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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.
How is Prednisone Used?
Prednisone is used alone or with other medications to treat symptoms when a person has low corticosteroid levels (a lack of certain hormones that are usually produced by the body and are needed for normal body functioning).
Prednisone is also used in people whose corticosteroid levels are normal, but who have conditions that require treatment to reduce swelling/redness or change how their immune system works. These conditions include certain types of arthritis, severe allergic reactions, serious systemic diseases such as multiple sclerosis or lupus, and nephrotic syndrome. It is typically the first drug of choice for most patients with primary nephrotic syndrome.
How is Prednisone Administered?
Prednisone is taken by mouth, either in a tablet or liquid form. Patients prescribed prednisone should take it exactly as directed by their physicians. Using the medication as directed may help decrease the risk of potentially serious side effects and speed up recovery time. The dosage will be different for different patients.
Most doctors recommend taking prednisone at the same time each day. Taking this medicine with food or milk can help prevent 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 take prednisone for a long time, do NOT stop using it suddenly without talking to your doctor first. You may need to decrease your dose slowly before stopping it completely to prevent withdrawal symptoms.
What is Prednisone Tapering?
Prednisone tapering is a gradual reduction in the dosage to reduce or avoid symptoms of withdrawal. Doses will 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 that humans produce naturally. The presence of prednisone sends a signal to the adrenal system to stop making cortisol. When the prednisone is abruptly withdrawn, the body is suddenly without optimum cortisol levels — this can lead to adrenal suppression, a potentially serious condition.
Without tapering off prednisone, hypothyroidism, complete fatigue, serious mood disruptions, and even adrenal failure can occur. Do NOT suddenly stop taking this medicine without talking to your doctor first.
*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.
Frequently Asked Questions
Additional 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 treatment.
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 dosage when taking prednisone.
Pregnancy
Studies in pregnant women have demonstrated a risk to the fetus when taking prednisone. However, the benefits of therapy in a life-threatening situation or a serious disease may outweigh the potential risks. Studies also suggest that this medication poses minimal risk to the infant when used during breastfeeding.
Other Medical Conditions
The presence of other medical conditions 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.
Make sure any doctor or dentist who treats you knows that you are taking prednisone. This medicine may affect the results of certain skin tests.
*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.
Are you weaning off or have taken steroids for a long time and are feeling extreme fatigue, joint pain, nausea, or intolerance to hot and cold? If so, you may be experiencing adrenal suppression.
What are adrenal glands?
Adrenal glands are triangular-shaped glands that sit on top of your kidneys. They produce cortisol, a hormone that plays many important roles in keeping your body functioning, including:
- Suppressing inflammation
- Regulating blood pressure
- Increasing blood sugar
- Helping to control your body’s use of fats, proteins, and carbohydrates
What is adrenal suppression?
Many individuals with rare, protein-spilling diseases take steroids to prevent protein from spilling into their urine. While short-term steroid treatment does not pose major risks, long-term use of steroids can put one at risk of adrenal suppression.
Adrenal suppression occurs when the adrenal glands don’t produce enough cortisol. This condition can be caused by suddenly stopping or slowly weaning off chronic or high-dose steroid medication, and can also affect patients who take chronic, low-dose steroid medication on a daily basis. Taking steroids for a prolonged period of time can cause the adrenal glands to stop producing enough cortisol for the body’s normal needs.
Symptoms of adrenal suppression include:
- Fatigue
- Weakness
- Nausea
- Vomiting
- Diarrhea
- Intolerance to hot and cold temperatures
- Headaches
- Abdominal pain
- Muscle pain
- Joint pain
- Muscle spasms
- Stunted growth
- Weight loss
Adrenal suppression can lead to an “adrenal crisis,” a medical emergency caused by a lack of cortisol. When your body becomes stressed, which can be due to an infection, surgery, extreme physical activity, or emotional stress, among other causes, you may need a “stress dose,” or an emergency dose of steroids, to prevent severe complications. If left untreated, an adrenal crisis can be fatal.
How is adrenal suppression diagnosed?
If your doctor thinks you may be suffering from adrenal suppression, they will order blood work to check your blood for cortisol and ACTH (a hormone released from the pituitary gland, a small gland in your brain). In some cases, your doctor may order other tests to determine how your adrenal glands are functioning. If you are concerned about your risk of acquiring adrenal suppression, talk to your doctor and ask for a referral to see an endocrinologist.
Should you see an endocrinologist?
If you are weaning from long-term steroid use or taking low-dose steroids daily, you should consider seeing a doctor who specializes in endocrine glands and hormones, called an endocrinologist. An endocrinologist will be able to look at your lab work to see if you are experiencing adrenal suppression and talk to you about your risk for an adrenal crisis.
References
Elshimy, G., Alghoula, F., & Jeong, J.M. (2020). Adrenal Crisis. https://www.ncbi.nlm.nih.gov/books/NBK499968/ Rushworth, R.L., Torpy, D.J., & Falhammar, H. (2019). Adrenal Crisis. The New England Journal of Medicine 381(9), 852-861. https://doi.org/10.1056/NEJMra1807486
Although certain medicines should never be used together because of potential interactions, there are some cases where prednisone and a different medicine may be used together even if an interaction might occur. In these cases, your doctor may change your dosage, or other precautions may be necessary.
It’s very important to tell your doctor and other health care professionals if you are taking any other drugs before starting prednisone. Additionally, you shouldn’t take any other drugs while taking prednisone without discussing it with your doctor first. This includes prescription medicines, over-the-counter (OTC) medicines, vitamins, and even herbal supplements.
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.
