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Prednisone quick review
Hormone description: a synthetic steroid hormone that resembles naturally produced cortisol, a white to practically white, odorless, crystalline powder.
Biological functions: puts down the body's response to the allergen (the cause of the allergy) and reduces swelling, redness, itching, and other symptoms of allergy.

Health benefits: used in the management of inflammatory conditions, autoimmune diseases, kidney diseases, and to prevent and treat rejection in organ transplantation.
Side effects : depression, euphoria, hypertension, nausea, anorexia, high blood sugar levels, and increased susceptibility to infection.
 

Prednisone


Prednisone is a synthetic compound that resembles naturally produced cortisol and is one of the commonly used oral steroids. Steroid refers to these three groups that contain a hydrogenated cyclopentano perhydro phenanthrene ring system. 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. Corticosteroid is a synthetic or naturally occurring 21-carbon steroid structure substances with four fused rings and vary functional branches attached to the ring system. Natural corticosteroids are divided into two major groups: glucocorticoid and mineralocorticoid. Glucocorticoids regulate carbohydrate, lipid, and protein metabolism and inhibit the release of ACTH (adrenocorticotropic hormone). Glucocorticoids also affect muscle tone and the microcirculation, participate in the maintenance of arterial blood pressure, increase gastric secretion, alter connective tissue response to injury, impede cartilage production, inhibit inflammatory, allergic, and immunologic responses, invoke shrinkage of lymphatic tissue, reduce the number of circulating lymphocytes, and affect the functions of the central nervous system. In humans, the most important glucocorticoids are cortisol, cortisone, and corticosterone. Prednisone is very similar to the hormone cortisone, which the body manufactures. Prednisone is a white to practically white, odorless, crystalline powder. It is very slightly soluble in water; slightly soluble in alcohol, in chloroform, in dioxane, and in methanol. Prednisone is the generic form; some common brand names are Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M, and Prednisone Intensol. Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug.
 

Functions and health benefits of prednisone


Prednisone puts down the body's response to the allergen (the cause of the allergy) and reduces swelling, redness, itching, and other symptoms of allergy. It also reduces the body's ability to fight infection. Prednisone decreases inflammation by preventing white blood cells from completing an inflammatory reaction. Prednisone depresses the inflammatory response and is directly toxic to T cells, which mediate the body's response to allergy and infection. Prednisone acts as an immunosuppressant. Prednisone is used in the management of inflammatory conditions or diseases in which the immune system plays an important role. Prednisone is particularly effective as an immunosuppressant and affects virtually all of the immune system. It can be used in autoimmune diseases, inflammatory diseases (such as asthma and Crohn's disease), various kidney diseases including nephrotic syndrome, and to prevent and treat rejection in organ transplantation. Prednisone is used to treat many different conditions. 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. People with sarcoidosis normally respond to the effects of prednisone. Prednisone also is used with other drugs to prevent rejection of transplanted organs and to treat certain types of cancer.

 

Side effects of prednisone


Short-term use is usually not harmful but is relatively contraindicated if you have diabetes, active ulcer disease, or emotional instability. All of these can be aggravated by high dose prednisone. Short-term side effects, as with all glucocorticoids, include high blood glucose levels, especially in patients who already have diabetes mellitus or are on other medications that increase blood
glucose (such as tacrolimus), and mineralocorticoid effects such as fluid retention. Long-term side effects include Cushing's syndrome, weight gain, osteoporosis, glaucoma, type II diabetes mellitus, and depression upon withdrawal. Long-term use of prednisone can lead to adrenal suppression. Side effects of treatment with prednisone can be depression, euphoria, hypertension, nausea, anorexia, high blood sugar levels, and increased susceptibility to infection. Prednisone must be used cautiously in HIV+ people because the drug is immunosuppressive and can increase the risk of getting opportunistic infections.

Weight gain from fluid retention or changes in mood (usually nervousness, trouble sleeping and restlessness) can occur. In addition, indigestion can be a problem. Prednisone may cause a depressed mood. High doses used to treat rejection may cause euphoria (an inappropriate feeling of well-being) that wears off in a few days. Be aware that these feelings are usually temporary. Prednisone may cause blurry vision or a change in your eyesight. More serious conditions, such as glaucoma and cataracts, can occur after long-term prednisone use. Some women notice that they grow more hair on their limbs and face while taking the medication. This is reversible. Some women choose to bleach the hair or have electrolysis. Prednisone can make the body lose potassium. A very low level of potassium can cause health problems, so a blood test may be necessary from time to time to check the level. You may need to eat more fruits which contain potassium - like bananas or apricots - or take potassium tablets. Rarely the blood sugar increases during treatment with prednisone and it may be necessary to check the level. It can be treated if need be and is reversible when the dose is reduced or the medication stopped.

 

Taking prednisone properly


Prednisone comes as a tablet, solution, concentrate, and syrup to be taken by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. The initial dose of prednisone varies depending on the condition being treated and the age of the patient. Schedules are determined by the body's response to the prednisone. Severity of Myasthenia Gravis, control of Myasthenia Gravis symptoms, and the development of adverse effects are all taken into consideration when your physician determines your dosage of prednisone.

Do not stop taking prednisone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, nausea, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. Adrenal suppression occurs if prednisone is taken for longer than seven days, a condition which means the body is unable to synthesise natural corticosteroids and becomes dependent on the prednisone taken by the patient. For this reason, prednisone should not be stopped abruptly if taken for longer than seven days, but needs to be reduced slowly; this reduction may be over a few days if the course of prednisolone was short, but may take weeks or months if the patient has been on long-term treatment. Abrupt withdrawal will lead to an Addisonian crisis, which may be life-threatening. Prednisone is best taken with food. Prednisone can irritate the stomach lining and therefore should be taken with food which serves as a buffer and reduces the irritation. Never take prednisone on an empty stomach. It is usually best to take it in the morning, after breakfast and before 9 a.m. If your prescription requires that you take prednisone more than once a day, be sure to eat before taking the other doses.

 

Contraindications, interactions, precautions


Certain medications may react adversely with prednisone: aspirin, arthritis medications, anticoagulants (Coumadin), diuretics, birth control pills, and seizure medications. Glucocorticoid hormones should not be used in combination with medications of the NSAID class (ie aspirin, Rimadyl, phenylbutazone etc.) as the combination of these medications could lead to bleeding in the stomach or intestine. Ulceration could occur.

Prednisone and prednisolone are considered to be intermediate acting steroids, meaning that a dose lasts about a day or a day and a half. After two weeks or more of use, it is important to taper the dose to an every other day schedule so as to keep the body's own cortisone sources able and healthy. The same salt retention that accounts for the excessive thirst and urination may also be a problem for heart failure patients or other patients who require sodium restriction.

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. Patients taking prednisone should be on high protein/low salt/low carbohydrate diets and eat well-balanced meals. Avoid alcohol (includes wine, beer, and liquor). Alcohol increases risk of stomach irritation/ulcers.