Prescriptions 101: Prednisone
Here's the skinny on Prednisone:
Dosage: Various. I've had 5mg tablets and cut them in half (for 2.5mg dosages), and I've had 20mg tablets and taken 3 0r 4 of them at a time. It just depends on the activity of your disease. My doctor is a big proponent of pulse therapy - if I'm on a 20mg dose every day, after a period of a few weeks or months (or however long it takes before my body shows signs of stability), my doctor will taper the drug as follows: 20mg one day/15mg the next. I'll do that for 2 weeks (or whatever time frame he specifies), and then I'll go down to 20/10, 20/5, and then finally 20/0mg.
At each interval decrease, there's usually an adjustment period where your body has to become accustomed to the lower dose of prednisone. In fact, you may experience increased joint pain, swelling, or your other typical Lupus symptoms as you decrease your dosage (typically known as withdrawal). My doctor's rule of thumb was this: if after the second or third day of tapering, you're continuing to feel worse, your body may not be ready for the lower dosage. If you're tapering down, feel free to ask your doctor when and/or how you can determine if you've gone too low. The last thing you want to do is continue tapering if you're not ready for it! You have to be the one to alert your doctor though - as you may not have an appointment schedule until after it's too late.
Known side-effects: I'll put an asterisk by those symptoms that I've experienced. These are all very common, but should you experience any one of the symptoms listed below, it should be communicated to your doctor. Here's a great link to a more in-depth look at the known side-effects.
*1)Swelling of the face, often referred to as "moon face" or "chipmunk cheeks"; some patients feel ugly and say that they do not recognize themselves in the mirror. Remember, these changes are reversible. 2)A hump on the upper part of the back; this hump is made of fat, not bone.
3)Bloating or swelling of the abdomen.
4)Weight gain; prednisone may cause a great increase in appetite. Weight gain can be controlled by a low calorie diet, by exercise and by avoidance of salt. Avoid salty foods and do not add any salt.
*5)Stomach problems - ex. Ulcers and/or Heartburn; to ease the burning, try taking prednisone with food. This problem may require anti-ulcer medication.
*6)Mood changes; sometimes the change is for the better. However, depression may be made worse by prednisone.
*7)Insomnia; patients may have difficulty sleeping at nights.
*8)Shakiness; patients may have feelings of being "hyper: or that "things are running fast inside my head".
*9)Weakness of the thigh muscles; patients may have difficulty in climbing stairs, getting out of the bath or getting up from a chair or toilet seat.
*10)Interruption of the menstrual cycle; periods may stop altogether.
*11)Increased risk of infections; patients may have more infections including some caused by germs that the body is normally resistant to.
*12)Acne; don't hesitate to seek help from a dermatologist on this one. Many prescription topical drugs can eliminate the breakouts completely.
Long term side-effects
*12)Easy bruising of the skin; bruising from prednisone use often happens without any obvious injury and may require that blood clotting ability be checked by the physician. 13)Stretch marks; these may occur on the upper body, the arms, the abdomen and the thighs. 14)Excessive growth of body hair; this hair growth usually appears on the face and will stop when prednisone is decreased. 15)Cataracts; these are a cloudiness of the lens of the eyes that cause a decrease in vision. Occasionally, surgery may be required. 16) Osteonecrosis; this condition means "dead bone" and most frequently affects a bone in the hip joint called the femur (other bones may be involved as well). Osteonecrosis is becoming a more important cause of pain and disability in lupus patients. If this problem is found early, worsening of the process may be prevented by performing a surgical procedure. In many patients, the damage caused by osteonecrosis eventually comes to a stop. In some patients, where damage to the bone has been severe, an artificial joint may be needed.
*17)Osteoporosis; this results from a loss of calcium from the bones and often leads to fractures, particularly in the spine. These may be a major cause of pain and disability. However, this process is at least partly reversible if prednisone can be stopped. If prednisone must be continued, this side effect may be decreased by exercise, by eating foods rich in calcium and by taking extra calcium and vitamin D as prescribed by your physician. These preventive measures should be started as soon as a high prednisone dose is begun.
*18)Heart attacks; several factors (including smoking, high blood pressure and high blood sugar) combined with long term prednisone treatment may lead to a narrowing of the blood vessels of the heart and early heart attacks. This risk can be decreased by maintaining a reasonable weight, controlling blood pressure and, most importantly, not smoking.
Administering: I always took prednisone with a small snack, preferably something of substance. (Taking 30mg of prednisone in the morning along with a donut is NOT a good idea!)
Cost: Very inexpensive. When I have a prescription filled, my pharmacy sometimes opts not to run it through my insurance - because a cost to me (sans insurance) for a month's supply can be as little as $3!
Limitations: Other than trying not to be too clumsy while on prednisone (because you'll bruise so easily!), my doctor found it necessary to prescribe a medicine like Fosamax or Actonel to help with the osteoporosis brought by prednisone. These drugs slow bone loss while increasing bone mass, and have limitations of their own: they must be taken 30 minutes before you eat or drink anything (other than the water you take with the pill); must be taken with 6-8oz of water; you cannot lie down for 30 minutes after taking your required dosage; and you cannot be pregnant or plan on becoming pregnant on either of these drugs. In fact, my doctor was most comfortable stopping these drugs at least 6 months before I planned on even thinking about pregnancy. Guess one is never sure how long these types of things stay in the body.
In order to monitor my bone density, I had a DEXA bone scan every year or two, and unfortunately with each scan, an increase in bone loss was revealed. However, after spending the last 1 1/2 off of prednisone completely, and having been on low dosages for the year or two prior (because of the effectiveness of drugs like plaquenil and cellcept that seemed to work quite well for me), my bone density has actually improved! It's not what it once was - but I'm thrilled to say that it's at least stabilized.
That's it for Prednisone - Next Up: Plaquenil
Yet when i suggest i will never take this steriod again and i find it way more danergous to my health than the percocet that is all i have left as a pain reliever (i am violently allergic to all NSAIs now after taking them for 16 years straight) my doctor suggests i am looking to just take more percocet. Yet with pain relief i can still excersize and continue to try to live my life. Not the way i want to continue but at least i am not a fat ugly blob sitting in bed whining. Yes i am still in significant pain because if i take enough of this horrid pain killer to actually remove the pain i cant function anyhow. Still one i can take and keep moving the other is a trap that seems one cannot get out of. So why is it that for me as a lupus patient i am told to go with something so dangerous and such huge threat to my overall health. Yes i am aware that the percocet will addict my body. There is no way it will ever get my mind and i can control my weight with it. I can still excersize and work.
Background I was on Predisone for 2.5 years. Gained 130 pounds. Hated myself and my life. And no the hair on your face does NOT go away when you quit taking this steriod! I was a physically unfit as it is possible to be. I couldnt breath if i walked down the block forget run up the stairs. My skin was a mess. And the second the doctors cut the steriods back the lupus pain was still unbelievable. So then i was stuck taking the pain killers anyhow except now fat, ugly amd miserable. Somehow i am missing the logic behind pushing me to take prednisone instead of percocet?
Maybe someone else can explain the reason i would want to risk ever taking prednisone again in my life unless it was needed as a emergency stop gap to save my life? Other than it is inconvient for doctors and drugstores to have to deal with dispensing percocet as it is a drug some people like to abuse. I am treated as a drug abuser because i chose not to take another steriod ever? I actually would do just about anything to be able to take 4 advil again instead of the percocet. Unfortunately, it is not an option unless i wish to committ a slow painful suicide. This actually really makes me angry, That i get treated like a abuser because i dont chose to destroy my body even worse with a drug that is so dangerous to my overall health.
Sorry but please explain this logic to me if you can?
The worst parts of the drug! I found my dermatologist helped with my skin during that time, and i still find that drinking herbal tea throughout the day helps my appetite. (Not, like, one measly mini cup of tea. 😉 I'm talking keeping a carafe of iced herbal tea in the fridge and drinking it throughout the day.) I also found that turning my focus to lower sodium foods helped. It kinda of gave me something to focus on, because i actually had to educate myself on the subject. And exercise - so so hard when you're hurting! But even leg lifts and arm exercises in the prone position (yes, from my bed!) made me feel like i was doing something. Tracking this stuff (even two things like a single exercise and an ingredient to cut out) might help. Best of luck. Managing the effects of Prednisone can be a full time job, I know. So many layers and side effects. But it's brought me back from the dark many times. Keep us posted.
can be such a troublemaker! Best of luck at the doctor. Think that swell new guy of yours could accompany you to your appt.? Always helpful to have a fresh set of ears while you and your doctor talk. And I always like leaving my appt with a plan between visits...for my medicine, if it stops working, if I start flaring, etc. Hope you can get some answers. Even a few would help! Take care.