Side Effects Of Prednisone

Side Effects and Complications in Prednisone Users

Prednisone, commonly sold under the brand name Deltasone, is pharmacologically classified as a steroid hormone (also known as corticosteroids). This class of drug is widely prescribed as an anti-inflammatory or immunosuppressant agent to minimize overt complications and discomfort resulting from aggressive inflammatory processes. The overall incidence of prednisone use among individuals for rheumatoid arthritis alone is as high as 8.9% per year[1].

Prednisone exerts its action primarily by modulating the immunological responses of the body (or in simple words by suppression of the immune system). Under ideal situations, prednisone is obviously not recommended, yet in specific medical scenarios such as ulcerative colitis, skin lesions, allergic disorders, lupus, psoriasis, arthritis, and disorder of respiratory system, not only does it improve the quality of life but also acts as a life-saving treatment. Prednisone has a number of advantages and clinical indications, but is it also safe and risk free?

Notable Side Effects Reported in Prednisone Users

Unfortunately, the possible benefits and uses of prednisone are highlighted by most pharmaceutical companies, yet people know very little about the side effects or complications of prednisone abuse or long-term use. Liron Caplan conducted a study[1] to analyze the prevalence of prednisone use in rheumatoid arthritis patients and the results were alarming. It was identified that 35.5% of all the rheumatoid arthritis patients were reportedly using prednisone at the time of study; whereas the lifetime prevalence was even higher (65.5%). Caplan also identified that approximately 21- 25% patients continue to use prednisone regardless of their disease status.

The above statistics are fairly alarming and suggestive of poor awareness among general population regarding prednisone use. Based on research and statistics, prednisone use is associated with the following adverse effects:

Cardiovascular and Respiratory System

Prednisone intake interferes with the maintenance of serum lipid concentration. long-term users may experience changes in the concentration of serum triglycerides and bad quality cholesterol. In individuals with pre-existing hyperlipidemic conditions, dose adjustment or modification is needed. As many as 12% develop hypertension with long-term prednisone therapy[5]. The changes in blood pressure are attributed to fluid retention and electrolyte abnormalities reported in long-term prednisone users.

Immunological Side Effects

Prednisone use is associated with significant changes in the metabolic activities of the body[2] such as catabolism of proteins and alteration in the synthesis/production of proteins. This results in loss of muscles which also damages bone and joint function. In addition, this action of prednisone is responsible for impaired wound healing and a higher risk of developing infections.

Digestive System

Psychological Issues

Dermatological Side Effects

Endocrinological Side Effects

Intake of exogenous Glucocorticoids (or prednisone) can interfere with the normal biochemical balance of a number of hormones:

Ocular complications

Long-term intake of prednisone is associated with changes to normal vision such as glaucoma, cataracts, and changes in intraocular pressure. Data indicates that 10 mg of prednisone given over a long period of time (more than 1 year as prescribed after organ transplantation) increases the risk of developing a cataract (33% patients developed posterior subcaspular cataracts within a period of 26 weeks in a clinical trial).

Miscellaneous

Please be aware that the above mentioned are some of the most common side effects, but this is not a complete list. You should seek advice from your doctor regarding additional side effects.

How Can You Minimize the Risk of Developing Side Effects or Complications?

Here are a few recommendations that may help in minimizing the side effects or complications while on prednisone:

Complications of Long-term Prednisone Consumption

If steroids are used for a longer time span, the risk of systemic complications increases significantly as evidenced by a number of clinical and research studies. The overall mortality rate in long-term prednisone users is as high as 5.7% as opposed 2.6% in previous prednisone users. In the table below, a brief comparison of long-term complications in current and previous prednisone users may help you in understanding how important it is to monitor prednisone intake.

Complication

Long-Term Prednisone Users

Previous Prednisone Users

Work disability

28.4%

17.2%

Total joint replacement surgery

18.5%

13%

It is also noteworthy that 1/3rd of all prednisone users are long-term users. Other notable complications reported in long-term users are:

The risk of a variety of complications such as osteoporosis increases in individuals who are chronic smokers. In addition, individual who don't exercise are also at risk of developing overt complications (especially musculoskeletal complications) with long-term prednisone use. Likewise, those who have low calcium and vitamin D due to dietary or metabolic factors are also at a fairly higher risk of developing osteoporosis.

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References:

  1. Caplan, L., Wolfe, F., Russell, A. S., & Michaud, K. (2007). Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. The Journal of rheumatology, 34(4), 696-705.
  2. Horber, F. F., & Haymond, M. W. (1990). Human growth hormone prevents the protein catabolic side effects of prednisone in humans. Journal of Clinical Investigation, 86(1), 265.
  3. van Everdingen, A. A., Jacobs, J. W., van Reesema, D. R. S., & Bijlsma, J. W. (2002). Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Annals of internal medicine, 136(1), 1-12.
  4. Bollet, A. J., Black, R., & Bunim, J. J. (1955). Major undesirable side-effects resulting from prednisolone and prednisone. Journal of the American Medical Association, 158(6), 459-463.
  5. Lozada, F., Silverman, S., & Migliorati, C. (1984). Adverse side effects associated with prednisone in the treatment of patients with oral inflammatory ulcerative diseases. The Journal of the American Dental Association, 109(2), 269-270.
  6. Sen, R. P., Walsh, T. E., Fisher, W., & Brock, N. (1991). Pulmonary complications of combination therapy with cyclophosphamide and prednisone. CHEST Journal, 99(1), 143-146.