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Prednisone

Prednisone is a type of Steroid. It is very closely related to prednisolone, so all information on this page can be applied to Prednisolone as well.

Prednisone is a potent drug. It has a high success rate in inducing clinical Remission for persons with Crohn's Disease. Prednisone can act very quickly, reducing symptoms in a matter of days. However, there are some unpleasant side effects associated with its use. The risk of side effects increases as the dose increases, and long term use can be particularly problematic. For this reason, prednisone is typically prescribed for short term use, to reduce inflammation quickly and induce remission and allow other, less potent drugs to be phased in to maintain remission. However, some conditions and patients require longer term Prednisone therapy.

Contents


Important Information

Never Quit Prednisone "Cold Turkey"
If you are taking prednisone, you must follow dosage instructions carefully. In particular you must never suddenly stop taking it, as the body needs time to readjust the levels of natural steroids in the body. The dose of prednisone should be lowered gradually (Tapered) to allow this to happen. Patients taking prednisone should consider carrying a card with their tapering schedule and medical information, so that treatment can be continued in the event of a medical emergency.

If prednisone is suddenly stopped, rather than gradually tapered, Acute Adrenal Insufficiency can occur and may result in death.

For More Information on Prednisone Withdrawal, including Steroid Withdrawal Syndrome, Click HERE
Infection / Vaccines
You are more susceptible to infections when you are on prednisone especially at higher doses of the drug. Tell your doctor if you have herpes, even if you are not having an outbreak. You may also be less able to recover from infections.
Live Vaccines / Live Attenuated Vaccine
Never Receive a "Live" Vaccine (including the Flu Vaccine Nasal Spray when on Prednisone.
A "Live Vaccine", also called Live Attenuated Vaccine (LAV), contains a weakened form of the actual bacteria or virus you are being vaccinated for.
The objective of taking prednisone is to quiet the immune system. If given a "live" vaccine it is possible your body may not be able to clear what you are being vaccinated against and you may actually get the disease.
Types of "Live Vaccine"
- Influenza Virus "Flu" (Given in the Nose as a Spray)
- MMR (Measles Mumps Rubella) [8]
- Varicella [8]
- Herpes Zoster [8]
Recombinant and Inactivated Vaccines
If it is necessary for a person to receive a vaccine while on Prednisone, the "Inactivated" (Killed) -, or "Recombinant" - type of Vaccine can often be given. However, people on Prednisone, or other Immunosuppressant, may not mount a strong Immune Response to the Vaccine. As a result, they might not be well-protected against the disease.
A doctor can perform a Blood Test to determine how well the Immune System responded to the Vaccine, called an Antibody Titer Assay. It takes a long time for the body to complete the Immune Response to the Vaccine so the Antibody Titer testing can not be performed immediately.
Types of Recombinant and Inactivated Vaccines
- Influenzavirus "Flu - Shot" (Given by Injection)
Osteoperosis / Bone Loss
Patients taking prednisone should also take calcium supplements, preferably with Vitamin D, as long term steroid use can rob the body of calcium, leading to osteoporosis. In addition, discuss the idea of taking Vitamin K, specifically Vitamin K2, with your doctor as it has been shown to help move calcium to the bones rather than arteries.

Long-term prednisone administration is typically given with a Bisphosphonate drug to prevent and/or treat glucocorticoid-induced osteoperosis. Regularly prescribed Bisphosphonate drugs include: Actonel (Risedronate)[2], Boniva (Ibandronate)[3] or Fosamax (Alendronate sodium)[4].
Steroids can Cause Vitamin D Deficiency
Steroids (Prednisone) can lead to Vitamin D Deficiency. This can exacerbate immune malfunctioning, and cause osteoperosis and muscle weakness. [6]

Prednisone and Mucosal Healing

While Prednisone is excellent for inducing clinical remission, it has been shown to be poor when it comes to the healing of the mucosa which is now thought to be an important variable for long term health and remission. One study found that 92% of patients experienced clinical remission within 7 weeks, however, only 29% achieved mucosal healing. Another study of patients on Infliximab found a lower rate of mucosal healing when the patient was also on steroids at the same time.[5]

Steroid Side Effects

Dermatologic (Skin) Effects
- Bruising (Ecchymoses)
- Slower Healing After Injury or Surgery
- "Moon Face"
- Petechiae
- Redness of the Skin (Especially on Patches of the Face)
- Sweating
- Thinning of the Skin
- Urticaria (Hives) or Rash
Eyes
- Cataracts
- Exophthalmos (Bulging of the Eye)
- Glaucoma
- Increased Eye Pressure
Fluid and Electrolyte Side Effects
- Congestive Heart Failure (CHF) in Susceptible Patients
- Fluid Retention (Water Retention)
- Hypertention (High Blood Pressure)
- Hypokalemic Alkalosis
- Potassium Loss ([wiki]Hypokalemia[/h]
- Sodium (Salt) Retention
Gastrointestinal
- Abdominal Distention (Swelling) [9][10]
- Hunger / Food Cravings / Weight Gain
- Nausea / Vomiting
- Pancreatitis (Inflammation of the Pancreas) [9][11]
- Peptic Ulcer and/or Perforation
- Ulcerative Esophagitis
Hormone / Endocrine
- Adrenocortical / Pituitary Hyporesponsiveness During Stress
- Carbohydrate / Sugar Tolerance Reduced (and/or Diabetes Mellitus Symptoms Increased)
- Cushingoid State
- Growth Suppression (in Children)
- Irregular Menses (Female Monthly Cycle)
Immune System
- Less Able to Fight Infection
- More Likely to Get Infection
- Healing is Reduced
- Immunosuppression
---- Opportunistic Infection
---- Thrush (Yeast Overgrowth)
Muscle and Skeletal
- Muscle Atrophy / Loss of Muscle Mass
- Muscle Weakness
- Steroid Myopathy
- Osteoporosis
---- Bone Fracture (Break)
Nervous System / Brain
- Headache
- Increased Intracranial Pressure (Pressure within the skull)
- Siezures
- Vertigo (Feeling Dizzy)
Psychiatric / Mood / Mental State
- Anxiety / Panic [12]
- Insomnia (Inability to Sleep)
- Mania / Increased Energy /Elevated Aggression
- Memory Loss
- Mood Swings / Labile Mood
- In Patients with PTSD (Post Traumatic Stress Syndrome) Symptoms can be Increased

In some patients, use of steroids may lead to serious Mood Disorders developing, such as Bi-Polar Like Disorder, Psychosis, Mania or Depression, in which case treatment may be discontinued.

For More Information on Steroid Psychiatric and Mood Effects Click HERE

Prednisone Side Effect Reduction Techniques

Food Related Side Effects
Eating a protein-rich, low salt diet may help alleviate the effects of an increased appetite, and help prevent excessive weight gain.

Taking Prednisone with a Meal may help alleviate side effects.
Prednisone Side Effects May Vary by Different Dosing Schedules
Always Check with your Doctor before Altering Any Medication Dosing Schedule
Time of Day
Taking Prednisone Early in the Morning, as a Single Dose may help reduce Steroid-Induced Insomnia.
- Patients who take the same daily dosage of Prednisone but spread throughout the day report higher rates of Insomnia.
-- Some patients may require a sustained level of Prednisone for effective treatment of their condition and may not be able to tolerate the Single Dosing technique.
Prednisone Alternate Day Dosing Schedule
An Alternate Day Dosing Schedule may be beneficial to some patients, especially for Children taking Prednisone.

In Alternate Day Dosing, a Double Dose of Prednisone is taken on alternate days (with no Prednisone taken on the following day).
- Some patients see reduced side effects using the Alternate Day Dosing Schedule
- Some patients may not be able to tolerate Prednisone Alternate Day Dosing, espeially those that require sustained levels of Steroid treatment.

Alcohol and Prednisone

For information about Alcohol and Prednisone please click HERE

References

1. http://www.sciencemag.org/content/77...e2=tf_ipsecsha Swingle WW, Pfiffner JJ, Vars HM et al. The function of the adrenal cortical hormone and the cause of death from adrenal insufficiency. Science. 1985;77: 58-64.
2. Actonel http://www.actonel.com/global/Actonel_MG.pdf
3. Boniva http://www.gene.com/gene/products/in.../med_guide.pdf
4. Fosamax http://www.merck.com/product/usa/pi_...fosamax_pi.pdf
[pos]5a[/pos]5. "Advanced Therapy in Crohn's Disease" - Mucosal Healing in IBD: Essential or Cosmetics? - Pages 637-641
6. Branley D. Oral steroids linked to severe vitamin D deficiency. Updated Sept 2011. Accessed June 2012. http://www.einstein.yu.edu/news/rele...tionwide-study
7. Possible Side-effects from Vaccines. Department of Health and Human Services Centers for Disease Control and Prevention. Updated February 2012. Accessed June 2012. http://www.cdc.gov/vaccines/vac-gen/...ffects.htm#flu
8. Wasan SK, Skolnik PR, and Farraye FA. A 24-Year-Old Patient With Crohn's Disease Starting Immunosuppressive Therapy: Vaccination Issues to Consider. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. 2010; 8(12):1013-1016 DOI: 10.1016/j.cgh.2010.07.001 Accessed June 2012. http://download.journals.elsevierhea...6510006774.pdf
9. Prednisone Tablets, USP. Cadista Pharmaceuticals Inc. Accessed June 2012. http://www.google.com/url?sa=t&rct=j...C1HPc_jqkakAsw
10. http://www.nlm.nih.gov/medlineplus/e...cle/003122.htm
11. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002129
12. www.seattlechildrens.org/pdf/pe438.pdf

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09-16-2014, 10:38 PM   #1
Cross-stitch gal
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Join Date: Dec 2011
Location: Vancouver, Washington
It has been brought to my attention that the use of Prednisone can cause sleep problems. Even when you are no longer on this medication it can take a year or longer in order to finally get the drug totally through your system to where you can sleep as you normally did before taking Prednisone.
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Diagnosed:
Ulcerative Colitis/IBD 1996, Iritis 2001, Ulcerative Proctitis 2013, Indeterminate Colitis 2016, Remission 2017, Hand Eczema

Current Meds:
Pentasa 1000mg 2xday or Mesalamine DR 1.2gm 2xday, Canasa Suppositories (when needed) 1000mg 1xday, Tylenol 3 with codeine 300-30mg (when needed)

Non-Meds:
600+D Calcium 2xday, Multivitamin, 65mg Iron 1xday, Fish Oil 1000mg, Vitamin D3 5,000 I.U., Eye Drops 2xday


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