Prednisone is an anti-inflammatory and immunosuppressive steroid drug (partly immunosuppressive), which is an analogue of hormones that are produced by adrenal glands. Prednisone is a prodrug, because it is an inactive precursor of prednisolone. Once it gets into the body, prednisone is activated in the liver and converted into therapeutically active prednisolone. For this reason, prednisone is not recommended for people with severe liver disease because in this case, part of the drug will simply remain inactive and the target therapeutic dose will not be achieved.
Prednisone is used in the treatment of systemic connective tissue diseases (systemic lupus erythematosus, vasculitis, rheumatoid arthritis, etc.), severe allergic reactions (swelling), bronchial asthma, inflammatory eye diseases, skin diseases, many kidney diseases, brain edema, blood diseases, etc. Prednisone is also used to eliminate vomiting and nausea associated with chemotherapy and to stimulate appetite in people with cancer.
Prednisone is similar to cortisone by its nature of action, but has more active anti-inflammatory effect and less pronounced side effects.
Prednisone is by 4 times more effective than cortisone by its anti-inflammatory effect and requires lesser dose for treatment. This drug maintains the desired concentration in the blood longer than cortisone and its effect begins earlier. Specialists use this drug to treat a huge number of inflammatory, autoimmune and oncological diseases.
Both doctors and patients need to know the possible side effects of prednisone in order to take prophylactic measures and reduce health risks.
The side effects of Prednisone depend on:
1) The duration of treatment, that is, the time, during which the patient takes prednisone. The longer the treatment without a break, the greater the risk of side effects.
2) A daily corticosteroid dose – the quantity of the drug that the patient receives daily. The higher the prednisone doses taken, the greater the likelihood of side effects.
3) Keeping the circadian rhythm. Prednisone is best absorbed in the morning, because this is the time when natural glucocorticoids are released into the blood and the risks of side effects of treatment are reduced.
Possible side effects of prednisone
- Increased appetite and weight gain – a side effect that is most commonly disturbing patients treated with prednisone and other corticosteroids. The amount of weight gained is individual for each person. In addition, prednisone can lead to a redistribution of the body fat with the formation of “fat pads” in undesirable areas, e.g., the face (at the chin), at the base of the neck (“buffalo hump “), above the clavicles and at the abdomen. Fat deposition mainly in the upper part of the body is another feature of prednisone-related weight gain .
- Prednisone possesses an immunosuppressive effect, so the body becomes more susceptible to infections. People, treated with prednisone or other steroids are more to fungal infections, herpes exacerbation and more severe diseases (e.g., pneumonia). The risk of some infectious diseases may be reduced by preventive antibiotic treatment. Only the doctor can choose and prescribe a proper antibiotic. For that reason, if you are waiting for an operation or you are being treated for an infectious disease, do not forget to tell your doctor that you are taking or have recently finished taking prednisone;
- Sleep disorders and hyperactivity (when people find it hard to remain calm and stationary) – this effect can be observed only during the first time after starting prednisone therapy;
- Increased irritability, unstable mood, psychosis (hallucinations, space disorientation) –these manifestations are usually short-lived;
- Fluid retention in the body with a decrease in the amount of urine and face puffing;
- Acne – often appears on the face after several weeks of high-dose prednisone treatment.
- Disturbances in glucose tolerance – usually a short-term side effect. Blood sugar rises, but this is usually a reversible process. After lowering the dose of prednisone or after cessation of prednisone treatment, normal blood glucose level is restored.
- Increased blood pressure – this is also a reversible process. After discontinuation of prednisone or dose reduction, blood pressure drops to normal.
- Discomfort in the gastrointestinal tract – nausea, constipation, discomfort after meals, reduction in appetite.
Possible side effects from prolonged use of high doses of prednisone
- Increased growth of facial hair; women may suffer from hirsutism – an excessive hair growth in those parts of the body where terminal hair does not normally occur or is minimal;
- Bone fractures. Long-term prednisone treatment may cause bone fragility even among those people who are not usually prone to osteoporosis (men, young patients). Prednisone may accelerate loss of bone tissue in people who are prone to osteoporosis (women after 45-50 years). However, the ways of preventing osteoporosis have significantly increased in recent years. All patients taking prednisone for a long period, if necessary, receive medicines to prevent increased bone fragility.
- Increased risk of blood clots in the vessels;
- Appearance of stretch marks – purple stripes on the sides of the torso and abdomen, often appear after long period of large doses of prednisone.
- Ease of skin damage – prednisone may lead to the “thin skin” phenomenon, when a large bruise occurs after a slight trauma (for example when a person slightly strikes his leg against a chair and breaks his skin with a large bruise.
- Glaucoma – increased intraocular pressure with further damage of the optic nerve.
- Cataract – lenticular opacity, that require surgical removal of the lens and its substitution with artificial lens in case of decreased vision
If you have any of the side effects mentioned above or other unusual reactions when taking prednisone, you should inform your doctor.
There are also some severe side effects. When they occur, you should immediately seek medical help:
- severe allergic reactions ( itching; rash; breathing difficulties; swelling of the face, lips, eyelids, tongue, neck);
- diarrhea, black tarry stools;
- depression, headache, convulsions;
- menstrual irregularities;
- fever, muscle weakness;
- swelling of legs or feet, puffing of the face;
- fast weight gain or weight loss;
- vomiting something that looks like coffee grounds;
- increased intraocular pressure and reduced vision;
- severe nausea or vomiting.
Side effects in children
Suppression of adrenal glands is one of the effects of prednisone in children. That is why the dependence of a young body on steroids increases, and the ability to produce its own corticosteroids is reduced. This can be prevented by gradual and not sudden withdrawal of the medicine. It is also possible for a child to develop type 2 diabetes, obesity, and hirsutism. Many side effects in children are associated with fast growth and development of the organism. Therefore, the targets of side effects are organs and systems that are mostly affected by developmental changes. This may result in loss of bone density, increased fractures, peptic ulcers, increased blood pH level (alkalosis).Children more often get neurological problems while taking prednisone: mood swings, insomnia, hyperactivity, and depression.
Side effects during pregnancy
According to some studies, there is a very small risk of cleft lip or cleft palate in children whose mothers took prednisone during the first 13 weeks of pregnancy. There is also a very small risk of preterm birth. One study revealed a small risk of low-weight births in women treated with prednisone during pregnancy. The available data are insufficient for scientists to firmly determine whether these problems are caused by prednisone, or whether they arose because of the peculiarities of the organism and the health of the pregnant women.
In any case, pregnant women in need of corticosteroid therapy must not refuse prednisone treatment, because the probabilities of side effects usually do not exceed the health risk to women in case of refusal of treatment. It is important to consult your doctor before deciding to accept or refuse treatment.
Most of the side effects of prednisone are reversible. Unfortunately, it is not always possible to stop taking prednisone, even under severe side effects. So doctors have to additionally prescribe drugs for the treatment of the side effects of steroids. There are situations where a patient together with a doctor has to weigh the advantages and disadvantages of prednisone and make an informed decision about further treatment. Nevertheless, it is very important to remember that prednisone can not only cause side effects but also significantly improve life quality and life expectancy.
It is also worth remembering that every medicine can cause side effects, but many people may witness little or no side effects. When used properly, prednisone helps protect internal organs from damage caused by diseases, and in many cases even saves lives.