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Prednisone is a corticosteroid with potent anti-inflammatory effects. It is used to treat most types of vasculitis and is often used in combination with other immunosuppressive medications. Prednisone is usually taken orally and can be administered in various forms, including tablets, liquids, and concentrated solutions. The drug acts quickly and is often prescribed at high doses during the initial diagnosis to control the condition. However, taking high doses of prednisone for an extended period can lead to an increased risk of specific side effects, including muscle pain and weakness. This condition is known as corticosteroid-induced myopathy and typically occurs with doses higher than 10 mg of prednisone per day for four weeks or longer. The risk of side effects is also influenced by the length of time a patient remains on the medication.
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What You'll Learn
Corticosteroid-induced myopathy
The treatment for corticosteroid-induced myopathy involves the reduction or discontinuation of corticosteroids, with close monitoring for adrenal insufficiency and exacerbation of the primary illness during the discontinuation process. For patients unable to taper off steroids, replacement of fluorinated glucocorticoids with non-fluorinated glucocorticoids, such as dexamethasone with prednisone or hydrocortisone, should be considered. Physical therapy with aerobic and resistance exercises is also effective at modulating muscle atrophy in patients with corticosteroid-induced myopathy.
It is important to note that the exact incidence of steroid myopathy is unknown, and the weakness associated with it typically resolves after reducing or discontinuing the corticosteroid dose. However, recovery can take weeks or months, and there have been reports of a lack of full recovery and difficulty weaning patients off mechanical ventilation. Corticosteroid-induced myopathy can lead to complications such as osteoporosis, morbidity, and subsequent mortality associated with chronic muscle weakness.
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Prednisolone side effects
Prednisolone is a medicine that can cause side effects, especially at higher doses and with long-term use. The higher the dose and the longer the duration of use, the greater the chance of side effects. Side effects may also be more likely to occur if you take prednisolone with other medications, such as St. John's wort, cimetidine (Tagamet), or aspirin. It is important to consult your doctor and pharmacist about any medications, vitamins, supplements, or herbal products you are taking or plan to take while using prednisolone.
Some common side effects of prednisolone include stomach upset, mood changes, weight gain, increased hunger, water retention, and a rounder face. These side effects can occur immediately or after several weeks or months of taking the medication.
More serious side effects may include a high temperature, chills, a very sore throat, ear or sinus pain, a cough, increased saliva production, and mouth sores. These could be signs of an infection. Additionally, feeling sleepy or confused, increased thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath could indicate high blood sugar.
In rare cases, prednisolone can cause a serious allergic reaction (anaphylaxis), with symptoms such as swelling of the face, throat, or tongue, difficulty breathing, skin discolouration, confusion, dizziness, and a rash. This requires immediate medical attention.
Prolonged use of prednisolone at higher doses can also slow down the normal growth of children and teenagers, although this does not seem to significantly affect their eventual adult height. Their doctors should carefully monitor their height and weight and adjust the treatment if necessary.
Furthermore, prednisolone has been associated with corticosteroid-induced myopathy, a condition causing muscle weakness and atrophy. This typically occurs with doses higher than 10 mg prednisone equivalents per day for four weeks or longer. Treatment involves reducing or discontinuing the corticosteroid, replacing fluorinated glucocorticoids with non-fluorinated alternatives, and physical therapy with aerobic and resistance exercises.
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Risk of infection
Prednisone is a corticosteroid medication that can be life-saving and has revolutionised the treatment of many diseases, including vasculitis. However, it is associated with a long list of side effects, and the risk of these side effects occurring increases with higher doses and longer durations of therapy. One of the most significant risks is an increased susceptibility to infections.
Prednisone is an immunosuppressive medication, meaning it lowers your body's resistance to infections. This can range from minor fungal infections in the mouth ("thrush") to life-threatening infections such as Pneumocystis carinii pneumonia. Patients on prednisone may also be at risk of contracting vaccine-preventable infections, as the medication may interfere with the effectiveness of vaccines. Therefore, it is recommended that patients on prednisone avoid live vaccines and consult their doctor before receiving any immunizations.
The risk of infection is further heightened when prednisone is combined with other immunosuppressive medications, such as cyclophosphamide. To mitigate this risk, specific types of antibiotics may be taken prophylactically, as directed by a doctor.
It is important to be vigilant for signs of infection while on prednisone. If you experience any symptoms such as fever, chills, sore throat, ear or sinus pain, cough, increased saliva production, mouth sores, or wounds that are not healing, contact your doctor immediately. Additionally, certain infections, such as chickenpox or measles, can be severe and even life-threatening in individuals taking prednisone. Therefore, exposure to these infections should be reported to a doctor right away.
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Joint damage
While prednisone is a potent anti-inflammatory corticosteroid, it can cause a long list of side effects, especially at high doses and with long-term use. One of the adverse effects of taking prednisone is joint damage, most often of the hips. This is known as avascular necrosis or osteonecrosis, which literally means "bone death". In this condition, the part of the leg bone that inserts into the pelvis dies, leading to pain when bearing weight and some loss of joint function. Many patients suffering from avascular necrosis require joint replacements.
The risk of joint damage and other side effects increases with higher doses of prednisone and longer durations of therapy. Prednisone is typically used at high doses during the initial diagnosis to quickly bring conditions like vasculitis under control. Subsequently, the dosage is gradually reduced ("tapered") while another immunosuppressive drug is introduced for long-term treatment. This strategy helps to mitigate the side effects associated with long-term use of high-dose prednisone.
In addition to joint damage, prednisone can cause muscle pain, weakness, and cramps, which may be indicative of low potassium levels. Patients may also experience mood changes and mental health issues, including anxiety, sleep problems, confusion, memory issues, hallucinations, and strange or frightening thoughts. The higher the dosage of prednisone, the more intense these mood changes can be.
Furthermore, prednisolone can lead to weight gain, a rounder face ("moon face"), high blood sugar, and an increased risk of infections, including minor fungal infections and life-threatening conditions such as Pneumocystis carinii pneumonia. Long-term use of prednisone in children and teenagers can slow down their normal growth and development, so their height and weight must be carefully monitored.
To manage these side effects, doctors may adjust the dosage of prednisone, recommend dietary changes or prescribe supplements, and encourage patients to engage in regular physical exercise to prevent muscle atrophy and maintain joint health.
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Weight gain
Prednisone is a synthetic version of cortisol, a hormone produced by the adrenal glands to reduce inflammation in the body. It mimics cortisol by binding to the brain's hunger control region and stimulating appetite. Prednisone may also interrupt the sleep cycle, disrupting hormones that regulate appetite.
To manage increased appetite, it is important to control calorie intake and nutrient quality. Eating fibre-rich foods, such as fruits, vegetables, and complex carbohydrates, and including protein with each meal can help. Small, frequent meals on a schedule can also help manage appetite. Additionally, a low-carbohydrate, high-protein diet may be effective in suppressing appetite and promoting weight loss.
Fluid retention, another contributor to weight gain, can be controlled by consuming a low-sodium diet (no more than 2,000 mg per day) and increasing potassium intake through potassium-rich foods.
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Frequently asked questions
Prednisone is a corticosteroid with potent anti-inflammatory effects. It is often used to treat vasculitis and is usually taken with food one to four times a day or once every other day.
High doses of prednisone (greater than 10 mg/day) can cause muscle pain and weakness, known as corticosteroid-induced myopathy. This condition typically develops with higher doses taken for four weeks or longer.
Other side effects of high prednisone doses include joint damage, thin skin, bruising, abdominal stripes, weight gain, increased risk of infections, high blood sugar, and mood changes. Children taking prednisone may experience slower growth and bone problems.
If you experience muscle pain or any other side effects from taking prednisone, consult your doctor immediately. Tapering or discontinuing the medication may be recommended, along with switching to non-fluorinated glucocorticoids or alternate-day dosing. Physical therapy and regular exercise can also help prevent and treat steroid-induced myopathy.
