Prednizone- the correct spelling is “prednisone”- is a commonly used oral glucocorticoid medicine.
The adrenal glands manufacture a natural form of glucocorticoid. Glucocorticoids are responsible for many functions in the body including maintenance of blood pressure, proper use of sugar, protein, and fat metabolism, response to stress, and many other tasks.
Glucocorticoids manufactured by the body are referred to as endogenous steroids- meaning a person’s own body makes these steroids.
When steroids are taken in from the outside either by mouth, intramuscularly or intravenously, they are referred to as exogenous steroids. Taking glucocorticoids orally or intravenously can reduce the ability of the person’s own adrenal glands to continue to manufacture glucocorticoids.
Without the ability to increase steroid production in the face of stressors such as injury, infection, and surgery, a patient can go into shock.
The chances of the adrenal glands being suppressed increase as the dose of “outside” steroid exceeds the average daily equivalent output of the adrenal glands which is about 5.0-7.5 mg prednisone, therapy continues for more than a few weeks or months, doses are given late in the day or in split doses, or long-acting corticosteroid preparations are used.
Patients who require high doses of prednisone (more than 20 mgs a day) for extended periods of time often will develop side-effects.
Taking steroids on an alternate day (every other day) schedule lessens the chance of adrenal insufficiency but does not do away with it altogether.
Other side-effects include:
o Increased risk of bacterial or opportunistic infections such as fungi, tuberculosis, pneumocystis carinii
o Elevated blood sugar
o Fat distribution changes leading to moon face, buffalo hump
o Elevated blood lipids
o Aggravation of hypertension
o Electrolyte abnormalities such as low blood potassium
o Fluid retention leading to edema
o Easy bruisibility
o Increased body hair
o Increased sweating
o Purple stretch marks
o Impaired wound healing
o Glaucoma
o Cataracts
o Muscle wasting
o Stomach ulcers
o Pancreatitis
o Accelerated hardening of the arteries
o Osteonecrosis (bone death)
o Psychiatric disturbance
o Insomnia
o Bowel perforation
o Masking of infection
The use of prednisone for different diseases such as arthritis needs to be assessed with the potential benefits vs. the risks. These benefits and risks need to be discussed with your rheumatologist.
