Prednisone is a known steroid drug that’s usually taken orally to solve various autoimmune and inflammatory diseases such as Crohn’s disease and Systemic Lupus Erythematosus. It belongs to the group of synthetic corticosteroids, which is a variety of steroid with similar actions to a group of hormones synthesised and secreted by the adrenal glands.
Prednisone is commonly used in rheumatic diseases, including articular and muscular disorders, especially when they involve autoimmune and inflammatory problems. It is also used in bronchial and pulmonary diseases such as bronchial asthma and interstitial lung diseases. Some dermatologic affections might also be improved after applying prednisone, such as pemphigus and certain types of dermatitis. It is useful to prevent anemia when it is caused by an autoimmune component, and other hematological problems such as lymphoma, leukemia, agranulocytosis, and thrombocytopenic purpura.
Additionally, prednisone improves several gastrointestinal diseases such as Crohn’s diseases and other types of ulcerative colitis, hepatitis, glomerulonephritis, and even ophthalmologic inflammatory conditions such as conjunctivitis and keratitis. Since prednisone has a similar action to adrenal hormones, it is also used as replacement therapy when the adrenal gland is not working for some reason.
How does it work?
Prednisone is a known glucocorticoid drug with anti-inflammatory potential. The drug is not active until it is converted in our bodies to prednisolone. This happens in the liver, just after prednisone is absorbed, which is why it is called “first-pass hepatic metabolism”. The resulting prednisolone binds to glucocorticoid receptors in the cells, specially designed to receive the signal from hormones in the bloodstream. That’s how prednisolone reduces inflammation by very complex chemical pathways.
As a result, prednisolone has an anti-inflammatory effect in the cells that is four times higher than cortisol, but less potent compared to other drugs like dexamethasone. By reducing inflammation, prednisone also improves edema, reduces bronchial obstructions, reduces the formation of mucus and its viscosity by the bronchial cells. After having its effect on the body, prednisone is metabolised by the liver and eliminated from the organism by the kidneys after a half-life of 18 to 36 hours.
Presentation and concentrations
Prednisone is often found under the brand name Sterapred, Sterapred DS, Deltasone, Rayos, Prednicot. You can find it in solution, tablets, tablets with delayed release, and intramuscular injections. The most common concentrations are 2,5 mg, 5 mg, 10 mg, 30 mg, and 50 mg.
What you need to consider before using prednisone
First off, do not use prednisone if you have known hypersensitivity to this drug or any other component in the formulation you’re using. Be careful to check the label if you suffer from immune reactions against common drug excipients. You should never use prednisone if you have a coexisting infection with viral infections such as herpes virus, herpes zoster, varicella zoster (chickenpox), and similar diseases. If you received a vaccination against one of these viral infections, it would be wise to start your treatment after 2 weeks of your last dose, and if you’re planning to receive a prophylactic vaccine, it will be safe after 8 weeks of your last prednisone dose.
Before starting your prednisone medication, note that you may need a prophylactic treatment to avoid osteoporosis, especially in older adults. This is because prednisone affects the way our bodies exchange calcium ions in and out of the bone tissue. However, this effect depends on the dose and the duration of the treatment, which is why you need to ask your doctor whether or not you need to take extra calcium supplements or start another prophylactic measure.
If you need a prolonged treatment, you might also need to get an ophthalmologic check-up every 3 months or so, especially if you’re under a high dosage. Among other medical evaluations, you should perform regularly, you need to monitor your potassium levels and your cardiovascular system, especially if you suffer from heart insufficiency. In most cases, it will be advised to use potassium supplements and have a diet low in sodium along with the long-term treatment with prednisone.
Also, if you suffer from hypothyroidism or hepatic cirrhosis, minimal dosages may give you lasting effects, and you may even need to adjust your prednisone dose several times before reaching the ideal.
Prednisone in pregnancy and lactation
If you need to use prednisone during your pregnancy, rest assured you’re not to cause birth defects or pregnancy problems if you continuously use prednisone. The most recent studies about the prevalence of cleft lip refuted previous assumptions that prednisone caused this birth defect. Even if there’s a very slight risk, it is not considered clinically significant. However, prednisone is not to be taken lightly, and only a health professional should prescribe it for pregnant women, and you should ask your physician before suspending or changing the dose.
According to studies, by taking prednisone, you may have a slight risk of having a premature baby, which means a baby that’s been born before 37 weeks of gestation. However, keep in mind that prednisone is used to treat many conditions that would have the same effect and many others. Therefore, it is not clear whether this higher risk of premature birth is caused by prednisone or the underlying disease in women under prednisone. Similar studies have reported that women usually have better pregnancy outcomes when carefully following their prednisone treatment compared to those who don’t follow it properly.
A woman may also use oral prednisone during lactation because only small concentrations of the drug will ever pass down to breast milk. The molecular structure of prednisone is very similar to other hormones found in milk in similar levels, which is why we would not expect to find any alteration in the hormonal profile of an infant if they receive breast milk from a woman under prednisone.
If you’re using prednisone for a short period of time, the incidence of adverse effects is very low. However, it is essential to take into consideration the possibility of developing or worsening your gastric or duodenal ulcers, which are frequently caused by stress and may be asymptomatic at times. It is also common to experience a change in the metabolism of energy with an impaired tolerance to glucose and reduced immunity against certain types of infections.
In long-term treatments, we have a higher chance of experiencing adverse effects. For example:
- Endocrine problems: Since prednisone mimics the action of certain types of hormones, one of the most common side effects are endocrine problems such as Cushing syndrome, amenorrhea (the absence of menstrual periods during reproductive age), hirsutism (excessive hairiness in women in body parts where only males grow hair), and sexual impotence. Since the body perceives prednisone as an excess hormone, the adrenal gland may reduce the activity, which may even cause atrophy of the gland.
- Dermatologic effects: patients may describe a slower wound healing process and acne.
- Musculoskeletal problems: prednisone may aggravate osteoporosis and cause muscular weakness or atrophy because it has a catabolic effect on tissues.
- Ophthalmologic effects: In the eyes, prednisone may cause cataracts and glaucoma.
- Neurological disorders: Prednisone may increase the likelihood of many neurological or psychiatric problems such as irritability, depression or euphoria, seizures, increase in the appetite, and an increase in the intracranial pressure, known as pseudotumor cerebri.
- Digestive problems: They are common as well, and may appear in both long-term and short-term treatments. Prednisone may increase the likelihood or aggravate a gastric or duodenal ulcer and cause gastrointestinal haemorrhages.
- Metabolic problems: As stated earlier there’s a change in the metabolism of energy, which is why we might find an impaired tolerance to glucose. Additionally, we may have a sodium retention and increased release of potassium by the kidneys, which causes edema and other alterations. In pediatric patients, the metabolic changes may lead to growth retardation if not appropriately addressed.
- Cardiovascular side effects: The only known cardiovascular problem associated with prednisone is hypertension.
- Immune and blood alterations: Prednisone may cause an impairment in the normal formation of immune cells such as lymphocytes and eosinophils. Prednisone may also aggravate an underlying immune problem, and make it more difficult to detect infectious diseases.
- Withdrawal symptoms: Prednisone has a withdrawal syndrome after long-term treatments, which is why patients should not reduce their dosage too quickly or stop their treatments suddenly. Otherwise, they would get symptoms such as joint pain, muscular pain, shortness of breath, low appetite, nausea, vomiting, fever, hypoglycemia, and adrenal insufficiency. Some of these effects might be life-threatening, which is why it is advised to ask your physician before you decide to stop your treatment or change your dose.
Interactions with other drugs
Prednisone has plenty of interactions with other drugs. Be careful and ask your physician if you’re taking one of the following medications:
- Anticoagulants: Prednisone often affects the efficacy of anticoagulant medications. Ask your physician if you have coagulation problems because these medications are very dangerous when out of control.
- Anticholinesterases: They are used in Miastenia Gravis, Parkinson, and other diseases. In myasthenia gravis patients, prednisone may increase muscle weakness and aggravate the symptoms of the disease.
- Birth Control pills: If you’re taking birth control pills, prednisone may have an increased effect in your body.
- Antidiabetic medications: You will need to increase the dosage of some glucose-lowering drugs to maintain their effect.
- Anti-inflammatory drugs: If you’re taking oral NSAID’s, you need to be extra careful because of the risk of gastric or duodenal ulcers will increase by taking oral prednisone at the same time.
- Digitalins: If you’re taking Digoxin or any other drugs to treat heart failure, be extra careful about your potassium levels because they may increase your risk of arrhythmia.
- Diuretics: Some diuretics reduce the levels of potassium in the blood and should not be taken along with prednisone in long-term treatment.
- Prophylactic vaccines: As stated previously, be careful to start prednisone at least 2 weeks after applying a vaccine. If you’re planning to get one, you need to be off prednisone for at least 8 weeks.
- Rifampicin, barbiturates, phenytoin: They are enzymatic inductors, speeding up the action of the enzymes that metabolise glucocorticoids. You may need to adjust your prednisone dose if you are under one of them at the same time.
What to do in the event of an overdose
An overdose of prednisone may cause the following symptoms:
- Gastrointestinal cramps and hemorrhages
- Peripheral edema
In the event of an overdose, you need to look for urgent medical attention and increase the intake of oral liquids in the meantime. To control an overdose, you would need oxygen therapy, intravenous fluids to speed up clearance by the kidneys, and constant monitoring of your levels of sodium and potassium with the proper adjustment if required. Thus, this event should be handled by a professional within a health institution.
A final word of advise
Prednisone is a powerful drug with many applications and side effects when used in long-term treatments. It is a safe drug only when used under careful medical surveillance. However, patients would need to be communicative with their healthcare providers, especially if they see any sign of infection during treatment. Any sore throat or fever should be reported, as well as joint pain episodes, especially those concerning your hip and shoulders.
If you experience menstruation problems, muscle weakness, an increase in weight, and any other unusual alteration during treatment, be sure to ask your doctor for further advice. If you’re undergoing surgery, you need to report to your surgeon if you’ve taken prednisone and any other corticoid drug during the last year.
Do not interrupt or change dosages of your prednisone treatment without following the advice of your doctor, and be sure to take your oral medications along with foods, especially if you’re experiencing abdominal discomfort. Finally, remember this medication reduces your immune function against certain viral diseases. If you have never been infected with varicella (chickenpox) and herpes, avoid any unnecessary contact with the disease because they usually trigger severe reactions when under prednisone.
You wouldn’t be able to do any movement at all without your spine. It’s the central axis of your whole body and provides stability and support every time you stand up, lay down, go running or start jumping. Even turning your head requires the stability and support of your spine. What’s more, in the spine we carry and shelter part of the nervous system, and it is essential for the movement of the rest of the body. No wonder why spinal disorders may turn out to be painful and crippling at times.
There are plenty of spinal problems depending on the primary cause. Some of them are genetic alterations causing congenital defects even before birth which may be fatal in some cases. On the other hand, most spinal disorders are acquired later in life, sometimes caused by trauma, bad posture, osteoporosis, and many other problems. In this article, we will review the most common types of acquired spinal disorders and the therapeutic approach they are usually given.
It is the most common symptom of a spinal disorder, and it is often considered an independent health issue when it is not possible to track the root cause. Back pain is sometimes very complicated because it may arise from different structures in the back, and sometimes it is caused by stress and other psychological causes.
Sometimes, back pain is the only symptom patients complain about, and we need to trace back pain by ordering additional studies to obtain additional clues. In some cases, we can’t find any, and the therapeutic approach is limited to analgesic medications and lifestyle changes. It is also vital to strengthen the back muscles through core exercises.
In the event of sustained back pain, it is essential to remember the alarm signs that would require urgent medical attention. If you ever feel intense pain with numbness or paralysis to your extremities, bladder problems or bowel movement disturbances, you should seek for medical care right away.
One of the most common causes of low back pain is a herniated disc. It is a problem in the intervertebral disc, a structure that lies between one vertebral body and the other and acts as a cushion to prevent friction between one another. They also help your spine maintain healthy mobility.
As a part of the aging process, the intervertebral discs become stiff and does not absorb stress and friction the same as it did before. Sometimes, this leads to ruptures or cracks in the intervertebral discs, and the central part of the structure of the disc is pushed and leaks into the spinal canal. In other words, a herniated disc is a protruding area of the intervertebral disc that usually applies pressure to the spinal canal and its structures. The painful symptoms associated with a herniated disc are often caused by this pressure applied to nerve roots, which also causes mobility issues in some cases.
In some cases, the solution given to a herniated disc is surgery. However, not every case needs to enter the operating room. Instead, most patients benefit from physical therapy along with exercise to strengthen their back muscles and temperature therapy. In the meantime, painkillers and medications to relax the muscles of the back may improve the symptoms and relieve pain without surgery. However, if your doctor determines your herniated disc is causing functional problems to your nervous system, you will probably find more benefit from surgery.
Vertebral compression fractures are common in older patients with osteoporosis, but also as a result of radiation therapy, excessive alcohol consumption, and any other health condition that affects the stability of the bone tissue. The weakened vertebral body does not withstand the pressure and collapses after any source of additional pressure.
Compression fractures usually cause a sudden and unexpected back pain that’s severe enough to look for urgent medical health. They are detected through imaging techniques and treatment is limited to powerful painkillers, bed rest, and sometimes using bone substitutes. However, in most cases treatment is not very effective and even if we can reduce the pain, it might be difficult to solve the underlying condition.
Scoliosis and spinal curvature disorders
One of the most common spinal disorders is curvature problems. They affect children and adults, and there are at least three types of curvature problems. Kyphosis is an abnormal protruding curvature in the upper back, lordosis or swayback is a pronounced inward curvature in the lower back, and scoliosis is an S-shaped curvature in any given area of the spine. Some types of curvature disorders are congenital, but most of them appear after 10 years of age, usually related to bad posture and other causes.
Depending on the type of curvature problem and the severity, kyphosis, lordosis and scoliosis may cause several symptoms. The most common is back pain, but it may also cause balance and mobility problems and various neurological problems as well.
Treatment options for spinal curvatures also depend on the type and severity of the spinal problem. In mild cases, it might not be necessary to perform any surgery or advanced treatment. Instead, they are often solved with physical therapy, exercises to strengthen the back and core muscles, and painkiller medications. More severe problems would require steroid injections and aggressive treatments such as spinal surgery.
Be careful about spinal disorders
Spinal disorders may be mild or very severe, and there are many subtypes. We have just reviewed a few of the most common types of spinal disorders, and how back pain is always a predominant symptom. However, if you start feeling numbness, a reduced sensibility or mobility, and additional neurological symptoms, it would be a good idea to ask your physician about your symptoms. A certified clinician would order further tests if necessary and perform a complete physical exam to determine the cause of your symptoms and recommend an appropriate therapeutic approach for you.