Prednisone and side effects
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The adrenal glands manufacture glucocorticoids (steroids). Glucocorticoids are responsible for many important functions in the body including maintenance of blood pressure, proper use of sugar, protein, and fat metabolism, response to stress, as well as others.
Glucocorticoids manufacture by the body are referred to as endogenous steroids- meaning a person’s own body makes these steroids.
When steroids are taken in from the outside either by mouth, intramuscularly or intravenously, they are referred to as exogenous steroids. Taking glucocorticoids orally or intravenously can reduce the ability of the person’s own adrenal glands to continue to manufacture glucocorticoids.
Without the ability to increase steroid production in the face of stressors such as injury, infection, and surgery, a patient can go into shock.
The most common oral steroid used in clinical practice is prednisone.
The chances of the adrenal glands being suppressed increase as the dose of “outside” steroid exceeds the average daily equivalent output of the adrenal glands which is about 5.0-7.5 mg prednisone, therapy continues for more than a few weeks or months, doses are given late in the day or in split doses, or long-acting corticosteroid preparations are used.
Patients who require high doses of prednisone (more than 20 mgs a day) for extended periods of time will get side-effects.
Taking steroids on an alternate day (every other day) schedule lessens the chance of adrenal insufficiency and other side effects but does not eliminate them.
These other side-effects include:
• Increased risk of bacterial or opportunistic infections such as fungi, tuberculosis, pneumocystis carinii
• Elevated blood sugar
• Fat distribution changes leading to moon face, buffalo hump
• Elevated blood lipids
• Aggravation of hypertension
• Electrolyte abnormalities such as low blood potassium
• Fluid retention leading to edema
• Easy bruisibility
• Increased body hair
• Increased sweating
• Purple stretch marks
• Impaired wound healing
• Muscle wasting
• Stomach ulcers
• Accelerated hardening of the arteries
• Osteonecrosis (bone death)
• Psychiatric disturbance
• Bowel perforation
• Masking of infection
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