Prednisone (also called Cortisone) represents a mainstay of treatment for several medical conditions, such as:
- rheumatic disorders (e.g., rheumatoid arthritis)
- autoimmune disorders (e.g., systemic lupus erythematosus)
- various dermatological conditions (e.g., psoriasis)
- allergy and hypersensitivity disorders
- adrenal insufficiency
- other conditions (e.g., multiple sclerosis, inflammatory bowel disease, etc)
Oftentimes, Prednisone treatment is administered on a long-term basis, or as recurrent treatment courses during illness flare-ups.
Prednisone can be given by mouth (orally), by IV or IM injection, by intra-articular injection directly inside a joint, by topical application (as creams or lotions applied to the skin), or as inhaled aerosols.
A wide variety of Prednisone products is available, which poses some difficulties as far as gauging the effects of different products comparatively.
Prednisone (Cortisone) is a synthetic formulation of the hormone Cortisol, which is naturally produced by the adrenal gland in our body.
Cortisol is also known as the "stress hormone", since its role is to help the organism overcome stressful situations. As such, the adrenal gland will increase its Cortisol production during high stress conditions. The regulatory mechanism responsible for this involves a feed-back loop between the adrenal gland and the pituitary gland in the brain. Under stress, the pituitary gland releases the hormone ACTH, which stimulates the adrenal gland to make more Cortisol. In turn, high amounts of Cortisol have an inhibitory effect on the pituitary gland, causing it to decrease its ACTH secretion. The equilibrium between these 2 processes determines the amount of Cortisol in our body.
The effects of Cortisol on the body are as follows:
- increases stamina and alertness
- stimulates appetite
- decreases the need for sleep
- has natural anti-inflammatory action
- has anti-allergic and immuno-suppressant action
- increases gluconeogenesis and raises blood sugar levels
- speeds up the breakdown of proteins to provide a substrate for other metabolic processes
- redirects the deposition of fat, causing preferential accumulation around the mid-section
The above are normal effects of Cortisol, intended to help the organism adapt to stressful or demanding circumstances. However, when Cortisol is administered externally (as Prednisone or similar products), in higher amounts than normally produced by the body, all the above actions are magnified and may lead to certain unwanted side effects. Below is a list of side effects most commonly encountered during Prednisone treatment.
- Weight Gain, with fat accumulation especially around the mid-section and on the face and neck
- Nervousness, Irritability, Anxiety, and occasionally Depression
- Attention Deficit resulting impaired task performance
- Hyperglycemia (increased blood sugar), occasionally resulting in frank diabetes
- Unsightly striae (skin marks) due to protein breakdown in the subcutaneous tissue
- Increased susceptibility to infection, especially of viral and fungal origin
- Prolonged wound healing time (due to increased protein breakdown)
Although Prednisone treatment may be unavoidable in order to adequately control a medical condition, the administration of such treatment can be tailored to minimize side effects. This involves the following:
- Systemic administration of Cortisone should be avoided whenever possible. This refers to agents that are given either orally (by mouth) or by IV/IM injection. In this case, Cortisone is distributed throughout the body and thus side effects are maximal. However, this situation can often be avoided by targeted administration of Cortisone products. For instance, an injection of Cortisone can be given directly inside the affected joint (knee, shoulder, spine, etc). Similarly, Cortisone can be given by inhalation (in aerosol form), which is the preferred form of administration in mild to moderate asthma.
- If the administration of oral or intravenous Cortisone is necessary, then the duration of therapy should be limited to the minimum required (usually days), and rapidly tapered down after symptoms are controlled.
- If long-term maintenance therapy is unavoidable, this should be tailored to the lowest possible dose that provides effective symptom control. After several weeks of maintenance therapy, a renewed attempt should be made to taper the dose and eventually discontinue treatment.
Please note: Cortisone treatment requires adequate dose tapering prior to discontinuation. Sudden discontinuation can result in extreme weakness, lethargy, electrolyte imbalance and other serious side effects.)
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