Risk of using prednisone -
Looking for:
- Side effects of prednisolone tablets and liquid - NHS |
Prednisone (Oral Route) Side Effects - Mayo Clinic - Appointments at Mayo Clinic
Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, inflammatory bowel disease and asthma. But these drugs also carry a risk of various side effects. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis, asthma or skin rashes.
Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues. Corticosteroid drugs are used to treat rheumatoid arthritis, inflammatory bowel disease IBDasthma, allergies and many other conditions. These drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients.
Corticosteroids also treat Addison's disease, a relatively rare condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs. Corticosteroids are administered in many different ways, depending on the condition being treated:. Corticosteroids carry a risk of side effects, some of which can cause serious health problems.
When you know what side effects are possible, you can take steps to control their impact. Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive and may include:. When using an inhaled corticosteroid, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:.
If you gargle and rinse your mouth with water — don't swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Some researchers have speculated that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma. Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare.
Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient's situation.
Corticosteroids may cause a range of side effects. But they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. Talk with your doctor to help you better understand the risks and benefits of corticosteroids and make informed choices about your health.
There is a problem with information submitted for this request. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID, plus expertise on managing health. To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you.
If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission.
Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only. This content does not have an English version. This content does not have an Arabic version. See more conditions. Request Appointment. Prednisone and other corticosteroids. Products and services. Prednisone and other corticosteroids Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication.
By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Ritter JM, et al. The pituitary and the adrenal cortex. Elsevier; Accessed Oct. Grennan D, et al.
Steroid side effects. Saag KG, et al. Major side effects of systemic glucocorticoids. Major side effects of inhaled glucocorticoids. Roberts WN, et al. Joint aspiration or injection in adults: Complications.
Nieman LK. Pharmacologic use of glucocorticoids. Long-term glucocorticoid therapy. Mayo Clinic; Wilkinson JM expert opinion.
Mayo Clinic. Acetyl-L-carnitine: Can it relieve MS fatigue? Addison's disease Adrenal fatigue: What causes it? Albuterol side effects Alcoholic hepatitis Allergies Allergies and asthma Allergy medications: Know your options Allergy-proof your home Aplastic anemia Arthritis Arthritis pain: Do's and don'ts Aspergillosis Aspirin allergy Asthma Asthma and acid reflux Asthma attack Asthma diet Asthma inhalers: Which one's right for you?
Asthma: Colds and flu Asthma medications Asthma: Testing and diagnosis Asthma treatment: 3 steps Asthma treatment: Do complementary and alternative approaches work? Atopic dermatitis eczema Atopic dermatitis: 6 ways to manage itchy skin Atopic dermatitis: Proper bathing can reduce itching Atopic dermatitis: Understand your triggers Avoid rebound nasal congestion Baker cyst Base tan? Bad idea Behcet's disease Explaining multiple sclerosis Treating Pericarditis Bullous pemphigoid Bursitis Can baby eczema be prevented?
Can I exercise if I have atopic dermatitis? Infographic: Cardiac sarcoidosis: A heart under attack Carpal tunnel exercises: Can they relieve symptoms? Does stress make rheumatoid arthritis worse? Drug allergy Dust mite allergy Ease rheumatoid arthritis pain when grocery shopping Ease stress to reduce eczema symptoms Eczema bleach bath: Can it improve my symptoms?
Emerging treatments for multiple sclerosis Emphysema Exercise and multiple sclerosis Exercising with arthritis Giant cell arteritis Glomerulonephritis Hip labral tear How do I reduce fatigue from rheumatoid arthritis? How to treat baby eczema Hyperinflated lungs: What does it mean? Hypopituitarism I have atopic dermatitis. How can I sleep better? Interstitial lung disease Is depression a factor in rheumatoid arthritis? Juvenile idiopathic arthritis Keloid scar Knee bursitis Knee pain Living better with atopic dermatitis eczema Living better with rheumatoid arthritis Managing Headaches Mangosteen juice: Can it relieve arthritis pain?
Migraines and Vertigo Migraines: Are they triggered by weather changes? Alleviating migraine pain Mixed connective tissue disease Mononucleosis Mononucleosis: Can it recur? Mononucleosis and Epstein-Barr: What's the connection? What is multiple sclerosis? Ocular migraine: When to seek help Oral lichen planus Ozone air purifiers Paraneoplastic syndromes of the nervous system Pericarditis Pink eye conjunctivitis Pink eye: How long is it contagious? Plantar fasciitis Pneumonitis Polymyalgia rheumatica Polymyositis Prednisone withdrawal: Why taper down slowly?
Preeclampsia Preterm labor Protect your joints while housecleaning Ramsay Hunt syndrome Reactive airway disease: Is it asthma? Rheumatoid arthritis and exercise Rheumatoid arthritis: Can it affect the eyes?
Rheumatoid arthritis: Can it affect the lungs? Sacroiliitis Salt craving: A symptom of Addison's disease? Sarcoidosis Sciatica Sepsis Sinus infection and toothache: Any connection?
Hand exercises for people with arthritis Joint protection Spinal stenosis Stop your next migraine before it starts Sulfa allergy Sunburn Sunburn treatment: Do I need medical attention?
Thrombocytopenia Thumb arthritis Thumb Reconstruction Tips to make your mornings easier Trichinosis Asthma attack video Carpal tunnel symptoms: Role of nonsurgical treatment Carpal tunnel syndrome surgery: Immediate and long-term results Dry powder disk inhaler Dry powder tube inhaler Video: How to use a peak flow meter Single-dose dry powder inhaler Using a metered dose asthma inhaler and spacer Vitamin D and MS: Any connection?
Vitamins for MS: Do supplements make a difference? Whipple's disease Show more related content. ART Home Prednisone risks, benefits. Legal Conditions and Terms Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Advertising Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Advertising and sponsorship policy Advertising and sponsorship opportunities.
❿Risk of using prednisone. Corticosteroids
To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information.
If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices.
You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission.
Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only. This content does not have an English version. This content does not have an Arabic version. See more conditions. Request Appointment.
Prednisone and other corticosteroids. Products and services. Prednisone and other corticosteroids Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication. By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry.
Show references Ritter JM, et al. The pituitary and the adrenal cortex. Elsevier; Accessed Oct. Grennan D, et al. Steroid side effects.
Saag KG, et al. Major side effects of systemic glucocorticoids. Major side effects of inhaled glucocorticoids. Roberts WN, et al. Joint aspiration or injection in adults: Complications. Nieman LK. Pharmacologic use of glucocorticoids. Long-term glucocorticoid therapy. Mayo Clinic; Wilkinson JM expert opinion. Mayo Clinic. Acetyl-L-carnitine: Can it relieve MS fatigue? Addison's disease Adrenal fatigue: What causes it? Albuterol side effects Alcoholic hepatitis Allergies Allergies and asthma Allergy medications: Know your options Allergy-proof your home Aplastic anemia Arthritis Arthritis pain: Do's and don'ts Aspergillosis Aspirin allergy Asthma Asthma and acid reflux Asthma attack Asthma diet Asthma inhalers: Which one's right for you?
Asthma: Colds and flu Asthma medications Asthma: Testing and diagnosis Asthma treatment: 3 steps Asthma treatment: Do complementary and alternative approaches work? Atopic dermatitis eczema Atopic dermatitis: 6 ways to manage itchy skin Atopic dermatitis: Proper bathing can reduce itching Atopic dermatitis: Understand your triggers Avoid rebound nasal congestion Baker cyst Base tan?
Bad idea Behcet's disease Explaining multiple sclerosis Treating Pericarditis Bullous pemphigoid Bursitis Can baby eczema be prevented? Can I exercise if I have atopic dermatitis? Infographic: Cardiac sarcoidosis: A heart under attack Carpal tunnel exercises: Can they relieve symptoms?
Does stress make rheumatoid arthritis worse? Drug allergy Dust mite allergy Ease rheumatoid arthritis pain when grocery shopping Ease stress to reduce eczema symptoms Eczema bleach bath: Can it improve my symptoms? Emerging treatments for multiple sclerosis Emphysema Exercise and multiple sclerosis Exercising with arthritis Giant cell arteritis Glomerulonephritis Hip labral tear How do I reduce fatigue from rheumatoid arthritis? Describe the possible adverse effects of corticosteroid therapy.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care to patients requiring corticosteroids. Access free multiple choice questions on this topic.
Corticosteroids are hormone mediators produced by the cortex of adrenal glands that are further categorized into glucocorticoids major glucocorticoid produced by the body is cortisol , mineralocorticoids major mineralocorticoid produced in the body is aldosterone , and androgenic sex hormones. Endogenous cortisone was first isolated in and synthesized in In , Dr. Philip S Hench published administered cortisone called Compound E at that time to a year-old woman who was bed-ridden secondary to active rheumatoid arthritis.
The patient was able to walk after three days of treatment. This case was published in , and in , Philip S. Hench, Edward C. Kendall, and Tadeusz Reichstein were awarded the Nobel Prize in Physiology or Medicine "for their discoveries relating to the hormones of the adrenal cortex, their structure, and biological effects. Glucocorticoids GCs are a group of drugs structurally and pharmacologically similar to the endogenous hormone cortisol with various functions like anti-inflammatory, immunosuppressive, anti-proliferative, and vaso-constrictive effects.
Their actions are used medically for the treatment of various conditions indicated below. The list of indications of glucocorticoids is extremely long. We have categorized and mentioned the most important and broad-spectrum indications below. Mineralocorticoids are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cells of the collecting ducts of the kidney.
The use of mineralocorticoid drugs is limited to their replacement therapy in acute adrenal crisis and Addison disease. Due to several roles played by corticosteroids in the human body, they see extensive use in medical practice to treat various diseases. As a result, their side-effects have, in turn, become another significant medical issue requiring special attention. The anti-inflammatory and immunosuppressive effects of glucocorticoids are dose-dependent, with immunosuppressive effects seen mostly at higher doses.
The pharmacological anti-inflammatory and immunosuppressive effects of glucocorticoids are extensive and can occur via genomic or non-genomic mechanisms. Most effects of glucocorticoids are via the genomic mechanisms, which takes time, while immediate effects via the non-genomic mechanisms can occur with high doses of glucocorticoids such as pulse therapy. Clinically, it is not possible to separate these effects. Being small, lipophilic substances, glucocorticoids readily pass the cell membrane by diffusion and enter the cytoplasm of the target cells, where most of their action is mediated by binding to the intra-cytoplasmic glucocorticoid receptors.
In the nucleus of the target cells, this complex reversibly binds to several specific DNA sites resulting in stimulation transactivation and suppression transrepression of a large variety of gene transcription.
The immediate effects of high dose-glucocorticoids are mediated via non-genomic mechanisms. At high doses, glucocorticoids bind the membrane-associated glucocorticoid receptors on target cells such as T-lymphocytes, resulting in impairment of receptor signaling and immune response of the T lymphocytes. High-dose glucocorticoids also interact with the cycling of calcium and sodium across the cell membrane resulting in a rapid decrease in inflammation.
By altering the cytokine production via the genomic and non-genomic mechanisms, glucocorticoids lead to suppression of the immune system and decreased inflammation. They target a wide variety of cells, including T-lymphocytes, macrophages, fibroblasts, neutrophils, eosinophils, and basophils.
Notably, glucocorticoids have almost no effect on B-cell function and immunoglobulin production. The downstream effects of glucocorticoids are summarized below:.
Glucocorticoids exert negative feedback effects on the HPA axis. Chronic HPA axis suppression by glucocorticoids leads to functional adrenal atrophy sparing the mineralocorticoid producing outer adrenal cortex that is functionally independent of ACTH.
The risk of this functional adrenal atrophy and insufficiency is challenging to predict and varies from patient to patient but is largely dependant on the dose and duration of glucocorticoid therapy.
The adrenal function generally recovers by slow tapering of glucocorticoids. Glucocorticoids bind to mineralocorticoid receptors MRs and produce their mineralocorticoid effect i. Several preparations of glucocorticoids are available, each with varying efficacy. Dexamethasone and betamethasone are long-acting with the highest glucocorticoid efficacy with a biological half-life of 36 to 54 hours.
Cortisone and cortisol are short-acting with a biological half-life of under 12 hours and are not frequently used. Prednisone, prednisolone, methylprednisolone, and triamcinolone are intermediate-acting with a biological half-life of 18 to 36 hours. The glucocorticoid and mineralocorticoid effects of each available preparation vary, with cortisol and cortisone having almost 1 to 1 glucocorticoid and mineralocorticoid effects while all others with almost no mineralocorticoid effects.
Equivalent glucocorticoid doses can be calculated for these various preparations. Parenteral intravenous administration of high doses of glucocorticoids may be warranted in emergencies, such as septic shock, COPD exacerbation, and severe acute asthma.
Pulse therapy of glucocorticoids mg intravenous methylprednisolone divided over 3 to 4 daily doses for several days has been studied in several rheumatological conditions.
This approach is recommended only for organ-threatening or life-threatening situations, including lupus nephritis Class III or IV , giant cell arteritis with vision loss, ANCA-associated vasculitis, etc.
Americal College of Rheumatology also recommends using intravenous glucocorticoids in patients with acute gout who are unable to take medications orally. Oral preparations are usually useful in both acute and chronic indications. Tapering dose packs starting at high doses and tapering daily over 7 to 9 days are commercially available and can be used in these situations as well. Long-term oral corticosteroid therapy may be necessary for chronic illnesses such as polymyalgia rheumatica, SLE, RA, vasculitis, myositis, IgG4-related disease, chronic myelogenous leukemia CML , lymphoma, leukemia, multiple sclerosis, organ transplantation, etc.
Clinicians must make every effort to use the glucocorticoids at the lowest possible dose and for the shortest possible duration in these cases. A slow taper shall be attempted in patients with prolonged exposure to glucocorticoids to prevent adrenal crisis. Glucocorticoid administration can be via several non-systemic routes, including intra-articular joint injections for joint inflammation, inhalational for asthma, topical for dermatological problems, ocular drops for eye conditions, and intra-nasal for seasonal rhinitis.
Clinicians generally avoid intramuscular IM glucocorticoids due to the risk of local muscle atrophy due to depot effect, and the only indications for intramuscular glucocorticoids are for IM triamcinolone acetonide for specific inflammatory disorders and IM injection of betamethasone to a pregnant mother less than 37 weeks of gestation to stimulate fetal lung maturity. When appropriate, a non-systemic route is preferable to the systemic route of administration to minimize systemic adverse effects.
Given the diversity in the mechanism of action of glucocorticoids, they can cause a wide array of adverse effects ranging from mild to severe, some of which are unavoidable. Of all the factors influencing the adverse effects of glucocorticoids, dose and duration of therapy are the most important independent and well-documented risk factors. Other adverse effects may follow a threshold dose-response pattern with an elevated frequency of events beyond a specific threshold value weight gain and epistaxis at prednisone dose greater than 5 mg daily, glaucoma, depression, hypertension at prednisone dose greater than 7.
Several other factors may influence the adverse effects of glucocorticoids. Older age, comorbid conditions such as diabetes mellitus , concomitant use of other immunosuppressive agents, severity and nature of the underlying disease, and poor nutritional status can all influence the occurrence and magnitude of side effects. Glucocorticoids induced Osteoporosis is one of the well-known and devastating adverse effects of long-term use of glucocorticoids.
The trabecular bone is initially affected, with cortical bone loss seen with longer-term use. The loss of trabecular bone can occur within the first 6 to 12 months of therapy. Steroid-induced myopathy, which is a reversible painless myopathy and is a direct result of muscle breakdown, can occur in both the upper and lower extremities, usually with high-dose long-term use of glucocorticoids.
Muscle enzymes CK and Aldolase are typically normal, and findings on electromyography are non-specific. Muscle biopsy reveals Type-II fiber atrophy without inflammation. Withdrawal of glucocorticoids and exercises usually results in the resolution of myopathy. It characteristically presents with a severe, diffuse, proximal, and distal weakness that develops over several days.
Although it is usually reversible, critical illness myopathy can lead to prolonged ICU admissions, increased length of hospital stays, severe necrotizing myopathy, and increased mortality. Osteonecrosis can be seen especially with long-term use of prednisone more than 20 mg daily. Patients with SLE and children are at higher risk.
Hips and knees are the most commonly involved joints with less common involvement of shoulders and ankles. Pain is the initial feature, which may eventually become severe and debilitating. Magnetic resonance imaging is the most sensitive test, especially for early detection. Plain radiographs may be negative initially but can be useful for follow-up. Systemic glucocorticoids cause a dose-dependent increase in fasting glucose levels and a more significant increase in postprandial values in patients without preexisting diabetes mellitus, but the development of de novo diabetes in a patient with initially normal glucose tolerance is uncommon.
Risk factors for new-onset hyperglycemia during glucocorticoid therapy appear to be the same as those for other patients. However, patients with diabetes mellitus or glucose intolerance exhibit higher blood glucose levels while taking glucocorticoids, leading to increased difficulty with glycemic control. The development of cushingoid features redistribution of body fat with truncal obesity, buffalo hump, and moon face and weight gain are dose and duration-dependent and can develop early.
Cushingoid features showed a linear increase in frequency with dosing. Glucocorticoid therapy is the most common cause of Cushing syndrome. The clinical presentation in the pediatric population is similar to that in adults and includes truncal obesity, skin changes, and hypertension. In children, growth deceleration is also a feature. Administration of glucocorticoids can suppress the hypothalamic-pituitary-adrenal HPA axis decreasing corticotropin-releasing hormone CRH from the hypothalamus, adrenocorticotropic hormone ACTH from the anterior pituitary gland, and endogenous cortisol.
Prolonged ACTH suppression cause atrophy of adrenal glands, and abrupt cessation or rapid withdrawal of Glucocorticoids in such patients may cause symptoms of adrenal insufficiency. The clinical presentation of adrenal suppression is variable. Adrenal suppression is the most common cause of adrenal insufficiency in children and is associated with higher mortality in the pediatric population.
In adults, the symptoms of adrenal suppression are non-specific; therefore, the condition may go unrecognized until exposure to physiological stress illness, surgery, or injury , resulting in an adrenal crisis. Children with adrenal crisis secondary to adrenal suppression may present with hypotension, shock, decreased consciousness, lethargy, unexplained hypoglycemia, seizures, and even death.
The impairment of growth in young children and delay in puberty commonly presents in children receiving glucocorticoids for chronic illnesses like nephrotic syndrome and asthma. The effect is most pronounced with daily therapy and less marked with an alternate-day regimen and can also occur with inhaled glucocorticoids. Although growth impairment can be an independent adverse effect of corticosteroid therapy, it can also be a sign of adrenal suppression. Moderate to high dose use of glucocorticoids poses a significant risk of infections, including common mild infections as well as serious life-threatening infections.
There is a linear increase in the risk with dose and duration of therapy, especially with common bacterial, viral, and fungal pathogens. Concomitant use of other immunosuppressive agents and the elderly age further increases the risk of infections.
Patients taking glucocorticoids may not manifest common signs and symptoms of infection as clearly, due to the inhibition of cytokine release and the associated reduction in inflammatory and febrile responses leading to a failure in early recognition of infection. Mineralocorticoid effects, especially as seen with cortisol and cortisone, can lead to fluid retention, edema, weight gain, hypertension, and arrhythmias by increasing renal excretion of potassium, calcium, and phosphate.
Hypertension usually occurs with higher doses only. Several cutaneous adverse effects can occur even at a low dose use of glucocorticoids, although the risk increases linearly with the increasing dose and duration of glucocorticoid therapy.
Although cutaneous adverse effects appear to be clinically significant by physicians, they are usually of most concern to the patients. The risk of cataracts is significantly high in patients taking prednisone more than 10 mg daily for more than one year, with a dose-dependence in a linear fashion.
However, an increased risk of cataracts has been reported even with low-dose glucocorticoids. After discontinuing systemic therapy, the elevation in intraocular pressure usually resolves within a few weeks, but the damage to the optic nerve is often permanent.
A rare adverse effect of systemic or even topical use of glucocorticoids is central serous chorioretinopathy; this leads to the formation of subretinal fluid in the macular region, which leads to separation of the retina from its underlying photoreceptors. This condition manifests as central visual blur and reduced visual acuity. Glucocorticoids increase the risk of adverse GI effects, such as gastritis, gastric ulcer formation, and GI bleeding.
Other complications associated with glucocorticoid use include pancreatitis, visceral perforation, and hepatic steatosis fatty liver that can rarely lead to systemic fat embolism or cirrhosis.
Patients receiving glucocorticoids often experience an improved sense of well-being within several days of starting the medications; mild euphoria or anxiety may also occur. Hypomanic reactions and activated states are more common early in the therapy than depression, but the prevalence of depression is greater in patients on more longstanding therapy.
Psychosis can occur but does so almost exclusively at doses of prednisone above 20 mg per day given for a prolonged period. Disturbances in sleep are reported, especially with split doses that may interfere with the normal pattern of diurnal cortisol production.
Akathisia motor restlessness is a common glucocorticoid side effect. The risk of developing a given neuropsychiatric disorder following glucocorticoid therapy may increase among patients with a history of the condition. Rare cases of pseudotumor cerebri have also correlated with glucocorticoid use. There is specific documentation of neuropsychiatric adverse effects with glucocorticoid therapy in children with acute lymphoblastic leukemia ALL receiving dexamethasone or prednisone for the induction and maintenance of treatment.
Preexisting conditions that should be assessed for and treated when starting glucocorticoids include:. Before initiating long-term systemic glucocorticoid therapy, the clinician should perform a thorough history and physical examination to assess for risk factors or preexisting conditions that may potentially be exacerbated by glucocorticoid therapy, such as above.
In children, the clinician should also examine nutritional and pubertal status. American College of Rheumatology has published specific guidelines addressing this issue to help prevent and manage GiOp. The HPA axis should undergo assessment if the patient has received systemic corticosteroids for more than two consecutive weeks or more than three cumulative weeks in the last six months or if the patient has persistent symptoms of adrenal suppression.
Screening is by measuring early morning salivary cortisol after tapering off the dose of cortisol. If morning cortisol is normal, but the patient has symptoms of adrenal suppression, perform a low-dose ACTH stimulation test to confirm the diagnosis. Consider endocrinology referral for confirmation of diagnosis. Growth in children and adolescents on chronic glucocorticoid therapy shall be monitored every six months and plotted on a growth curve. Lipid profile shall be monitored one month after glucocorticoid initiation and then every 6 to 12 months.
Glycemic control requires assessment via screening for classic symptoms at every visit: polyuria, polydipsia, weight loss.
Monitor glucose parameters for at least 48 hours after glucocorticoids initiation, then every 3 to 6 months for the first year and annually afterward. In children, an annual oral glucose tolerance test merits consideration if the child is obese or has risk factors for diabetes.
An annual ophthalmological examination shall be considered, especially for those with symptoms of cataracts, and early referral for intraocular pressure assessment should occur if there is a personal or family history of open-angle glaucoma, diabetes mellitus, or high myopia. Patients who also require concomitant treatment with non-steroidal anti-inflammatory drugs NSAIDs or anticoagulants shall receive therapy with proton pump inhibitors PPI.
Patients who require an extended course of glucocorticoids, especially high doses, shall receive appropriate immunizations before the institution of therapy. Prophylaxis for opportunistic infection with Pneumocystis jirovecii pneumonia PCP is also recommended in patients receiving prednisone at a dose of 20 mg or more for more than two weeks. The prophylaxis can stop once the dose of prednisone is below 20 mg daily dose. Concomitant use of other medications also merits attention before initiating therapy as significant drug interactions exist between glucocorticoids and several drug classes.
Abrupt cessation of chronic glucocorticoid therapy can be dangerous as there is a risk of HPA axis suppression. Withdrawal of glucocorticoid therapy needs tapering over the period. In general, patients who are given acute corticosteroid therapy for less than 14 to 21 days do not develop HPA axis suppression, and treatment can stop with no need for any tapering regime in them.
If the therapy has been ongoing for greater than three weeks, tapering is needed e. Acute psychosis can develop in patients receiving high-dose glucocorticoids. Immediate cessation of the drug on the appearance of symptoms is the first step. Although many drugs, including antipsychotics, antidepressants, benzodiazepines, and hydrocortisone, have been tried with variable success, currently, there is no consensus on the ideal therapeutic remedy to stop and reverse the corticosteroid-induced neuropsychiatric adverse effects in adults or children.
Their specific adverse effects further limit the use of the medications mentioned above. Physiologic doses of hydrocortisone have shown to improve mild to moderate psychosocial disturbances and insomnia experienced by children who developed severe behavioral problems with dexamethasone-based treatment regime administered to treat ALL. No adverse effects were found with oral KCl supplementation. Glucocorticoids are widely used to manage many acute and chronic inflammatory disorders.
The adverse effects of glucocorticoids are extensive and can involve many organ systems. While short-term use of corticosteroids is associated with mild side effects, long-term use can result in several severe adverse effects, some of which are irreversible.
This is why an interprofessional team approach to corticosteroid therapy and subsequent monitoring is necessary.
❾-50%}Prednisone and other corticosteroids: Balance the risks and benefits - Mayo Clinic.Corticosteroids | NHS inform
If you want to check your medicines are safe to take with corticosteroids, ask your GP or pharmacist, or read the patient information leaflet that comes with your medicine. Anticoagulant medicines are medications that make the blood less sticky. They are often prescribed to people with a history of blood clots or an increased risk of developing them.
Combining corticosteroids with anticoagulant medicines can sometimes make anticoagulants less effective. Alternatively, it can increase their blood-thinning effect, which can cause bleeding inside the digestive system.
Anticonvulsants are medicines used to prevent seizures fits and are often used to treat epilepsy , but they can reduce the effectiveness of corticosteroids. Depending on how frequent and severe your seizures are and the condition the steroids are being used to treat, you may be advised to temporarily stop taking anticonvulsants.
Corticosteroids can decrease the effectiveness of medications used to treat diabetes. If you need to take both of these medications, your blood glucose levels will usually be checked more regularly and your dose of diabetes medication may need to be adjusted.
Corticosteroids, including steroid inhalers, can sometimes interact with a type of medication known as protease inhibitors such as ritonavir used to treat HIV. The HIV medication may increase the level of corticosteroid in your body, which might increase your risk of experiencing side effects.
Some vaccinations contain a weakened form of the infection they are designed to protect against. These are known as live vaccines. Examples of live vaccines include:. As corticosteroids can weaken your immune system and make you more vulnerable to infection, you should avoid any live vaccine until at least three months after your course of corticosteroids has finished.
Non-steroidal anti-inflammatory drugs NSAIDs are a group of commonly used painkillers, such as ibuprofen , that are available over the counter at pharmacists. Combining NSAIDs and corticosteroids can increase your risk of developing stomach ulcers and internal bleeding. If you need to take both medications, you may be given an additional medication called a proton pump inhibitor PPI to reduce the risk of stomach ulcers. Some of the main side effects are listed below, but this is not a complete list.
To learn about all the possible side effects of your medication, read the patient information leaflet that comes with it. Inhaled steroids usually have few or no side effects if used at normal doses.
However, they can sometimes cause:. Rinsing your mouth out with water after using your medication can help to prevent oral thrush, and using a device called a spacer with your medication can help to prevent many of the other problems.
There is also some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease COPD can increase the risk of chest infections such as pneumonia. Inhaled steroids at high doses can sometimes cause some of the more serious side effects that are more often linked with steroid tablets see below , but this is rare.
Steroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days. Steroid injections can also cause muscle or tendon weakness, so you may be advised to rest the treated area for a few days after the injection. Other possible side effects can include infections, blushing, and thinning and lightening of the skin in the area where the injection is given.
Because of the risk of side effects, steroid injections are often only given at intervals of at least 6 weeks and a maximum of 3 injections into one area is usually recommended.
Steroids that are injected into a blood vessel intravenous steroids may sometimes cause some of the more widespread side effects described below. Short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects.
Most side effects should improve if you're able to reduce your dosage or eventually stop taking the medication. You may have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take steroid tablets on a long-term basis.
Source: NHS 24 - Opens in new browser window. Last updated: 07 January Home Tests and treatments Medicines and medical aids Types of medicine Types of medicine. Corticosteroids See all parts of this guide Hide guide parts 1.
Introduction 2. Who can use them 3. Medicines that interact with them 4. Side effects. Introduction Corticosteroids, often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions. Corticosteroids are available in different forms, including: tablets oral steroids injections — which can be into blood vessels, joints or muscles inhalers — such as mouth or nasal sprays lotions, gels or creams topical steroids What are corticosteroids used for?
Corticosteroids are mainly used to reduce inflammation and suppress the immune system. They are used to treat conditions such as: asthma allergic rhinitis and hay fever urticaria hives atopic eczema chronic obstructive pulmonary disease COPD painful and inflamed joints, muscles and tendons lupus inflammatory bowel disease IBD — including Crohn's disease and ulcerative colitis giant cell arteritis and polymyalgia rheumatica multiple sclerosis MS Corticosteroids can also be used to replace certain hormones that are not being produced by the body naturally — for example, in people with Addison's disease.
Possible side effects Corticosteroids will only be prescribed if the potential benefits of treatment outweigh the risks. Potential side effects of long-term treatment include: increased appetite — potentially leading to weight gain acne thinned skin that bruises easily increased risk of infections mood changes, mood swings and depression diabetes high blood pressure osteoporosis weak and brittle bones withdrawal symptoms caused by suppression of the adrenal glands If you have troublesome side effects after taking corticosteroids, don't stop taking your medication until your doctor says it's safe to do so, because of the possibility of these unpleasant withdrawal effects.
Cautions and interactions For most people, including pregnant or breastfeeding women, steroid inhalers and injections are safe.
Accessing medicines self-help guide Visit our self-help guide on accessing medicines if you have difficulty getting the medicines you need. Who can use them For most people, steroid inhalers and steroid injections should not cause any troublesome side effects. Steroid tablets Corticosteroid tablets are the most powerful type of steroid medication, because they can affect the whole body.
Steroid tablets should be used with caution in people with: liver problems, such as liver disease — corticosteroids may not be broken down by the liver at a normal rate, leading to increased levels of the medication in the blood mental health or behavioural problems, such as depression or alcohol dependence — corticosteroids can have unpredictable effects on behaviour and mood wounds — oral corticosteroids can delay wound healing They should also be used with caution in people with a health condition that could be made worse by taking oral corticosteroids, including: heart failure a recent heart attack high blood pressure diabetes epilepsy glaucoma underactive thyroid gland osteoporosis obesity psychosis stomach ulcers In these situations, you will only be prescribed oral corticosteroids if the benefits of treatment clearly outweigh any potential risks.
Steroid injections Most people can safely have corticosteroid injections, but they should be avoided or used with caution if you have an ongoing infection or a blood clotting disorder such as haemophilia.
Steroid inhalers and sprays There is generally no reason why someone shouldn't be able to use a steroid inhaler or steroid spray, but these should be used with caution in people with ongoing infections, such as tuberculosis TB. Pregnancy Corticosteroids are generally safe to use during pregnancy.
Breastfeeding If a woman needs to take steroid tablets while she is breastfeeding, a type called prednisolone is usually recommended, because it is thought to have the least chance of causing the baby any adverse effects. Medicines that interact with them Corticosteroids can interact with other medicines, and the effects of either medicine can be altered as a result. Prednisone is a corticosteroid cortisone-like medicine or steroid. It works on the immune system to help relieve swelling, redness, itching, and allergic reactions.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.
For non-prescription products, read the label or package ingredients carefully. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children. However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time.
Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine.
Make sure you tell your doctor if you have any other medical problems, especially:. Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine. Blood or urine tests may be needed to check for unwanted effects.
Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. Corticosteroids are hormone mediators produced by the cortex of adrenal glands that further categorize into glucocorticoids, mineralocorticoids, and androgenic sex hormones. They are used in a plethora of conditions, commonly called steroid-responsive disorders and dermatoses. Corticosteroids are used across all medical specialties.
This activity reviews the must-know properties of this group of drugs, their broad indications and contraindications, ways of administration, adverse event profile, practical aspects of the pharmacokinetics of different molecules, monitoring essentials, approach to maximize the benefit and minimize adverse effects, and clinically relevant drug-interactions pertinent for all specialists whether used in isolation or administered by an interprofessional team.
Objectives: Review the anti-inflammatory, anti-proliferative, and immunosuppressive actions of corticosteroids. Summarize the monitoring required for corticosteroid therapy. Describe the possible adverse effects of corticosteroid therapy. Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care to patients requiring corticosteroids. Access free multiple choice questions on this topic. Corticosteroids are hormone mediators produced by the cortex of adrenal glands that are further categorized into glucocorticoids major glucocorticoid produced by the body is cortisolmineralocorticoids major mineralocorticoid produced in the body is aldosteroneand androgenic sex hormones.
Endogenous cortisone was first isolated in and synthesized in InDr. Philip S Hench published administered cortisone called Compound E at that time to a year-old woman who was bed-ridden secondary to active rheumatoid arthritis. The patient was able to walk after three days of treatment.
This case was published inand inPhilip S. Hench, Edward C. Kendall, and Tadeusz Reichstein were awarded the Nobel Prize in Physiology or Medicine "for their discoveries relating to the hormones of the adrenal cortex, their structure, and biological effects. Glucocorticoids GCs are a group of drugs structurally and pharmacologically similar to the endogenous hormone cortisol with various functions like anti-inflammatory, immunosuppressive, anti-proliferative, and vaso-constrictive effects.
Their actions are used medically for the treatment of various conditions indicated below. The list of indications of glucocorticoids is extremely long. We have categorized and mentioned the most important and broad-spectrum indications below. Mineralocorticoids are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cells of the collecting ducts of the kidney.
The use of mineralocorticoid drugs is limited to their replacement therapy in acute adrenal crisis and Addison disease. Due to several roles played by corticosteroids in the human body, they see extensive use in medical practice to treat various diseases. As a result, their side-effects have, in turn, become another significant medical issue requiring special attention. The anti-inflammatory and immunosuppressive effects of glucocorticoids are dose-dependent, with immunosuppressive effects seen mostly at higher doses.
The pharmacological anti-inflammatory and immunosuppressive effects of glucocorticoids are extensive and can occur via genomic or non-genomic mechanisms. Most effects of glucocorticoids are via the genomic mechanisms, which takes time, while immediate effects via the non-genomic mechanisms can occur with high doses of glucocorticoids such as pulse therapy. Clinically, it is not possible to separate these effects. Being small, lipophilic substances, glucocorticoids readily pass the cell membrane by diffusion and enter the cytoplasm of the target cells, where most of their action is mediated by binding to the intra-cytoplasmic glucocorticoid receptors.
In the nucleus of the target cells, this complex reversibly binds to several specific DNA sites resulting in stimulation transactivation and suppression transrepression of a large variety of gene transcription. The immediate effects of high dose-glucocorticoids are mediated via non-genomic mechanisms. At high doses, glucocorticoids bind the membrane-associated glucocorticoid receptors on target cells such as T-lymphocytes, resulting in impairment of receptor signaling and immune response of the T lymphocytes.
High-dose glucocorticoids also interact with the cycling of calcium and sodium across the cell membrane resulting in a rapid decrease in inflammation. By altering the cytokine production via the genomic and non-genomic mechanisms, glucocorticoids lead to suppression of the immune system and decreased inflammation. They target a wide variety of cells, including T-lymphocytes, macrophages, fibroblasts, neutrophils, eosinophils, and basophils.
Notably, glucocorticoids have almost no effect on B-cell function and immunoglobulin production. The downstream effects of glucocorticoids are summarized below:. Glucocorticoids exert negative feedback effects on the HPA axis. Chronic HPA axis suppression by glucocorticoids leads to functional adrenal atrophy sparing the mineralocorticoid producing outer adrenal cortex that is functionally independent of ACTH. The risk of this functional adrenal atrophy and insufficiency is challenging to predict and varies from patient to patient but is largely dependant on the dose and duration of glucocorticoid therapy.
The adrenal function generally recovers by slow tapering of glucocorticoids. Glucocorticoids bind to mineralocorticoid receptors MRs and produce their mineralocorticoid effect i. Several preparations of glucocorticoids are available, each with varying efficacy.
Dexamethasone and betamethasone are long-acting with the highest glucocorticoid efficacy with a biological half-life of 36 to 54 hours. Cortisone and cortisol are short-acting with a biological half-life of under 12 hours and are not frequently used.
Prednisone, prednisolone, methylprednisolone, and triamcinolone are intermediate-acting with a biological half-life of 18 to 36 hours. The glucocorticoid and mineralocorticoid effects of each available preparation vary, with cortisol and cortisone having almost 1 to 1 glucocorticoid and mineralocorticoid effects while all others with almost no mineralocorticoid effects.
Equivalent glucocorticoid doses can be calculated for these various preparations. Parenteral intravenous administration of high doses of glucocorticoids may be warranted in emergencies, such as septic shock, COPD exacerbation, and severe acute asthma.
Pulse therapy of glucocorticoids mg intravenous methylprednisolone divided over 3 to 4 daily doses for several days has been studied in several rheumatological conditions. This approach is recommended only for organ-threatening or life-threatening situations, including lupus nephritis Class III or IVgiant cell arteritis with vision loss, ANCA-associated vasculitis, etc. Americal College of Rheumatology also recommends using intravenous glucocorticoids in patients with acute gout who are unable to take medications orally.
Oral preparations are usually useful in both acute and chronic indications. Tapering dose packs starting at high doses and tapering daily over 7 to 9 days are commercially available and can be used in these situations as well. Long-term oral corticosteroid therapy may be necessary for chronic illnesses such as polymyalgia rheumatica, SLE, RA, vasculitis, myositis, IgG4-related disease, chronic myelogenous leukemia CMLlymphoma, leukemia, multiple sclerosis, organ transplantation, etc.
Clinicians must make every effort to use the glucocorticoids at the lowest possible dose and for the shortest possible duration in these cases. A slow taper shall be attempted in patients with prolonged exposure to glucocorticoids to prevent adrenal crisis.
Glucocorticoid administration can be via several non-systemic routes, including intra-articular joint injections for joint inflammation, inhalational for asthma, topical for dermatological problems, ocular drops for eye conditions, and intra-nasal for seasonal rhinitis.
Clinicians generally avoid intramuscular IM glucocorticoids due to the risk of local muscle atrophy due to depot effect, and the only indications for intramuscular glucocorticoids are for IM triamcinolone acetonide for specific inflammatory disorders and IM injection of betamethasone to a pregnant mother less than 37 weeks of gestation to stimulate fetal lung maturity. When appropriate, a non-systemic route is preferable to the systemic route of administration to minimize systemic adverse effects.
Given the diversity in the mechanism of action of glucocorticoids, they can cause a wide array of adverse effects ranging from mild to severe, some of which are unavoidable. Of all the factors influencing the adverse effects of glucocorticoids, dose and duration of therapy are the most important independent and well-documented risk factors.
Other adverse effects may follow a threshold dose-response pattern with an elevated frequency of events beyond a specific threshold value weight gain and epistaxis at prednisone dose greater than 5 mg daily, glaucoma, depression, hypertension at prednisone dose greater than 7. Several other factors may influence the adverse effects of glucocorticoids.
Older age, comorbid conditions such as diabetes mellitusconcomitant use of other immunosuppressive agents, severity and nature of the underlying disease, and poor nutritional status can all influence the occurrence and magnitude of side effects. Glucocorticoids induced Osteoporosis is one of the well-known and devastating adverse effects of long-term use of glucocorticoids.
The trabecular bone is initially affected, with cortical bone loss seen with longer-term use. The loss of trabecular bone can occur within the first 6 to 12 months of therapy. Steroid-induced myopathy, which is a reversible painless myopathy and is a direct result of muscle breakdown, can occur in both the upper and lower extremities, usually with high-dose long-term use of glucocorticoids. Muscle enzymes CK and Aldolase are typically normal, and findings on electromyography are non-specific.
Muscle biopsy reveals Type-II fiber atrophy without inflammation. Withdrawal of glucocorticoids and exercises usually results in the resolution of myopathy. It characteristically presents with a severe, diffuse, proximal, and distal weakness that develops over several days. Although it is usually reversible, critical illness myopathy can lead to prolonged ICU admissions, increased length of hospital stays, severe necrotizing myopathy, and increased mortality.
Osteonecrosis can be seen especially with long-term use of prednisone more than 20 mg daily. Patients with SLE and children are at higher risk. Hips and knees are the most commonly involved joints with less common involvement of shoulders and ankles.
Pain is the initial feature, which may eventually become severe and debilitating. Magnetic resonance imaging is the most sensitive test, especially for early detection. Plain radiographs may be negative initially but can be useful for follow-up. Systemic glucocorticoids cause a dose-dependent increase in fasting glucose levels and a more significant increase in postprandial values in patients without preexisting diabetes mellitus, but the development of de novo diabetes in a patient with initially normal glucose tolerance is uncommon.
Risk factors for new-onset hyperglycemia during glucocorticoid therapy appear to be the same as those for other patients. However, patients with diabetes mellitus or glucose intolerance exhibit higher blood glucose levels while taking glucocorticoids, leading to increased difficulty with glycemic control.
The development of cushingoid features redistribution of body fat with truncal obesity, buffalo hump, and moon face and weight gain are dose and duration-dependent and can develop early. Cushingoid features showed a linear increase in frequency with dosing. Glucocorticoid therapy is the most common cause of Cushing syndrome. The clinical presentation in the pediatric population is similar to that in adults and includes truncal obesity, skin changes, and hypertension. In children, growth deceleration is also a feature.
Administration of glucocorticoids can suppress the hypothalamic-pituitary-adrenal HPA axis decreasing corticotropin-releasing hormone CRH from the hypothalamus, adrenocorticotropic hormone ACTH from the anterior pituitary gland, and endogenous cortisol.
Prolonged ACTH suppression cause atrophy of adrenal glands, and abrupt cessation or rapid withdrawal of Glucocorticoids in such patients may cause symptoms of adrenal insufficiency. The clinical presentation of adrenal suppression is variable. Adrenal suppression is the most common cause of adrenal insufficiency in children and is associated with higher mortality in the pediatric population. In adults, the symptoms of adrenal suppression are non-specific; therefore, the condition may go unrecognized until exposure to physiological stress illness, surgery, or injuryresulting in an adrenal crisis.
Children with adrenal crisis secondary to adrenal suppression may present with hypotension, shock, decreased consciousness, lethargy, unexplained hypoglycemia, seizures, and even death.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Taking prednisone can increase the chances of developing mild, serious or life-threatening infections. Larger doses increase the risk, especially doses for. Taking prednisone can increase the chances of developing mild, serious or life-threatening infections. Larger doses increase the risk, especially doses for. People taking prednisone can also experience higher blood sugar, which is a special concern for those with diabetes. Because prednisone. But it's important to know that prednisone can increase your risk of bacterial, viral, and fungal infections. This risk likely increases with. Do not take other medicines unless they have been discussed with your doctor.Drug information provided by: IBM Micromedex. Prednisone provides relief for inflamed areas of the body. It is used to treat a number of different conditions, such as inflammation swelling , severe allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, endocrine problems, eye or vision problems, stomach or bowel problems, lupus, skin conditions, kidney problems, ulcerative colitis, and flare-ups of multiple sclerosis.
Prednisone is a corticosteroid cortisone-like medicine or steroid. It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines.
Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children. However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time. Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.
The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. Take this medicine exactly as directed by your doctor.
Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package.
If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress.
Your dose of this medicine might need to be changed for a short time while you have extra stress. Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems.
Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness. This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away.
If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away. Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist eye doctor. While you are being treated with prednisone, do not have any immunizations vaccines without your doctor's approval.
Prednisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you.
Some examples of live vaccines include measles, mumps, influenza nasal flu vaccine , poliovirus oral form , rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long.
If you have questions about this, talk to your doctor. This medicine may cause changes in mood or behavior for some patients.
Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.
This medicine might cause thinning of the bones osteoporosis or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis.
If your child is using this medicine, tell the doctor if you think your child is not growing properly. Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain skin tests.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.
Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only.
Drugs and Supplements Prednisone Oral Route. Legal Conditions and Terms Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below.
Advertising Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission.
Comments
Post a Comment