About Prednisone By Dr. Fusco M.D. | Arthritis Information

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All About Prednisone

Robert D. Fusco, M.D.
  • Unless instructed otherwise, prednisone should be taken all at once with breakfast. Prednisone is not to be taken randomly during the day. This minimizes the risk of adrenal gland suppression and atrophy. (When high doses are required, the dose may have to be split between morning and evening doses for short periods of time.) In some patients prednisone can be given at twice the dose every other morning. This doesn't work for everyone, but when possible, allows your system a brief, yet helpful, reprieve from the drug.
  • 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. Tell your doctor if you have a tendency to form peptic ulcers since this may require special care.
  • Take the dose as prescribed. There is no fixed rule for the correct dose of prednisone. Each case is different. Your doctor will determine what initial dose is best for you depending on the activity of your disease, your age, weight, any other medical conditions you may have, and your response to treatment. Do not alter the dose on your own without your doctor's consent. Fine tuning of your prednisone dosage will take place as your doctor follows your progress. The goal, of course, is to control your illness with the lowest effective dose of prednisone possible for the shortest period of time. Your doctor will routinely reassess what dose is necessary for you.
  • Don't skip doses. This is not a casual drug and taking it inconsistently can be very dangerous. If you forget a dose, it is safe to take the normal dose of the medication as soon as you remember and resume your normal schedule the following morning. If you do not remember until the next day, skip the missed dose.
  • Do not abruptly stop taking this medication on your own. If prednisone is taken for months and years, the adrenal glands within the body lose their ability to produce steroids naturally. In fact, the adrenal glands can shrink in size. If you have been on prednisone for more than one month, it is important that you do not stop it "cold turkey." This can cause an acute withdrawal reaction that can lead to a crisis situation. Prednisone must be slowly tapered under your doctor's supervision. When you travel, always carry a supply of medication with you. When flying, keep all your medications in your carry-on baggage. If your checked luggage is lost or delayed, you won't miss a dose.
  • If you have taken prednisone for more than a month, you may require an extra dose during physically stressful situations such as major surgery or severe infections. These "booster" doses can be given either by vein or by mouth. Usually the dose need be raised for only a day or so. This may be true even up to one year after you have discontinued the medication. This point is well known to doctors, but it is important for you to remember if you are away from your doctor and require major surgery or develop a severe infection. If you are on long term prednisone therapy, carry a notice with you on a Medic-Alert bracelet or in your wallet. (Medic-Alert Foundation can be contacted a their website at www.medicalert.org/ at their toll-free number 800-825-3785.) Be sure that all your doctors know that you are taking chronic prednisone therapy.
    In 1948, physicians at the Mayo Clinic were the first to use steroids to treat disease. They gave cortisone to patients crippled by severe rheumatoid arthritis and were amazed by the results after just a few days of use. People, who couldn't rise from a chair, shave, open a door or lift a cup, now could walk and even dance. Cortisone was hailed as a "miracle drug." Unfortunately, it was too good to be true. Problems soon emerged. Patients taking cortisone in doses high enough to relieve inflammation routinely experienced harmful side effects. Physicians now recognize that prolonged use of cortisone-like drugs like prednisone can cause many side effects. But when serious disease occurs, the benefit of prednisone usually outweighs the potential risks. For difficult to manage conditions, prednisone can still be a miraculous medication. In general, the risk of side effects depends on the length of time you take prednisone and the amount you take. You can help limit side effects by taking the medication exactly as prescribed and reporting any problems to your doctor.
      1. Weight gain
      Usually the most dreaded of prednisone's side-effects, increased appetite and weight gain are seen to some degree by nearly all patients. The amount of weight gain varies from individual to individual. In addition to causing weight gain, prednisone also tends to redistribute body fat to places that are undesirable, particularly the face (moon face), back of the neck (buffalo hump), and abdomen. The higher the dose and the longer the treatment, the greater the effect. To some extent these changes can be minimized by exercise and the dietary changes described below. If you find this confusing, a consultation with a registered dietitian or nutritionist may be helpful. Ask your doctor for a recommendation.
      • Avoid salt
        Most of us consume much more salt (sodium chloride) than our body needs. Normally, our kidneys keep our body in balance any excess salt is excreted in the urine. Prednisone causes sodium retention and potassium loss which may lead to fluid retention, weight gain, bloating and low blood potassium levels. In some patients, this can cause high blood pressure or worsen a pre-existing condition. We suggest a no-added salt diet and avoidance of highly salted pre-packaged convenience foods. Use fresh herbs whenever possible. Read food labels. Don't add salt to cooking and remove the salt shaker from your table. Instead use low-salt spices to add flavor to your meals. Ask your doctor about using salt-substitutes which are helpful since they contain extra potassium. It may be helpful to add high potassium foods such as bananas, citrus fruits, melons, and tomatoes to your diet. Be sure that your blood pressure and blood tests are checked regularly.
      • Avoid fat
        Most Americans also eat too much fat. Fat has over twice the calories per gram than proteins and carbohydrates. By limiting the fat in your diet, you automatically reduce the calories and may lower your blood cholesterol at the same time. With the new food labels, it is easy these days to find low-fat items in your supermarket.
      • Avoid simple carbohydrates
        Most foods contain some fat, protein, and carbohydrates. Carbohydrates (sugars and starches) can be either simple molecules or complex molecules. Avoid simple carbohydrates which are digested too quickly and leave you hungry. Complex carbohydrates are more satisfying since they must be broken down by the digestive process and are absorbed more slowly into your system. Simple carbohydrates are foods like candy, cakes, pies, white bread Complexwould include whole wheat bread, rice, beans, sweet potatoes, high fiber cereals, sugar-free candies.
      • Small frequent feedings
        To combat increased hunger, snack frequently on low-calorie foods such as fruits, vegetables, low fat dairy products, low salt rice cakes, and sugar free candies. Instead of three large meals, eat smaller more frequent meals.
      • Eating out
        When eating out, tell the waiter what you need. Don't be embarrassed or apologetic. Just ask directly for what you want. In our health conscious culture, most restaurants are used to special requests - just tip accordingly. When flying, call the airlines and request a low-fat low-salt meal in advance. They are quite prepared to help you. If you are in a situation where a special meal is not possible, don't panic. Eating salty high fat or sugary foods occasionally is not going to make much difference. Just enjoy them in moderation and be more careful the next day.
        • Female sex
        • Caucasian or Asian heritage
        • Small, thin frame
        • Lack of regular weight-bearing exercise
        • Poor calcium intake in diet
        • Family history of osteoporosis
        • Early menopause or removal of ovaries
        • Low testosterone levels in men
        • Tobacco use or heavy alcohol use
        • Overactive thyroid Thyroid hormone pills
        • Diabetes
        • Prior ulcer surgery
        • Crohn's disease
        • Eating disorders like anorexia

        • Eat calcium rich foods
          Increasing the amount of calcium in your diet can lessen the risk of osteoporosis. Your goal should be 1500 mg per day. Low fat dairy products (skim milk, low fat yogurt, fat free cottage cheese) are a good source of calcium. Many new products are even fortified with extra calcium. Certain vegetables are a good source of calcium including kale, turnips, collard greens, and broccoli. Another simple way to add extra calcium is by taking Tums tablets that contain calcium carbonate. Take two tablets during a meal twice a day.
        • Take vitamin D
          Just eating more calcium is not enough. Vitamin D is required to help calcium be absorbed into your system and strengthen your bones. Vitamin D is obtained by exposure of your skin to sunshine, vitamin D fortified foods, and taking a vitamin supplement. We suggest about 800 mg per day - more can be harmful. One way to add calcium and vitamin D is a combination such as Citracal caplets + D which can be purchased without a prescription in the vitamin section of your local pharmacy. Take two tablets twice daily with food. This will provide an extra 1260 mg. of calcium and plenty of vitamin D each day. It is also recommended that you take a multivitamin supplement daily.
        • Exercise
          Prednisone can also cause muscle weakness and atrophy. A low impact daily exercise program will help burn up more calories, improve your sense of well-being, and help prevent muscle and bone loss. Exercise can also help prevent the weight gain that often occurs during prednisone therapy. This exercise program should include both aerobic exercises which burn calories and improve cardiovascular fitness as well as moderate weight-training which strengthens muscles and slows bone loss. It doesn't have to be complicated and you don't have to join a gym. For bone and muscle strength, weight-bearing exercises are especially important. A simple walking program is a good way to start. Start slowly and do the best you can. You don't have to be jock. If you are too fatigued one day, just try harder next time. The important thing is to have a program of regular exercise.
        • Estrogen replacement
          Estrogen, a female sex-hormone, protects and strengthens bones. After menopause, estrogen levels drop and women become more susceptible to osteoporosis. Adding prednisone to the picture more than doubles the risk. The good news is that taking a low dose estrogen supplement helps prevent this problem. If you are a post-menopausal woman and on prednisone, ask your gynecologist if you would be a candidate for hormonal replacement therapy.
        • Medications to strengthen bones
          In addition to diet, vitamins, exercise, and estrogen, two new drugs show great promise in prevention of osteoporosis. Miacalcin (calcitonin) is given as a nasal spray once a day and reduces bone loss. Fosamax (alendronate) is another new drug that has been shown to actually strengthen weak bones. It is given as a tablet, but may cause ulcers of the esophagus in some patients. Be sure you know how to take it correctly before starting treatment. Much research is being done and other new drugs are on the way.
        • Measuring bone density
          A simple painless x-ray is called a bone densitometry test can tell your doctor if your bone density is normal or below normal. In general, the lower your bone density, the higher your risk for fracture. Since osteoporosis has no early warning symptoms, beginning. its first visible sign may be a debilitating. Now we can better estimate who is at risk. If you are on long-term prednisone therapy, ask your doctor about bone densitometry.

         
         

        levlarry2010-02-24 06:43:15

        This article got lost in time so i thot that i would bump it back to the future.

        LEV

        Question for Dr.Fusco (or anyone who might have an answer for me)

        I'm currently tapering off prednisone. I started at 50 mg 9 months ago and am down to 7.5mg.

        I'm experiencing major pain in my right hand. No where else. Is this normal? The pain feels like when you hand goes to sleep but is maginfied about a hundred times. If I stand up and let my arm drop to side the pain goes away. When I lay down the pain will not stop no matter which way I lay. This has been going for 3 weeks now.

        If anyone has experienced this type of pain pleae let me know how long I can expect it to last.

        Thank you

        Don

        I don't know because I've been on Prednisone for 10 years and since all my docs are freaking out, my Rheumo has been weaning me down and I am down to 3mg one day and 2mg the next, for the next month.  And in the beginning I was still fine, but now I am getting to the end of the month and my pain is coming back and now I am the one freaking out....because I DO NOT want that pain in my shoulders and upper body back!  That was excruciating pain!  But for now....the only thing that is working for me (alittle) is adding a 250 mg. of Naproxen and hoping that when I get dosed down further that even the Naproxen won't work!  UGH!!

        I was told by the RA doctor that when you wean at some point you flare after i told her that i was experiencing great pain after getting down to 7.5. She told me that it would be in my best interest to try to handle the pain and that it should diminish. Apparently it is a natural occurance in the weaning process. Try to stay away from the pain pills or at least be very leary and careful using them and use the very minimun and only when absolutely nessasary.

        Good luck with our journies.

        LEV

        Dr. Fusco, I read your article and it was very helpful. Will you please tell us about the long term effects of using Methotrexate, for R.A.?? Can it cause bone loss, as well, especially when used with Prednisone? Thank you. Nana1.

        Just bumping this up for informations sake.

        LEV

        levlarry39449.7843981481any one know how long it should take to really start helping .
        20 mg 1x a day for 4 days now and not much improvement
        getting discouraged

        Dear Dr. Fusco, 

        I have been having unbearable ankle pain for 7 months, and back pain for a few years.  I went for a body bone scan and the results were inflammation, low back L4,5 neck C3,4 hands and feet especially left ankle(talon something).  Everywhere I have complained about, had adjustments for, taken anti inflammitories for, accupuncture, facet blocks.  My doctor an osteopath has determined so far that it is osteoarthritis and I am experiencing a flare up.  He put me on a dosage of 5, ten mg prednisone for 2 days then 4 for 2 days, then 3  and so on.

        I believe I had a severe reaction in the first three daysbut mentally I can barrely piece it together.  The first day I thought I was okay but by the second I was experiencing confusion, shaky, tingling in hands and feet almost like plugged in to an electrical socket, shortness of breath,loss of control of my bladder(just one time) nose full of cold sores, sore throat, chills and the worst was my mind would draw total blanks about events in my life.  I looked at my calender and had no idea who some of the names were I had on it,  I wondered momentarily if my father was still alive and living downstairs(he passed away 3 years ago)  I could not remember some things that have happened in the last 3 weeks, if told then I do but not on my own.  I felt like I had a stroke or something only it was all mental, I think.  We called the doctor who told me to cut back too 2,10mg for 2 days and then 1 for the same.

        I am now on my second day of 2, 10mg.  I still feel shaky and panicked about the things I cannot remember or things that I all of a sudden remember.  It is very frightening.

        I have never done a message board but I do look up things on the internet where I found your very understandable in laymens language, article all about prednisone.  I guess I just need some sort of direction and validation.  Please. Will I be okay? Have you ever heard of this kind of response?  Any advice I will appreciate.

        If anyone out there.....is able to help me  please do.  I am 62, normally pretty bright,  but I feel nuts and disjointed right now.

        Thank You,

        crazydaze 

         

         

        Hi Levlarry,  I did not realize that you had posted that wonderful article about prednisone.  As I said I am new to how message boards work.  I see you do follow this site and if you have any information or insights for me I am in need of them.  Do you think I could have had a stroke or some kind of seizure. 

        Thanking you again and in advance yours truly,

        Crazydaze

        Dear Happyhaze,
        Your descriptions of many of your complaints bring back forgotten memories. I do remember the brain fog, i still have it somewhat (mostly short term), i remember the tingling and the bladder thing, for a while i had to remember that when I had to go, I'd better go. That problem is long gone. I remember the tingling and every once in a while still have some tingling. I had alot of shaking and asked Dr. Kansal (an Indian Dr.) why my left hand shaked so much and he said, "Leddy, it is physiological." I said, "What does that mean?" and he said, "You are doing it yourself." I still laugh when I think about that conversation, Oh, and my left hand still shakes some time. The nose sores, sore throat and chills and such can very much be bugs that your normal immune system would have quickly destroyed before you even had the symptoms, keep in mind that prednisone and most all RA drugs lower your immune system allowing some bugs to grow to the pont of discomfort and beyond. All of this being said, never take anything for granted. When you are scared or worried always, always seek professional help and/or answers. I am going to add some more side effects of prednisone and you will see many of the sympoms that you described. The memory thing sure brings back memories, so many conversations were just ended because i would just forget what i was saying. Any way Happyhaze, you may want to consider a specialized doctor, maybe a rheumatoligist? Seven months is a long time to have undiognosed pain, unprescrbibed medication to help you. Maybe if you go to urgent care, they may get you on a good path. I went to urgent care because of extreme pain in my wrists (plueral), I thought that I had somehow broken all the bones in both of my hands. The u/c doctors sent me for x-rays and blood draws and told me that they were quite sure that i had ra. I remember going home feeling so good, oh boy I just have rhuematoid arthritis, a couple of advils or aleves like the commercials say and I'm good to go. NOT. Anyway, I'm dragging this out as usual but I am going to post the other side effects and also a site that explains rheumatoid arthritis, just click on the blue link and it will take you there. Happyhaze, take my unprofessional professional opinion,  when you think something isn't right with your body, go see your doctor or go to urgent care righ away. We at this and other forums are good for information but certainly not professional help. I look forward to hearing from you again and wish you good luck on your medical journey. Just remember that most conditions can be controlled and we can live quite comfortable lives, meds just sometimes play havoc with our bodies and minds.........................LEV
         
        Side-effects

        Short-term side-effects, as with all glucocorticoids, include high blood glucose levels, especially in patients that already have diabetes mellitus or are on other medications that increase blood glucose (such as tacrolimus), and mineralocorticoid effects such as fluid retention (although it is worth noting, however, that the mineralocorticoid effects of prednisone are very minor; this is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly). Additional short-term side-effects include insomnia, euphoria, and, rarely, mania. Long-term side-effects include Cushing's syndrome, weight gain, osteoporosis, glaucoma, type II diabetes mellitus, and depression upon withdrawal.

        [edit] Major

        [edit] Minor

        Here are some links for information about rheumatoid arthritis:

         
         
        LEV
         
        levlarry2008-02-02 15:53:37Hi, I am a newby here on this site. I have been taken prednisone for over 15 years due to Lupus sle, which is in remission. However, because I had a kidney transplant going on 6yr. I am still taking 7.5mg per day.
         
         Well, I started having rib pain in my upper back thoracic-area. My family doctor had me get a DEX scan done and just found out that I have osteaporosis. I asked the nurse should I take any calicum supplements and she said he had nothing written down, that a lot of people have osteaporosis. ok, I assume the test was not really that bad.
         
        I heard  that a DEX scan don't really test the upper back area, is that true? I am in moderate pain give it a 5 from 1-10 scale. Haven't felt this type of pain in a long time. What can I do? Should I let my nephrologist kidney doctor know that I had a DEX scan test doneor just wait until my next month appointment with the nephrologist?
        Am I being a worry wart over nothing? Because of transplant, I think the family doctor is scare to give me anything or he knows this was bound to happen because of the long years of taking prednisone and still have too due to transplant.
        One of those dang if you do or dang if you don;t
         
        Bumping for information's sake.Lev, when you were weaning down and having the joint pain - did it indeed go away?  How long did it take? I'm wondering if my recent mini-flares are actually Pred withdrawal and if I should just muscle through them.  Thanks.Hi Tara,
         
        I weaned down mostly on a fluctuating regimine. 10mg, 10mg, 9mg, 10mg, 10mg, 9mg, 10mg, 9mg, 9mg, 10mg, 9mg, 9mg, 9mg, 9mg, 8mg, 9mg, 9mg, 8mg, 9mg, 8mg, 8mg and bla bla bla. When I got down to closer to the 5mg I had to slow to 1/2mgs. Yes, I did flare when I went down fast but usually lasted only 5-7 days. I still weaned faster than recommended. The rituxan made it pretty easy. I guess Tara, maybe you are getting to the dose of where you need to be with your other drugs? Also, if I am sick, I always flare some. I wish I could give you better advise rather than this long drawn out story but since i don't keep a diary, I am going by my reollection and that's not really that trustworthy. How long are you flaring and what mg did you start your wean from. What is your weaning regimine?
         
        LEV

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