What You Need to Know About Prednisone

It's used to treat a variety of conditions, but proper use is essential

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Prednisone is a potent anti-inflammatory medication used to treat inflammatory types of arthritis and other conditions. 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, there are some facts about the drug you should know. 

To begin with, 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.

What Does Prednisone Treat?

Prednisone is used to treat arthritis, to reduce inflammation and suppress immune system activity. It's available in tablet form, liquid, or concentrated solution to take by mouth.

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.

A patient should review all other medications and supplements which they take with their doctor. It is possible that your dose of prednisone may need to be adjusted with other medications or supplements you take. Depending on the condition being treated, a starting dose between 5 mg and 60 mg per day 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 you take prednisone. Your dose may need to be adjusted temporarily.

Long-Term Effects of Prednisone

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

Patients are often told not to stop taking prednisone 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 patient could put themselves in jeopardy of entering into adrenal crisis (e.g., nausea, vomiting, shock).

Drug interactions are possible with prednisone.

 For example, 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 of 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. Patients 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.

In addition, prednisone may cause osteoporosis, a brittle bones condition.

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

Sources:

 Arthritis Foundation Drug Guide:  Prednisone/ About Corticosteroids

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