Prednisone

How it works

     * Prednisone is a corticosteroid that is used to reduce inflammation
       and calm down an overactive immune system. Its glucocorticoid
       activity is greater than its mineralocorticoid activity, which
       means that it has more effects on the immune response and
       inflammation than it does on electrolytes and fluid. Prednisone may
       also be called a glucocorticoid.
     * Prednisone mimics the effect of glucocorticoid hormones that are
       secreted naturally by our adrenal glands in response to stress and
       which are essential for life. Prednisone is a man-made (synthetic)
       version of these hormones.

Upsides

     * Prednisone helps dampen down an over-reactive immune system and
       reduces inflammation.
     * Can help control severe or incapacitating allergic conditions
       unresponsive to conventional treatment including asthma, allergic
       rhinitis, and atopic dermatitis.
     * Controls excessive inflammation associated with certain eye
       diseases, skin diseases, hematological disorders, and respiratory
       diseases.
     * May be used short-term in the management of acute flare-ups or
       exacerbations of arthritis (includes Rheumatoid arthritis,
       osteoarthritis, and psoriatic arthritis), ankylosing spondylitis,
       bursitis, and other inflammatory disorders.
     * May be used short-term for the management of collagen disorders
       including systemic lupus erythematosus, polymyositis, and acute
       rheumatic carditis.
     * Used for the palliative care of certain leukemias and lymphomas.
     * In people with endocrine disorders, mineralocorticoids such as
       hydrocortisone or cortisone are mostly preferred over prednisone;
       however, in certain circumstances, prednisone may be given.
     * Can help regain control over the inflammatory process associated
       with diseases such as ulcerative colitis and regional
       enteritis. May be used in the treatment of some kidney disorders.
     * May be used short-term for a number of other conditions.
     * Generic prednisone is available.

Downsides

   If you are between the ages of 18 and 60, take no other medication or
   have no other medical conditions, side effects you are more likely to
   experience include:
     * Agitation or irritability, dizziness, indigestion, headache, an
       irregular heart beat, swelling, and mood changes are common side
       effects reported with short-term use. Facial hair growth
       (especially in women); high blood pressure and other cardiovascular
       effects; an increased appetite which may result in weight gain;
       slow skin healing and skin thinning; osteoporosis (brittle bones);
       the onset of diabetes; and stomach ulcers are associated with
       moderate-to-long term use.
     * Prednisone increases a person's susceptibility to infection. The
       risk is greater with higher dosages. Some signs of an infection may
       be masked by prednisone. Some infections associated with prednisone
       use have been fatal, especially those associated with viral
       illnesses such as chickenpox or measles.
     * Prednisone exacerbates systemic fungal infections and should not be
       used in people with systemic fungal disease (such as candidiasis or
       aspergillosis). Latent diseases (caused by pathogens such as
       amoeba, tuberculosis, or Toxoplasma) may also be activated.
     * Side effects are more likely to be experienced at dosages greater
       than 7.5 mg/day and with long-term therapy. Long-term prednisone
       administration has been associated with the suppression of the
       hypothalamic-pituitary adrenal (HPA) axis (a complex interactive
       signaling and feedback system involving the hypothalamus, the
       pituitary gland, and the adrenal glands). Suppression of this axis
       can result in corticosteroid insufficiency - where natural
       corticosteroid levels are no longer adequate to maintain vital
       bodily processes - after withdrawal of treatment. For this reason,
       moderate-to-long-term prednisone therapy should be withdrawn
       gradually.
     * The dosage of prednisone requires adjusting during times of stress.
     * All corticosteroids, including prednisone, can cause salt and fluid
       retention, which may lead to blood pressure elevation and increased
       potassium excretion. Calcium excretion is also increased.
     * Prolonged prednisone use may affect growth and development in
       children.
     * Cataracts, glaucoma, eye infections, an increase in new episodes of
       optic neuritis and corneal perforation associated with herpes
       simplex of the eye, have all been reported with prednisone use.
     * Alcohol should be limited or avoided to help reduce the risk of
       gastrointestinal side effects.
     * With high doses of corticosteroids, live or live-attenuated
       vaccines should be delayed until several months after
       corticosteroid treatment has stopped.
     * May not be suitable for some people including those with
       cardiovascular disease, low thyroid levels, gastrointestinal
       disease, pre-exisiting bone disease, or psychiatric disorders.
     * May interact with a number of other drugs including some
       anti-infectives, antidiabetic agents, bupropion, NSAIDs, and drugs
       metabolized by CYP 3A4 liver enzymes.

   Notes: In general, seniors or children, people with certain medical
   conditions (such as liver or kidney problems, heart disease, diabetes,
   seizures) or people who take other medications are more at risk of
   developing a wider range of side effects. For a complete list of all
   side effects, [84]click here.

Bottom Line

     * Prednisone effectively controls inflammation and an overactive
       immune system but may not be suitable for everybody. Long-term use
       is limited by potentially severe side effects such as adrenal
       suppression and an increased risk of infection. Prednisone should
       always be used at the lowest effective dose for the shortest
       possible time.

Tips

     * Take with food and a full glass of water to reduce the risk of
       prednisone adversely affecting your stomach.
     * Single doses are preferred over split doses; however, larger
       dosages may be split. Some people may be instructed to only take
       prednisone every other day (alternate day therapy).
     * Take prednisone in the morning, before 9 AM (unless instructed
       otherwise) to more closely mimic your body's natural secretion of
       cortisol. Take your prednisone exactly as directed by your doctor.
       Never increase the dosage unless under your doctor's advice.
     * Stopping prednisone suddenly can be dangerous. Your doctor will
       advise you on how to taper down your prednisone dose if you have
       been taking it for more than a few weeks.
     * If you are taking higher dosages of prednisone, you should not
       receive any live or live-attenuated vaccines. Your response to
       killed or inactivated vaccines may also be diminished.
     * Avoid contact with anybody known to have, or recently exposed to,
       viral illnesses such as chickenpox or measles. If you inadvertently
       come into contact with somebody, contact your doctor immediately as
       immune globulin or antiviral treatment may be required.
     * Limit or avoid alcohol use while taking prednisone to help reduce
       the risk of indigestion and the development of stomach ulcers.
     * Talk with your doctor as soon as possible if you are taking
       prednisone and you become unwell, for any reason.

Response and Effectiveness

     * Prednisone takes approximately 60 minutes to be metabolized in the
       liver to its active form, prednisolone. Liver disease does not
       appear to affect metabolism. Effects can last from 18-36 hours,
       meaning that alternate day dosing is possible.
     * Temporary dosage increases may be necessary during disease
       flare-ups or during times of stress or infection.
     * Prednisone is five times more potent at relieving inflammation than
       naturally occurring cortisol.

References