Many patients are not as well informed about prescription medications as they ought to be. We believe the more you know about your medications, the better. This leaflet has been written to help you understand more about what prednisone is and the importance of taking it properly. If any of the information below causes you special concern or if you want additional information about prednisone and its use, check with your doctor or pharmacist. Remember to keep all prescription drugs out of reach and sight of children when not in use. Store all medicines in their original labeled containers and always read the label before using.
What is prednisone?
Prednisone is a steroid. Steroids are a group of hormones with similar chemical structures. They are normally produced by your adrenal glands, located on top of your kidneys, and your reproductive organs (ovaries and testicles). Steroids help control metabolism, inflammation, immune function, salt and water balance, development of sexual characteristics and your ability to withstand the stress of illness and injury.
One of the steroids produced by the outer portion of the adrenal glands is called cortisone. It normally helps regulate the body's salt and water balance and reduces inflammation. Introduced in 1955, prednisone is a man-made replica of cortisone. The adrenal glands normally produces an amount of steroids equivalent to about 5 mg. of prednisone a day. When prescribed in doses that exceed natural levels, prednisone suppresses inflammation and can help treat a variety of diseases such as severe allergies or skin problems, asthma, arthritis, ulcerative colitis, and Crohn's disease. Prednisone is also used to help prevent rejection of organ transplants.
Prednisone is the generic form; some common brand names are Deltasone, Meticorten, Orasone, and SK-Prednisone.
What prednisone is not
Prednisone is not the same as the dangerous anabolic steroids used by weight lifters to increase muscle mass. It is not a sex hormone like testosterone or estrogen and does not cause sexual dysfunction. Prednisone is not addictive. It does not cause drowsiness and in the usual doses will not affect your driving or working. There is no special food interaction and mild alcohol consumption is not a problem on prednisone.
How does prednisone work?
The exact mechanism of how prednisone works is not known.
Taking prednisone properly
In 1948, physicians at the Mayo Clinic were the first to use steroids to treat disease. They gave cortisone to patients crippled by severe rheumatoid arthritis and were amazed by the results after just a few days of use. People, who couldn't rise from a chair, shave, open a door or lift a cup, now could walk and even dance. Cortisone was hailed as a "miracle drug." Unfortunately, it was too good to be true. Problems soon emerged. Patients taking cortisone in doses high enough to relieve inflammation routinely experienced harmful side effects. Physicians now recognize that prolonged use of cortisone-like drugs like prednisone can cause many side effects. But when serious disease occurs, the benefit of prednisone usually outweighs the potential risks. For difficult to manage conditions, prednisone can still be a miraculous medication. In general, the risk of side effects depends on the length of time you take prednisone and the amount you take. You can help limit side effects by taking the medication exactly as prescribed and reporting any problems to your doctor.
Usually the most dreaded of prednisone's side-effects, increased appetite and weight gain are seen to some degree by nearly all patients. The amount of weight gain varies from individual to individual. In addition to causing weight gain, prednisone also tends to redistribute body fat to places that are undesirable, particularly the face (moon face), back of the neck (buffalo hump), and abdomen. The higher the dose and the longer the treatment, the greater the effect. To some extent these changes can be minimized by exercise and the dietary changes described below. If you find this confusing, a consultation with a registered dietitian or nutritionist may be helpful. Ask your doctor for a recommendation.
Another reason to avoid sugary foods is the fact that prednisone has a tendency to raise the level of glucose, or sugar, in the blood. In most individuals, this has little significance. However, in diabetics or those with a history of "borderline" diabetes, the rise in blood sugar can be significant. Overweight individuals, pregnant women, and those with a family history of diabetes may also be at risk. Some diabetics who have been previously controlled by diet or pills may have to switch to insulin for a short time. Fortunately, this rise in blood sugar usually resolves when the prednisone dose is decreased or discontinued. Make sure your doctor knows if you are diabetic and all patients on prednisone should have periodic blood sugar tests.
3. Preventing Osteoporosis
Most of us don't realize that our bones are living organs that are constantly changing. Every day old bone cells die and new ones are created to take their place. Prednisone increases the loss of bone and slows the formation of new bone cells. Eventually, this may result in a decrease in bone density, or osteoporosis. Osteoporosis is a common condition in adult Americans causing over 1.5 million fractures each year, including more than 300,000 hip fractures. Prednisone may cause osteoporosis even in people who are not usually at high risk such as males and young people. In people susceptible to osteoporosis, prednisone may accelerate the process of bone loss and increases the risk of fracture of the spine or hip. Other risk factors include:
If you are on long term prednisone, you must aggressively counteract your increased risk as noted below.
4. Avascular necrosis
Fortunately, this side effect of high dose prednisone is not common. For reasons that are not known, some patients develop a rare form of damage to the hip joint called avascular necrosis (or osteonecrosis, meaning "bone death"). This syndrome causes pain with weight-bearing and some loss of joint function. Many patients with avascular necrosis require joint replacements.
5. Skin problems
Prednisone may cause acne of the face, chest, and back - "steroid acne." This is especially a problem in teenagers, but can occur at any age. In most cases, keeping the skin as clean as possible and using topical antiacne medications will control the problem. If simple measures don't help, a consultation with a dermatologist may be needed. Patients on prednisone also often notice that they bruise easily, even with only slight trauma. Other skin problems include slow wound healing, redness of the face (plethora), stretch marks, night sweats, and increased facial hair. People on prednisone should keep their skin clean and protected and avoid skin trauma including sunburn.
6. Digestive upset
Prednisone is helpful to those with inflammatory disorders of the colon and small intestine such as colitis and Crohn's disease; but high doses may cause irritation of the upper digestive system. When inflammation occurs in the stomach lining, it is called gastritis. If severe, a peptic ulcer may develop. This is especially true if the patient is a past history of ulcers or regularly takes other anti-inflammatory drugs such as aspirin or prescription medications for arthritis.
In mild cases, simple over-the-counter antacids may be helpful; but all antacids - including Tums - can decrease the absorption of prednisone - so antacids shouldn't be taken within an hour of prednisone. If persistent symptoms of nausea or heartburn develop while on prednisone, your doctor can prescribe stronger medications that easily controls stomach inflammation.
7. Mood swings
People on prednisone commonly experience changes in mood, particularly when they are taking high doses. One day, they may feel euphoric for no apparent reason. Many have difficulty sleeping at night. At other times, there may be unexplained feelings of anxiety or a lack of concentration. It is common to feel tired and blue for a few days each time the dose of prednisone is being tapered downward. In most patients, these effects are mild, but can be very disturbing - both for the patient and their family.
Be prepared. If you experience mental changes during prednisone therapy, be reassured that you are not crazy and that these changes will subside as the medication is withdrawn. It is important to anticipate this problem and to discuss it with your friends and family. Let them know that you may experience mood swings, short temper, and irritability and it's not their fault. Try to minimize the stresses in your life. If you can't cope, discuss it with your doctor. He may have to adjust your dosage or suggest stress reduction counseling. In some cases, it may be necessary to take medications for anxiety or antidepressants for a short while. If insomnia is a problem, try taking a short nap in the afternoon.
8. Eye changes
High dose or long-term use of prednisone can cause two types of eye problems - cataracts and glaucoma. Cataracts are deposits in the lens of the eye and are part of the normal aging process. They are more common after long term prednisone usage and there is nothing you can do to prevent them. Fortunately, the cataracts caused by prednisone are usually small and usually not the type that interfere with normal vision. Prednisone can also increase the pressure of the fluid inside the eyeball, a painless condition known as glaucoma. If eyeball pressure rises high enough, vision may be permanently damaged. Blindness can result. However, once diagnosed, glaucoma can be treated with prescription eyedrops. Patients on prednisone should see their eye doctor at least once a year for a complete eye examination.
9. Immune system
One of the actions of prednisone is to weaken the body's immune system. This effect is beneficial when treating allergies or so-called "autoimmune" diseases like arthritis, lupus, ulcerative colitis and Crohn's disease. However, whenever you weaken the immune system, you increase the body's susceptibility to infection. Prednisone does not make an individual more likely to get a flu or catch a cold. But, it can increase susceptibility to chickenpox (varicella) and other herpes viruses. Individuals, who have recovered from tuberculosis, or TB, can experience reactivation of the disease when on prednisone. If you have not previously had chickenpox, tell your doctor. Do not take prednisone if you have tuberculosis (active or inactive), shingles or other herpes infection of eyes, lips, or genitals. You should not be vaccinated against any infectious disease while you are on prednisone especially live polio vaccine. Allergy skin tests and TB skin tests will usually be invalid while you are on prednisone. A small number of patients on prednisone develop yeast infections of the mouth (thrush) or vagina. Fortunately, effective medications are available to combat this problem should it occur.
Prednisone is one of the most powerful medicines prescribed and has many beneficial actions, but as noted above there can be many potential problems. Side effects are usually dose-dependent. This means the more prednisone you take over a longer period of time, the greater the risk of side effects. Therefore, once your condition comes under control, your doctor will usually suggest that the dose be gradually reduced. The goal is to get off the medication entirely although this is not possible in every case.
Just as taking prednisone can cause side effects, reducing the dose may cause problems as well. Prednisone is not addicting like a narcotic, but many patients experience withdrawal symptoms as the dose is reduced. These often include muscle soreness, joint pain, fatigue, and depression. Know that these effects are also temporary and worth bearing to allow a cutback in your dose. If you experience any unusual symptoms as your prednisone dose is reduced, contact your doctor. It may be necessary to temporarily increase your steroid dose until you are feeling better and then taper the dose more slowly.
Notify your doctor if you suffer from severe depression, diabetes, or high blood pressure. Be sure to inform him if you are taking diuretics (water pills), digoxin, Coumadin, phenobarbital, or medications for arthritis. Let your doctor know if you may be pregnant or plan to become pregnant in the near future. Low dose prednisone can be used in pregnancy if necessary. However, it is best to avoid all potent prescription drugs during pregnancy whenever possible.
Prednisone is a type of steroid medication that resembles cortisone, a hormone naturally produced by the body. It is a powerful drug with many helpful properties and, when used properly, prednisone saves lives. But as with all medications, side effects may occur. Before prescribing prednisone, your doctor considers alternatives and carefully weighs the benefits against the risks. You can best limit problems with this medication by taking it exactly as prescribed and seeing your doctor for regular follow-up visits. If you have any questions or concerns, please discuss them with your doctor.