Prednisone: The Benefits and Precautions

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, as a liquid, or as a concentrated solution to be taken by mouth.

When you are prescribed prednisone, it must be taken according to the directions and you should follow any safety warnings. Misuse can lead to undesirable side effects.

If you're going to start taking prednisone, here are some facts about the drug that you should know.

The Benefits

Prednisone belongs to a class of drugs known as corticosteroids. It is known to quickly decrease inflammation and that is why it is a popular and useful treatment for inflammatory types of arthritis.

Prednisone has the ability to manage flares and help people feel better by decreasing joint swelling, joint pain, and fatigue. In early rheumatoid arthritis, it may also slow joint damage because of its disease-modifying properties.

Generally, rheumatologists tend to prescribe oral corticosteroids early in the course of arthritis to quickly control inflammation until other disease-modifying anti-rheumatic drugs (DMARDs) can take effect. DMARDs are slow-acting medications, so prednisone can be very helpful in the interim.

The Side Effects

The side effects associated with prednisone can be mild to severe.

They occur more frequently with high-dose or long-term use. 

According to rheumatologist Scott J. Zashin, MD, "While it is unclear if doses of prednisone 3 mg or less are associated with clinically significant toxicity, doses of even 5 mg per day carry an increased risk of osteoporosis, cataracts, and affecting lipid levels.

Higher doses may have other potential toxicities including decreased wound healing, masking infection, and increasing the risk of infection."

Other side effects associated with oral corticosteroids include:

  • Elevated eye pressure (e.g., glaucoma)
  • Fluid retention (e.g., edema in lower legs)
  • Hypertension (high blood pressure)
  • Psychological effects, including mood, memory, and behavioral changes
  • Weight gain (fatty deposits in the face, abdomen, or back of the neck)

Dr. Zashin continues, "Certainly, there are patients with rheumatoid arthritis who remain on prednisone long term. In those cases, the doctor and patient must weigh the benefits of the drug, as well as its potential side effects, and consider the alternatives available when making the best treatment decision."

Long-term use of oral corticosteroids is associated with the following risks:

  • Cataracts in one or both eyes
  • High blood sugar
  • Greater risk of infections
  • Osteoporosis and fractures
  • Suppression of adrenal gland hormone production
  • Thinning of skin, with increased bruising possible
  • Myopathy
  • Peptic ulcer disease

Additional Side Effects

Prednisone can also result in sodium retention, 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 include stomach ulcers and aseptic necrosis as well as those already mentioned.

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

9 Things You Should Know

The issue with prednisone and other oral corticosteroids is that they are not targeted at a particular body part or function. Instead, these medications affect the entire body systemically.

This increases the likelihood of significant side effects when compared to corticosteroids that are administered topically or as a local injection. For this reason, it is important to be aware of potential side effects and try to minimize the impact.

It Mimics Cortisol

As a synthetic corticosteroid, prednisone is 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, and insulin release for blood sugar maintenance. It's also essential for 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. It is responsible for several stress-related changes in the body.

The Liver's Role

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.

When Adjustments Are Needed

It is important that you 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 taking these into consideration.

Depending on the condition being treated, a starting dose of 5 mg to 60 mg per day of prednisone is not uncommon. Your doctor may adjust this further based on your body's response to the treatment. The benefit is usually not immediate; it may take a few days or longer to see any results.

Drug Interactions

A number of drug interactions are possible with prednisone. This is another reason to tell your doctor about everything you're taking, including herbal supplements and vitamins.

For example, estrogen may interfere with the 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 medication, Dilantin (phenytoin), increases the activity of liver enzymes that eliminate prednisone, which may decrease its effectiveness. 

Taken With Food

The most common way to take prednisone is as a single daily dose with breakfast. The standard directions suggest that it should be taken with food. Sometimes, the dose can be split and taken either twice or four times a day. However, it's best to speak with your doctor before making your own adjustments.

If you are having a planned surgery or have a medical emergency, let the doctors know that you take prednisone. Your dose may need to be temporarily adjusted.

Effect on Adrenal Glands

Prolonged use of prednisone can cause adrenal glands to atrophy and stop producing cortisol. Due to this, people who take prednisone are often warned not to suddenly stop the medication. 

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, you could put yourself in jeopardy of entering into adrenal crisis (e.g., nausea, vomiting, shock).

Prednisone and Pregnancy

If you are taking prednisone and become pregnant, wish to become pregnant, or are breastfeeding, it's best to speak with 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 a cleft palate. It's also less likely than other corticosteroids to be secreted in breast milk but may still cause problems for the baby.

Infections and Vaccines

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.

Osteoporosis

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

Again, this is something to discuss with your doctor, particularly if you are already at high risk for osteoporosis.

A Word From Verywell

While an awareness of the risks of prednisone use is the first step in managing potential side effects, you can be proactive in minimizing the side effects. For example, you and your doctor may consider lowering your dose or using it for a shorter period of time. Some people find it helpful to have an intermittent dosing schedule in which they take prednisone every other day.

Try to pay attention to your diet and weight as well, even more than usual. Eating healthy can help reduce any potential weight gain and supply vital nutrients your body needs.

Also, keep in mind that if you have been taking prednisone for awhile, you should not discontinue it suddenly. Tapering the drug slowly will help you avoid or minimize side effects which can be caused by sudden discontinuation.

Sources:

Arthritis Foundation.  Drug Guide: About Corticosteroids

Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. Glucocorticoid Therapy. In: Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017: 932-957.

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