Drug Name

Prednisone (Prednisone)

Drug Uses

Prednisone is used in the management of inflammatory conditions or diseases in which the immune system plays an important role. Since prednisone is used in so many conditions, only the most common or established uses are mentioned here. Prednisone most often is used for treating several types of arthritis, ulcerative colitis, Crohn's disease, systemic lupus, allergic reactions, asthma and severe psoriasis. It also is used for treating leukemias, lymphomas, idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. Corticosteroids, including prednisone, are commonly used to suppress the immune system and prevent the body from rejecting transplanted organs. Prednisone is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of cortisol.

How Taken

Tablets of 2.5, 5, 10, 20, and 50 mg. Oral solution or syrup of 5mg/5ml. The initial dose of prednisone varies depending on the condition being treated and the age of the patient. The starting dose may be from 5 to 60 mg per day and often is adjusted based on the response of the condition being treated. Corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment. Prolonged therapy with prednisone causes the adrenal glands to atrophy and stop producing cortisol. When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover. (See side effects.) It is recommended that prednisone be taken with food.

Drug Class and Mechanism

Prednisone is an oral, synthetic (man-made) corticosteroid used for suppressing the immune system and inflammation. It has effects similar to other corticosteroids such as triamcinolone (Kenacort), methylprednisolone (Medrol), prednisolone (Prelone) and dexamethasone (Decadron). These synthetic corticosteroids mimic the action of cortisol (hydrocortisone), the naturally-occurring corticosteroid produced in the body by the adrenal glands. Corticosteroids have many effects on the body, but they most often are used for their potent anti-inflammatory effects, particularly in those conditions in which the immune system plays an important role. Such conditions include arthritis, colitis, asthma, bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. Prednisone is inactive in the body and, in order to be effective, first must be converted to prednisolone by enzymes in the liver. Therefore, prednisone may not work as effectively in people with liver disease whose ability to convert prednisone to prednisolone is impaired.

Missed Dose

If you take one dose daily, take the missed dose as soon as you remember. However, if you don't remember until the next day, skip the dose you missed and take only your regular daily dose. If you take more than one dose daily, you can either take the missed dose as soon as you remember, or you can take two doses at the next dose time. If you take one dose every other day, take the missed dose as soon as you remember, then go back to your regular every-other-day schedule.

Storage

Store at room temperature 20-25 degrees C (68-77 degrees F), and keep away from moisture.

Warnings/Precautions

Avoid alcohol. Acting together, alcohol and prednisone can be damaging to the stomach. Avoid sources of infection. Wash your hands frequently and keep them away from the mouth and eyes. Your immune system may be weakened while taking prednisone. Do not receive any immunizations during treatment with prednisone without first talking to your doctor. Prednisone may interact with estrogens and phenytoin (Dilantin). Estrogens may reduce the action of enzymes in the liver that break down (eliminate) the active form of prednisone, prednisolone. As a result, the levels of prednisolone in the body may increase and lead to more frequent side effects. Phenytoin increases the activity of enzymes in the liver that break down (eliminate) prednisone and thereby may reduce the effectiveness of prednisone. Thus, if phenytoin is being taken, an increased dose of prednisone may be required. Corticosteroids are secreted in breast milk and can cause side effects in the nursing infant. Prednisone is less likely than other corticosteroids to be secreted in breast milk, but it may still pose a risk to the infant.

Possible Side Effects

Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible damage, and they occur more frequently with higher doses and more prolonged treatment. Side effects include retention of sodium (salt) and fluid, weight gain, high blood pressure, loss of potassium, headache and muscle weakness. Prednisone also causes puffiness of the face (moon face), growth of facial hair, thinning and easy bruising of the skin, impaired wound-healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back ("buffalo hump"), obesity, retardation of growth in children, convulsions, and psychiatric disturbances. The psychiatric disturbances include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. Prednisone suppresses the immune system and, therefore, increases the frequency or severity of infections and decreases the effectiveness of vaccines and antibiotics. Prednisone may cause osteoporosis that results in fractures of bones. Patients taking long-term prednisone often receive supplements of calcium and vitamin D to counteract the effects on bones. Calcium and vitamin D probably are not enough, however, and treatment with bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel) may be necessary. Calcitonin (Miacalcin) also is effective. The development of osteoporosis and the need for treatment can be monitored, using bone density scans.

More Information

If you experience any of the following serious side effects, stop taking prednisone and seek emergency medical attention or contact your doctor immediately: an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); increased blood pressure (severe headache or blurred vision); or sudden weight gain (more than 5 pounds in a day or two). Other, less serious side effects may be more likely to occur. Continue to take prednisone and talk to your doctor if you experience insomnia; nausea, vomiting, or stomach upset; fatigue or dizziness; muscle weakness or joint pain; problems with diabetes control; or increased hunger or thirst. Other side effects that occur only rarely, usually with high doses of prednisone, include acne, increased hair growth, thinning of the skin, cataracts, glaucoma, osteoporosis, roundness of the face, and changes in behavior. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.