What is Prednisone and What is it Used For?

Prednisone is a medication classified as a corticosteroid, known for its anti-inflammatory properties. It’s essentially a synthetic version of hormones naturally produced by your body. Prednisone is prescribed to manage a wide array of conditions, including allergies, endocrine and musculoskeletal disorders, as well as dermatological, rheumatological, ophthalmological, and respiratory diseases, among others. Furthermore, it is a component of treatment regimens for certain cancers and is crucial in preventing organ rejection in transplant recipients.

When the body detects a foreign invader, it initiates an inflammatory response, releasing various chemical mediators to combat the threat. However, this response can sometimes become excessive and cause damage to the body itself.

This is where prednisone plays a vital role. It works by inhibiting the production of these inflammatory mediators, effectively controlling inflammation. Consequently, prednisone is often used in conjunction with other medications aimed at addressing the underlying cause of the inflammatory process.

Prednisone is prescribed for more severe clinical conditions due to its potent ability to manage inflammation. Pharmacist José Eduardo Gonçalves from the Federal University of Minas Gerais (UFMG) clarifies that inflammatory processes typically involve multiple pathways.

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, nimesulide, and diclofenac, target only one of these pathways, and usually at later stages. “Corticosteroids, on the other hand, inhibit the very beginning of this cascade of events. This is why they are extremely potent,” he adds.

However, it’s crucial to understand that while prednisone is highly effective, it comes with significant side effects and requires careful management. If these guidelines are not strictly followed throughout treatment, the medication can even be life-threatening. This is why it is only available with a medical prescription. We will discuss these aspects in more detail below.

Image: Prednisone medication pills for oral administration.

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How is Prednisone Administered?

“Prednisone is available in tablet or capsule form,” explains Gonçalves, highlighting a specific reason for this formulation.

Gonçalves explains that prednisone itself is not the active agent against diseases. “When you swallow a prednisone tablet, it is absorbed by the intestine. The substance is then transported to the liver, where it undergoes metabolic reactions,” he states.

It is through these processes that the molecule becomes activated and transforms into another substance called prednisolone. Prednisolone is the compound that exerts the potent anti-inflammatory action.

“For this conversion to occur, the drug needs to reach the liver, and to do that, it must pass through the gastrointestinal tract,” the professor reasons. This explains why oral administration is the chosen route.

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How Long Does Prednisone Treatment Last?

The duration of prednisone treatment varies depending on the condition being treated. For example, to resolve an allergic reaction, prednisone might be used for only a few days. However, in cases aiming to prevent organ rejection after transplantation or to manage autoimmune diseases (such as rheumatoid arthritis), treatment may be long-term, always under medical supervision.

The dosage also varies according to the specific condition and individual needs.

Adverse Reactions of Prednisone

As mentioned earlier, prednisone works by blocking the production of certain chemical mediators that cause inflammation in the body. However, these mediators also have other functions. For instance, prostaglandins not only contribute to inflammation but also protect the stomach lining from hydrochloric acid and regulate kidney blood pressure.

“Prednisone inhibits prostaglandin production. This is why, during its use, stomach discomfort, heartburn, and kidney damage due to the destruction of local blood vessels can occur,” points out Gonçalves.

But the list of potential side effects doesn’t end there. When treatment extends beyond 15 days, patients may develop Cushing’s syndrome, characterized by fluid retention, increased blood pressure, generalized edema, glucose intolerance, osteoporosis, thinning skin, and fat accumulation in the abdominal area and the nape of the neck.

Image: Visual representation of Cushing’s syndrome symptoms, a potential side effect of prolonged prednisone use.

Other adverse reactions include stomach ulcers, headaches, and mood changes.

Close medical monitoring and appropriate dosage adjustments are crucial to minimize these side effects. Never reuse prednisone tablets without consulting a doctor.

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Contraindications for Prednisone Use

Prednisone is generally not recommended for pregnant women, breastfeeding mothers, and children. This is due to an increased risk of fetal malformations and potential interference with growth hormone production in children.

“However, depending on the situation, there may be a necessity to use the medication in these populations. In such cases, it is essential to evaluate each case individually and use it with close medical supervision,” advises Gonçalves. This further emphasizes the importance of avoiding self-medication.

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Precautions and Warnings for Prednisone

Besides being aware of contraindications and side effects, certain precautions should be taken during prednisone treatment, regardless of its duration.

Firstly, it is recommended to avoid consuming alcoholic beverages during this period. “Some of the effects of corticosteroids, such as gastric discomfort, increased blood pressure, and fluid retention, are also caused by alcohol. When taken together, these adverse events are intensified,” warns Gonçalves.

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Prednisone can also interact with various medications, potentially reducing its anti-inflammatory efficacy. Inform your doctor about any medications you are currently taking and always check the package insert for potential drug interactions.

Another crucial point emphasizing the need for medical guidance is that prednisone should not be stopped abruptly. At the end of treatment, the dosage should be gradually reduced.

Since prednisone mimics certain hormones, the body may temporarily reduce its own hormone production during treatment, assuming there is an “excess” of the substance. If you suddenly stop taking prednisone, your body may experience a temporary hormone deficiency. “These hormones are vital for regulating essential functions. There is even a risk of death,” the pharmacist cautions.

Finally, prednisone can cause immunosuppression during treatment, making individuals more susceptible to infections, particularly fungal infections.

“In these cases, even a simple fungal infection can spread throughout the body because the medication reduces the immune system’s ability to fight back,” explains Gonçalves.

Due to this, the administration of certain vaccines (especially live attenuated vaccines) should be discussed with your doctor. Maintaining good hygiene practices is also essential to minimize the risk of infection.

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