Prednisone 5mg

Systemic Corticosteroid

“Special Alerts

Prednisone and Prednisolone Safety Alert August 2018

Health Canada has conducted a safety review and concluded that there may be a link between the use of oral prednisone and prednisolone, especially at higher doses, and the risk of scleroderma renal crisis in patients with systemic sclerosis. The review was triggered after the European Medicines Agency recently updated the product safety information for oral and injectable prednisone and prednisolone products to include this risk. Health Canada will be working with manufacturers to update the Canadian product safety information for oral prednisone and prednisolone products to inform health care professionals and patients about this risk.

Further information may be found at https://hpr-rps.hres.ca/reg-content/summary-safety-review-detail.php?lang=en&linkID=SSR00208.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Prednisone/Deltasone/Rayos/Winpred reduces polymorphonuclear leukocyte (a type of white blood cell) migration to the affected area and reverses the dilation and blood vessel permeability from the inflammatory response resulting in decreased access of cells to the site.  It also reduces lymphatic flow to the area which reduces immune activity.  At higher dosages it may reduce adrenal function.  Also has antitumor activity and antiemetic properties.

Prednisone/Deltasone/Rayos/Winpred is used on and off label for many autoimmune or other inflammatory conditions.  Some common examples include anaphylaxis, asthma exacerbations, COPD exacerbations (off-label), Bell palsy (off-label), gout flare, inflammatory bowel disease, multiple sclerosis exacerbation, systemic rheumatic disorders etc.

Before starting Prednisone/Deltasone/Rayos/Winpred make sure your physician is aware of any allergies, medications you currently take, knows your medical background and current/past medical conditions, or are pregnant or breastfeeding.   Bloodwork will likely be required before initiating this medication for long term use.

2.5-100mg daily (usually once daily but can be divided).  Due to the vast range of conditions prednisone may be used for, the dosage regimen can vary greatly and is individualized to patient needs.  It is common to require a slow tapering schedule to avoid Hypothalamus-pituitary-adrenal (HPA) Axis suppression, the details of which would depend on how long the medication has been used and which dosages were given.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature, ideally taken early in the day to avoid insomnia.  Taken after food or milk to reduce gastrointestinal upset.

You Need to Avoid: Do not skip follow up appointments or put off bloodwork requisitioned by your physician as this is how you are monitored for adverse effects to help avoid any serious reactions.  Do not stop this medication in the middle of a taper, complete it as prescribed to avoid adrenal suppression.

Prednisone/Deltasone/Rayos/Winpred has many detrimental long-term side effects that are dosage dependent.  Short term use generally only warrants mention of potential for upset stomach, and sleep disturbances.  

Long term effects can include infection, emotional lability, psychiatric disturbances, hypertension, Cushing’s syndrome, diabetes mellitus, fluid retention, growth suppression (children), peptic ulcer, esophagitis, increased liver enzymes, osteoporosis, glaucoma, wound healing impairment etc.

Note this is not a complete list of side effects.

1. Why would my physician prescribe a medication with such serious side effects?
   Your physician takes the most recent clinical guidelines to make evidence-based decisions on what medication is appropriate in which situations.  Your current medications, your allergies, age, cost of medication, comorbid conditions and many other factors will further complicate or limit which medications are appropriate.  Prednisone is used for many serious conditions and your physician has determined the benefits outweigh the risks.   Furthermore, they will be monitoring your bloodwork and symptoms closely to avoid many of the serious side effects and will keep you on the lowest effective dosage for the shortest amount of time possible.
2. What is HPA-Axis Suppression?
   The hypothalamic-pituitary-adrenal axis is complex neuroendocrine system that controls your body’s reaction to stress in a complex network related to cortisol regulation.  Cortisol is a hormone that has many functions throughout the body and affects most body systems to adjust them to optimally handle stress/fear, which is why prednisone has such a wide array of side effects.  Cortisol release during stress increases available glucose to facilitate fight or flight, it suppresses the high energy demanding immune system, and has many other effects.  Therefore, long-term stress is so bad for you as it results in continuously high cortisol levels.  When taking an exogenous glucocorticoid such as prednisone, your body interprets it as having high levels of cortisol and due to the excess, it shuts of production.  Long term use of a glucocorticoid can essentially shut down cortisol production, so if that agent is halted it can result in extreme fatigue, weakness, body aches, joint pain, nausea, loss of appetite and light headedness due to no cortisone activity.  Corticosteroids should be slowly decreased to allow time for the body to adjust and slowly start to produce its own cortisol again without any symptoms.
3. What do I do if side effects are intolerable?
   If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.