Prednisone Side Effects And Warnings

Learn Facts and Information About Prednisone, Both Side Effects and Benefits

Prednisone Indications

Prednisone Indications

Prednisone is classified as a lifesaving drug prescribed to critical patients in times of severe stress and shock. Once administered in recommended doses, according to the weight of the individual, the drug performs the following functions in the body:

1. Increases absorption of sodium from the kidney, a protective mechanism that helps in maintaining blood pressure

2. Decreases the production of inflammatory mediators and chemicals that cause allergic or immune response

3. Reduces edema or swelling in tissues

In lieu of all the functions that are performed by prednisone, it is indicated in the following situations:

Disorders of Endocrine Glands

  • Prednisone is the first and primary option to prevent shock and adrenal crisis in individuals suffering from inflammatory, infectious, malignant, congenital or ischemic (loss of blood supply) conditions of the adrenal gland leading to Adrenal insufficiency (or insufficient capacity of adrenal gland to produce hormones like cortisol).
  • Acute crisis or diseased state of any gland responds fairly well to prednisone prescription (like hyperfunctioning thyroid gland or pancreatic inflammation).

Rheumatic Disorders

Joint inflammatory conditions like acute exacerbation of rheumatoid arthritis requires prednisone to decrease inflammatory swelling, pain, redness, warmth and other signs of active illness to improve mobility.

Other similar conditions in which prednisone therapy may help are:

  • Tenosynovitis (inflammation of joint spaces and cartilage components)
  • Sub-acute and acute bursitis
  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Osteoarthritis
  • Other connective tissue disorders

Chronic Inflammatory or Autoimmune Diseases:

Autoimmune diseases are characterized by a hyperactive immune system which targets the body's own cells to cause diseases like systemic lupus erythematosus, rheumatoid arthritis and hemolytic anemias. Administration of prednisone decreases the production of immune cells and minimizes the reactivity of tissues to immune reaction. The overall effect is improvement in the flaring symptoms of chronic autoimmune diseases. It is important to keep in mind that prednisone suppresses the symptoms but it is not a curative treatment for inflammatory, infectious or autoimmune disorders.

Other indications are:

  • Polymyostitis
  • Systemic-dermatomyositis
  • Ulcerative colitis
  • Regional enteritis
  • Autoimmune hemolytic anemia

Dermatologic Diseases

Various skin conditions caused by bacterial, viral or fungal infection can cause a systemic response like bullous dermatitis herpetiformis (which may culminate in life threatening sequelae). Other similar dermatological conditions that require prednisone therapy are:

  • Severe psoriasis
  • Eczema
  • Seborrheic dermatitis
  • Mycosis fungoides
  • Exfoliative dermatitis
  • Pemphigus
  • Erythema multiforme
  • Bullous dermatitis herpetiformis

Allergic States

Allergic reactions are a result of the body's response to certain proteins (also known as allergens) which are capable of activating immune cells like white blood cells, lymphocytes and macrophages. These can be pollen, dust, mites, certain foods, bee stings, cigarette smoke etc. Most allergic reactions are mild and present as edema, swelling, rash or irritation.

However, in some cases, the allergic reactions may lead to uncontrolled systemic damage or even death. A few examples in which timely administration of prednisone may save lives are:

  • Serum sickness
  • Atopic dermatitis
  • Drug hypersensitivity reactions
  • Contact dermatitis
  • Bronchial asthma
  • Seasonal or perennial allergic rhinitis

Ophthalmic Diseases

Indications of prednisone use for the management of ophthalmological issues are:

  • Iritis and iridocyclitis
  • Optic neuritis
  • Chorioretinitis
  • Keratitis
  • Choroiditis or uveitis
  • Allergic ulceration of cornea
  • Viral infections of cornea or conjunctiva
  • Allergic conjunctivitis

Respiratory Diseases

Besides asthma and other allergic reactions involving the respiratory system, prednisone is also prescribed for the acute flaring of chronic respiratory issues such as:

  • Aspiration pneumonia
  • Disseminated pulmonary tuberculosis
  • Berylliosis
  • Loeffler's syndrome
  • Symptomatic sarcoidosis

Hematologic Disorders

  • Sudden or acute decrease in the production of blood cells, especially white blood cells (observed mainly as a consequence of certain viral infections like dengue virus or yellow fever virus) or a side effect of certain drugs that suppress bone marrow (especially chemotherapeutic drugs)
  • Thrombocytopenia (or lack of circulating platelets in the blood)
  • Anemia (decrease in hemoglobin levels due to decreased number of circulating red blood cells)

Terminal Diseases or Cancers:

In terminal diseases like advanced cancer, surgical management or chemo-radiotherapy is not an option. In all such cases, prednisone can be used in palliative care. Palliative care is a form of therapy that is only supportive and not curative i.e. designed to improve the quality of life, and includes medications to reduce the intensity of symptoms/body reactions. A few indications are:

  • Lymphomas and Leukemias
  • Widespread metastasis and involvement of multiple organs by cancerous cell spread
  • Edematous States
  • After transplantation to minimize the risk of transplant rejection (studies indicate that administration of prednisone can extend the life of the patient).

Miscellaneous

  • Tuberculous meningitis and other forms of meningitis
  • Encephalitis (infection of the brain that may lead to extensive edema and death due to vital tissue damage). Prednisone is prescribed to reduce edema after injuries and infections of the brain.
  • Exacerbation of multiple sclerosis
  • Trichinosis

Prednisone is effective and administered for a number of other conditions. This list reflects only the tip of the iceberg. However, benefits and response to therapy vary from individual to individual. Therefore, it is crucially important to monitor the drug and dose response very efficiently in all patients.

References:

  1. Apers, R. C., Oosterhuis, J. A., & Bierlaagh, J. J. M. (1976). Indications and Results of Prednisone Treatment in Thyroid Ophthalmopathy. Ophthalmologica, 173(3-4), 163-167.
  2. Calhoon, J. H., Grover, F. L., Gibbons, W. J., Bryan, C. L., Levine, S. M., Bailey, S. R., ... & Trinkle, J. K. (1991). Single Lung Transplantation. Alternative Indications and Technique. The Journal of Thoracic and Cardiovascular Surgery, 101(5), 816.
  3. Truelove, S. C. (1988). Medical Management of Ulcerative Colitis and Indications for Colectomy. World Journal of Surgery, 12(2), 142-147.
  4. Starzl, T. E., Klintmalm, G. B., Porter, K. A., Iwatsuki, S., & Schröter, G. P. (1981). Liver Transplantation With Use of Cyclosporin A and Prednisone. The New England Journal of Medicine, 305(5), 266.