Prednisone: A nasty drug, but a life saver

Steroids. We hear about steroids all the time. We hear about dishonest athletes using steroids to gain advantage and we also hear horror stories about steroid-rage, where someone who has been taking large amounts of steroids (usually without medical supervision) and goes on a rampage. But what about the steroids that save lives?

Prednisone is a commonly medically prescribed corticosteroid and can be given to people living with illnesses from asthma to cancer. For some illnesses, the medication improves quality of life, with others, the medication is literally a life saver.

In Canada, prednisone has been in the news for the past day or so, since it was revealed that the Canadian Minister of Finance, Jim Flaherty, is living with bullous pemphigoid, a skin disease that can be treated with prednisone if other approaches don't work. This news may never have come out but the side effects of the predisone were becoming obvious to journalists and observers, so to quell misinformation and rumours, Mr. Flaherty chose to reveal what has been going on.

What is prednisone?

Prednisone has been around for a long time. It is a glutocosteroid that is used as an anti-inflammatory for many conditions, such as:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Arthritis
• Lupus

Prednisone is not a first-line medication. Physicians generally try other types of medications first, although in urgent or serious situations, they may go straight to prednisone to get things under control.

Steroid therapy is also usually needed in transplants, to prevent rejection. Sometimes, prednisone is among the medications chosen.

Side effects

While prednisone can be and is a life saver for many, it also can be very nasty with its side effects. This is why it must be used with caution. The most commonly talked about side effects include:

• Difficulty sleeping
• Increase in appetite
• Weight gain
• Mood swings
• Nausea (particularly if taken on an empty stomach)

More serious side effects can occur, especially if the prednisone is taken in high doses or over a long period of time. The National Institutes of Health (NIH)  has listed these as "serious" and if you experience them, they urge you to contact your healthcare provider:
vision problems

• Eye pain, redness, or tearing
• Sore throat, fever, chills, cough, or other signs of infection
• Seizures
• Depression
• Loss of contact with reality
• Confusion
• Muscle twitching or tightening
• Shaking of the hands that you cannot control
• Numbness, burning, or tingling in the face, arms, legs, feet, or hands
• Upset stomach
• Vomiting
• Lightheadedness
• Irregular heartbeat
• Sudden weight gain
• Shortness of breath, especially during the night
• Dry, hacking cough
• Swelling or pain in the stomach
• Swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
• Difficulty breathing or swallowing
• Rash
• Hives
• Itching

Longer term prednisone can also make you more susceptible to contracting infections and lead to thinning of the bones, which can lead later to osteoporosis.

Taking prednisone

If your doctor has prescribed prednisone for you, it is very important that you take it exactly as prescribed to reduce the risk of side effects. If you are taking high doses temporarily, chances are you will be tapered off. This means that if you are taking 50 mg of prednisone every day, instead of just stopping, your doctor will bring down your dosage gradually, until it is low enough to stop. There is a good reason for this tapering as you could experience withdrawal symptoms, such as:

• Joint pain and/or muscle pain
• Fatigue
• Nausea and vomiting
• Headache
• Fever
• Low blood pressure

Other medications

Prednisone interacts with several types of medications, so be sure to speak with your doctor and your pharmacist about medications you are already taken. While doctors are knowledgable about what drugs to prescribe, pharmacists are the experts when it comes to drug interactions.

Don't ever take prednisone without a prescription, even if you have taken it before.

Prednisone is a life saver, but it has to be used with caution.