Prednisone and side effects
The adrenal glands manufacture glucocorticoids (steroids). Glucocorticoids are responsible for many functions in the body including maintenance of blood pressure, proper use of sugar, protein, and fat metabolism, response to stress, and many other tasks.
Glucocorticoids manufacture by the body are referred to as endogenous steroids- meaning a persons 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 persons 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 undoubtedly sustain side-effects.
Taking steroids on an alternate day (every other day) schedule lessens the chance of adrenal insufficiency but does not eliminate it.
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
Glaucoma
Cataracts
Muscle wasting
Stomach ulcers
Pancreatitis
Accelerated hardening of the arteries
Osteonecrosis (bone death)
Psychiatric disturbance
Insomnia
Bowel perforation
Masking of infection
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