Prednisone:

The Drug We All Love to Hate

WHAT IS PREDNISONE?

If you have lupus, or a lupus overlap disease, there is a high probability that at some point you will be prescribed what we in the lupus community like to call “The Devil’s Tic-Tacs,” 

AKA: prednisone.

Prednisone is a corticosteroid medication whose main purpose is to decrease inflammation. It is given to lupus patients for a variety of reasons, primarily to treat nephritis, rheumatoid arthritis, lupus skin rashes, and breathing conditions. Sometimes referred to as cortisone, hydrocortisone, solumedrol, or Decadron, it works by mimicking the body’s natural process of producing cortisol (a hormone made by the adrenal glands) and acts as a glucocorticoid, meaning it can stop inflammation by suppressing the immune system.

In lupus, the immune system is overactive, so prednisone can help control conditions like SLE, scleroderma, mixed connective tissue disease, and other inflammatory autoimmune disorders by lowering the immune response and regulating the inflammatory process. This drug is powerful, it acts fast, and in many instances, can save lives. However, with any drug, especially one as powerful as prednisone, it is important to know the facts so that you can have an open and honest conversation with your doctor about any questions or concerns.

This blog delves into the pros and cons of one of the most prescribed and powerful lupus treatments available. So let’s get into the zone … the predni-zone.

THE BENEFITS:

As hard as it is for some of us to accept, prednisone has many benefits and has helped countless individuals find relief from their lupus symptoms. In fact, before the widespread use of prednisone, no effective treatments existed for conditions such as lupus, psoriasis, asthma, bacterial meningitis, or even serious cases of pneumonia. It was so revolutionary that, in 1950, the Nobel Prize was awarded to the scientists who discovered the benefits of the effects of the use of cortisone/corticosteroids on patients. Back then, the death rate was 80% in two years for those diagnosed with lupus but improved dramatically when prednisone and plaquenil (hydroxychloroquine) were discovered to help with lupus.

The Good:

• It is fast-acting (takes approximately 60 minutes to be metabolized in the liver) and one dose can last 18-36 hours.

• It can control flares until other DMARD’s (disease-modifying antirheumatic drugs like methotrexate, and Benlysta) kick in.

• It works systematically, affecting multiple areas of inflammation (unlike targeted biologics and DMARD’S, meaning it does not target a specific cell or cell function).

• It can improve energy (you were exhausted before but now, on prednisone, you feel like you could lift your car to retrieve your child’s lost baseball).

• It can be given in high “blasts” or as a lower daily maintenance dose.

• It is generally affordable and covered by health insurance.

• It can save your life, time and time again.

SIDE EFFECTS:

It is a strong drug, and with any drug, there is the risk of experiencing side effects. Every person is unique in how he or she responds to the drug. Here are just some of the side effects that may occur with prednisone usage:

The Bad:

• Increase in appetite

• Dizziness and/or headaches

• Insomnia

• A buildup of fluid, causing swelling in your lower legs.

• High blood pressure.

• Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium.

• Anxiety, nervousness

• Irregular menstrual cycles

• Increased hair growth

• Slow healing of bruises and lacerations

• Change in vision or blurred vision

• Irregular heartbeat or shortness of breath

• Rash and/or hives

Occasionally, the side effects of prednisone can be serious. If you experience any of the following symptoms, call your doctor or 9-1-1 immediately:

• Seizures and convulsions

• Loss of vision

• Depression or confusion

• Difficulty swallowing

• Severe rash and/or hives

THINGS TO KNOW

Prednisone is administered in different ways depending on the condition being treated.

• Topically: Corticosteroid creams and ointments can be applied to the skin to treat various lupus skin conditions.

• By inhaler or nasal spray: Steroid inhalers are commonly used for asthma and allergy conditions.

• By mouth: Tablets, capsules, or even syrups may be administered to help treat pain and inflammation associated with certain chronic and inflammatory conditions like lupus, RA, and scleroderma. Your dose will depend on your condition and on how you respond to treatment. It is extremely important to follow the directions on your prescription label. Talk to your doctor first regarding questions about your steroid prescription. They are experts in the nuances of the drug.

• By injection: Steroid injections are used to treat the inflammation of small, localized areas of the body. They also can be given as systemic injections to help treat inflammation that is more widespread. One benefit of cortisone injections is that they can easily be administered right in the doctor’s office. Also, corticosteroid injections can provide relief of localized inflammation and is much stronger and quicker than traditional anti-inflammatory medications given orally (by mouth).

• Infusion: Sometimes it is necessary for individuals to receive medication intravenously (through the veins). IV steroids such as methylprednisolone (Solu-Medrol) are given to treat severe inflammatory attacks. These types of steroids are administered by an infusion pump that can take a few hours to process. This is a fast-acting treatment with noticeable results in a short period of time. Additionally, those who have been on steroids for extended periods may require an IV “stress dose” of medication. This is when a large dose is given before or after surgery, during labor, or in other stressful situations that may be putting additional pressure on the adrenal glands.

Things to be cognizant of:

• Take prednisone exactly as directed. Do NOT increase your dose because you think you should, or suddenly stop taking it. ANY change to the dosage without first consulting your doctor can result in potentially harmful side effects.

• Be honest with your doctor about all the medications (both prescription and nonprescription) and/or supplements that you are currently taking to avoid any negative drug interactions. Some drugs and supplements, such as St. John’s Wort, can decrease the effectiveness of prednisone. Make sure you speak to your doctor if you are planning to go out of the country and need certain vaccinations as well.

• Let your doctor know if you are pregnant, plan to become pregnant, or are breastfeeding. If you do become pregnant while taking prednisone, it is very important to call your doctor as soon as you can. Though prednisone is considered relatively safe during pregnancy, it is important to talk through any medication during this time. Thankfully, for those mothers who are breastfeeding, for doses up to 10 mg/day, the amount of drug an infant receives via breast milk is undetectable; however, the milk/plasma ratio increases with doses above 10 mg/day.

• If you are tapering (reducing the dosage) or suddenly stop taking prednisone, your body may not have enough natural cortisol to maintain normal function. This may cause symptoms such as weight loss, upset stomach, joint pain, body aches, weakness, severe fatigue, changes in skin color, sores in the mouth, and a craving for salt. Tapering or stopping prednisone should ONLY be done under the careful instruction of a physician.

• If you have been on prednisone for a while, or are currently on a high dose, it is a good idea to wear a medical alert bracelet.

• Be aware of your caffeine and sugar consumption while on prednisone. Prednisone can wreak havoc on your blood glucose levels, and make you feel jittery. Eating sugary foods and caffeinated beverages only intensifies the situation. Say no to the energy drinks and try some sugar-free candy.

• Prednisone can affect the growth of children who are taking the medication. If you feel your child is not growing normally, consult your child’s pediatric rheumatologist.

• Prednisone may decrease your ability to fight off infection. Your best defense is to wash your hands frequently and avoid people who are ill.

• While Omega-3 fatty acids (including fish oil) may protect against cardiovascular disease, and decrease some cancer and mental health risks, they may also increase some of the side effects of steroids such as prednisone and hydrocortisone.

Conclusion: Is it Worth It?

While higher doses of prednisone have been shown to lead to organ damage, lower doses, and short-term pulse therapy have good safety profiles.

This drug, despite the unpleasant side effects, is still prescribed time and time again because … it works. Though the side effects can be scary, remember, your doctor is prescribing the medication because he/she believes the benefits outweigh any potential side effects.

*With any new treatment, speaking openly with your doctor about your questions and concerns is important.

Written By:

Kelli (Casas) Roseta 

Sources:

Prednisone: What are 12 Things You Should Know? (drugs.com)

Prednisone and other corticosteroids (mayoclinic.org)

100 Years of Lupus (kaleidoschopefightinglupus.org)

Warning: Supplements and medications may not mix (USAToday.com)

The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years? - PubMed (nih.gov)

Steroids in Lupus: Enemies or Allies - PMC (nih.gov)

**All resources provided by this blog are for informational purposes only and are not intended to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog are owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus, 2024.

Updated June 2024