Prednisone (Steroids)

Prednisone is used in the management of multiple conditions or diseases in which the immune system plays an important role. Prednisone belongs to a class of drugs known as corticosteroids. Corticosteroids work by decreasing the body’s immune system response to various diseases or conditions that produce symptoms such as swelling, inflammation, and allergic-type reactions.

For what conditions is Prednisone used?

Prednisone is used alone or with other medications to treat symptoms when a person has low corticosteroid levels (lack of certain hormones that are usually produced by the body that are needed for normal body functioning). Prednisone is also used to treat people with normal corticosteroid levels, who have conditions for which a doctor wants to reduce swelling, redness or to change how the immune system works.

These conditions include certain types of arthritis, severe allergic reactions, serious systemic diseases such as; multiple sclerosis or lupus. It is also the first drug of choice for most patients with primary Nephrotic Syndrome.

How is Prednisone administered?

This medication is taken by mouth. Patients prescribed prednisone should take the medication exactly as directed by their physicians. Most doctors recommend taking the medication at the same time each day. Using the medication as directed may help decrease the risk of potentially serious side effects and speed up recovery time. It is important that you take the medication exactly as prescribed to reduce the chance of unwanted side effects. It is advisable to take this medicine with food or milk to avoid stomach irritation. You should swallow the delayed-release tablet whole. Do not crush, break, or chew it.

If prescribed the oral liquid (prednisolone), measure the proper dose with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package.

If you use this medicine for a long time, do NOT stop using it suddenly without checking first with your doctor. You may need to decrease your dose slowly before stopping it completely.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label.

Prednisone Tapering

Prednisone tapering is a gradual reduction in the dose of this medication to reduce or avoid symptoms of withdrawal. This means doses start higher and drop over several days, weeks, or months so the body can adjust to the reduction. This practice is considered a necessary part of therapy if patients have taken prednisone for more than two weeks.

One of the biggest concerns in using prednisone is that the body responds in ways that foster dependency on it. This occurs because of a chemical similarity between the manufactured hormone and cortisol, a hormone which humans produce naturally. The presence of prednisone sends a signal to the adrenal system to stop making cortisol. When the prednisone is abruptly withdrawn, suddenly the body is without optimum cortisol levels.

Without prednisone tapering, hypothyroidism, complete fatigue, serious mood disruptions and even adrenal failure can occur. Do NOT suddenly stop using this medicine without checking first with your doctor.

Common side effects of prednisone include:

• Headache
• Dizziness
• Nausea
• Vomiting
• Heartburn
• Increased appetite
• Weight gain
• Sleep disturbances
• Acne
• Changes in mood or personality
• Thin and fragile skin
• Bone pain
• Osteoporosis
• Increased hair growth
• Menstrual period changes
• Blurred vision and/or cataracts
• Muscle weakness may also occur
• Prednisone also decreases the healing time of cuts and bruises due to its effect on the immune system

The risk of side effects increases with higher doses or with prolonged use of the medication. Serious, potentially dangerous reactions can also occur with the use of prednisone tablets. These require immediate medical attention. Potential risks include seizures, uncontrollable tremors in the hands, numbness in the extremities and irregular heartbeat. Swelling in any part of the body, particularly the face, throat, or stomach area also requires immediate medical attention. Some patients may experience severe psychological effects, including depression and a loss of connection to reality.

Prolonged use of prednisone tablets can damage the adrenal glands, causing them to shrink and stop producing cortisol. When the medication is stopped abruptly, the glands are unable to prepare by producing enough cortisol to prevent withdrawal symptoms, which can include vomiting and shock. Long-term use of cortisone can also cause necrosis (erosion) of the hip joints, a painful and potentially fatal condition.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness or trouble breathing.

Remember that your doctor has prescribed this medication because he or she has decided that benefits are greater than the risk of side effects. Many people using this medication do not have serious side effects.

This is not a complete list of possible side effects. If you notice other side effects not listed above, contact your doctor immediately.

Other Considerations

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children. However, children are more likely to have slower growth and bone problems if prednisone is used for a long time. Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy.

Elderly

Appropriate studies performed to date have not demonstrated specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney or heart problems that may require caution and an adjustment in the dose when receiving prednisone.

Pregnancy

Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease may outweigh the potential risks.

Breastfeeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in some cases Prednisone and a different medicine may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is very important that you tell your doctor and other health care professionals if you are taking any other drugs – this includes prescription medicines and over-the-counter remedies.

Other Interactions

Some foods, alcohol or tobacco may cause interactions with Prednisone.  You should talk to your Doctor about the possibility of these interactions before taking Prednisone.

Other Medical Problems

The presence of other medical problems may affect the use of Prednisone. Make sure you tell your doctor if you have any other medical problems.

This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away.

Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

While you are being treated with prednisone, talk with your doctor before getting any immunizations (vaccines). Prednisone may lower your body’s resistance and the vaccine may not work as well. You might also get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. If you have questions about this, talk to your doctor.

This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression; mood swings; a false or unusual sense of well-being; trouble with sleeping; or personality changes while taking this medicine.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain skin tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

*Note: The decision to prescribe a medication is the responsibility of your physician/primary care provider based on his/her evaluation of your condition. The above is meant for informational purposes only. Discuss this information and all information about drugs/medications with your physician before starting or stopping any medication.