Prednisone is an immunosuppressant and belongs to a class of drugs known as corticosteroids. It resembles a natural hormone that is produced by the adrenal glands in the body; this drug is given to replace this hormone when the body does not produce sufficient amounts. This corticosteroid is frequently used to treat inflammation and prevent rejection of transplanted organs and treat certain types of cancer.
Oral corticosteroids, such as prednisone, are the only effective drugs in shrinking nasal polyps; these drugs provide a nonspecific anti-inflammatory response that reduces the size of the polyps and improves symptoms related to nasal obstruction. It is also noted to be cost-effective in the treatment of nasal polyps, since a generic formulation is available. Side effects associated with prednisone include upset stomach, vomiting, headache, dizziness, insomnia, and depression, among others. Additionally, the use of prednisone increases the risk for infection.
ORIGINAL USES (ON-LABEL)
Treatment of various allergic and various inflammatory disorders, including those of the skin, endocrine system, gastrointestinal, lung, rheumatic, blood.
NEWLY DISCOVERED USES (OFF-LABEL)
Alopecia areata, autoimmune hepatitis, bullous pemphigoid, canker sores (recurrent), complicated mononucleosis/Epstein-Barr, cystic fibrosis in children, drug-induced anaphylaxis, hemosiderosis, kidney stones, muscular dystrophy, myasthenia gravis, nasal polyps, pneumocystis jiroveci pneumonia, polyarteritis nodosa, polymyalgia rheumatica, sudden hearing loss, thrombotic thrombocytopenic purpura, ureteral stones, urticaria, West syndrome.
POTENTIAL SIDE EFFECTS
Long-term use of systemic corticosteroids in high doses can lead to decreased activity of the immune system and susceptibility to infection; the inflammatory response is reduced, which can mask signs of infection.
Disturbance in calcium metabolism results in loss of bone tissue, which can retard growth in children and exacerbate osteoporosis in adults.
Glucocorticoids affect protein metabolism, causing muscle weakness and thinning of the skin, with delayed wound healing and stretch marks (striae); glucose metabolism, resulting in diabetes mellitus; and the metabolism of fat, which is deposited in the face ('moon face'), on the shoulders ('buffalo hump'), and in the abdomen.
These signs of excess glucocorticoids are sometimes called 'Cushingoid features'.
Other side effects include indigestion (which is common) and possibly peptic ulceration; increased appetite and weight gain; acne; increased growth of facial and body hair; mood changes, ranging from euphoria to depression and paranoia; insomnia; and menstrual irregularities.
- People taking prednisone by mouth for more than one month are advised to carry a warning card; higher doses may be required during periods of illness or stress.
- Withdrawal of treatment after long-term use should be gradual.
- It should not be taken by people with systemic infections unless active treatment of the infection is given at the same time.
- People taking systemic corticosteroids for purposes other than replacement therapy should avoid contact with those suffering from chickenpox or shingles while taking the steroids and up to three months after treatment; anyone taking systemic steroids who has been in close contact with someone suffering from chickenpox should see a doctor.
- People taking high doses of prednisone systemically should not be given vaccinations with live vaccines.
- This drug reduce the effect of insulin and care must be taken by people with diabetes.
- Dosage may need to be reduced in the elderly, in whom side effects may be more pronounced.
- Corticosteroids should be used with caution during pregnancy.
- Antidiabetic drugs: their effect is reduced to a small extent.
- Antiepileptics: carbamazepine, phenobarbitone (phenobarbital), phenytoin, and primidone reduce the effects of corticosteroids.
- Antihypertensive drugs: their effect in lowering blood pressure is antagonized.
- Digoxin: there is an increased risk of toxicity from digoxin if plasma potassium concentrations fall.
- Diuretics: there is an increased risk of reduced plasma potassium concentrations, and steroids (especially mineralocorticoids) tend to cause water retention.
- Rifampicin: reduces the effects of corticosteroids.
Caffeine intake should be limited. May cause stomach upset; take with food or snack.
PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category C. Excreted in breast milk. Consult your doctor.
Prolonged therapy may result in suppression of adrenal gland function. Take single daily dose in morning prior to 9 a.m. Take multiple doses at evenly spaced intervals throughout the day. Increase dietary intake of pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus. Monitor blood pressure, blood glucose and electrolytes.
In a study conducted in Spain, approximately 53 patients with nasal polyps were given oral prednisone for two weeks and 56 patients were selected for surgery. After six and 12 months, significant quality-of-life improvements were seen with both medical and surgical treatment. Nasal symptoms and polyp size improved after both medical and surgical treatment at six and 12 months. Researchers concluded that both medical and surgical treatment resulted in similar quality-of-life improvements.
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