should know.

Prednisone is a synthetic corticosteroid designed to mimic cortisol action in the body.

An important hormone, cortisol is secreted by the adrenal glands and involved in functions such as glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance. It's also important to immune system functions and in how the body responds to inflammation. Cortisol has been nicknamed the stress hormone since it's secreted in higher levels during times of stress, and is responsible for several stress-related changes in the body.

Prednisone is inactive in the body until it is converted to prednisolone by liver enzymes. 

People who have liver conditions may less effectively convert prednisone to prednisolone. In some cases, a higher dose may be required to compensate for the liver problem.

You should review all medications and supplements that you take with your doctor.

It is possible that your dose of prednisone may need to be adjusted after considering the other medications or supplements you take.

Depending on the condition being treated, a starting dose between 5 mg and 60 mg per day of prednisone is not uncommon. The dose is further adjusted based on treatment response. The benefit is usually not immediate and may take a few days or longer.

The most common way to take prednisone is as a single daily dose taken with breakfast.

The usual directions suggest prednisone should be taken with food.

 Sometimes the dose can be split and taken either twice or four times a day. If you are having a planned surgery or have a medical emergency, let doctors know that you take prednisone. Your dose may need to be adjusted temporarily.

Prolonged use of prednisone can cause adrenal glands to atrophy and stop producing cortisol.

People who take prednisone are often warned not to stop the medication suddenly. After long-term use, the dose of prednisone must be tapered gradually to allow the adrenal glands, which may have atrophied, time to recover. Otherwise, the individual treated with prednisone could put themselves in jeopardy of entering into adrenal crisis (e.g., nausea, vomiting, shock).

Drug interactions are possible with prednisone. 

Estrogen may interfere with breaking down of prednisolone (the active form of prednisone). If an increased level of prednisolone results in the body, more side effects are possible. Another drug, Dilantin, increases the activity of liver enzymes that eliminate prednisone and may decrease the effectiveness of prednisone.

Side effects can occur with prednisone.

There are mild to severe side effects associated with prednisone use. The side effects occur more frequently with high-dose or long-term use of prednisone.

These may include sodium retention or fluid retention, weight gain, high blood pressure, and elevated blood sugar. Prednisone can also result in elevated blood fats, potassium loss, muscle weakness and headaches. People taking prednisone may bruise more easily, experience facial hair growth, facial puffiness, and wounds may take longer to heal.

Milder side effects of prednisone use include increased appetite and insomnia. More serious conditions that could be caused by prednisone use include cataracts, glaucoma, stomach ulcers, aseptic necrosis and psychiatric issues including depression and mood swings.

Women taking prednisone may see irregular periods, and it may stunt growth in children. 

If you are taking prednisone and become pregnant, wish to become pregnant, or are breastfeeding, you should alert your doctor.

Prednisone is less likely to cross the placenta than some of the other corticosteroids, but it may cause a birth defect, such as cleft palate. Prednisone is less likely than other corticosteroids to be secreted in breast milk, but still may cause problems for the baby.

Prednisone increases the risk of infections and decreases the effectiveness of vaccines and antibiotics.

It is imperative that you discuss a current or ongoing infection with your doctor. Because prednisone suppresses the immune system, adjustments may need to be made to your treatment plan.

Prednisone may cause osteoporosis, a condition of brittle bones.

High-dose and long-term use of prednisone may increase the risk of developing osteoporosis. People are usually advised to take calcium and vitamin D, and possibly one of the bisphosphonates (e.g., Fosamax, Actonel, Boniva, Calcitonin).

Sources:

Prednisone / About Corticosteroids. Arthritis Foundation Drug Guide

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