Prednisone

Generic name: prednisone (PRED ni sone)
Brand name: Rayos, Sterapred, Deltasone
Drug class: Glucocorticoids

Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

Prednisone is used as an anti-inflammatory or an immunosuppressant medication.

Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

Warnings

Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

You should avoid taking prednisone if you have a fungal infection that requires oral antifungals. Topical antifungals may not be an issue, but always let your doctor know what medicines you’re taking before starting this medicine.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Avoid being near people who are sick or have infections. Do not receive a "live" vaccine while using prednisone.

Call your doctor at once if you have shortness of breath, severe pain in your upper stomach, bloody or tarry stools, severe depression, changes in personality or behavior, vision problems, or eye pain.

You should not stop using prednisone suddenly. Follow your doctor's instructions about tapering your dose.

Before taking this medicine

You should not use this medication if you are allergic to prednisone, or if you have a fungal infection that requires oral antifungal treatment.

Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks.

To make sure prednisone is safe for you, tell your doctor if you have:

• any illness that causes diarrhea;
• liver disease (such as cirrhosis);
• kidney disease;
• heart disease, high blood pressure, low levels of potassium in your blood;
• a thyroid disorder;
• diabetes;
• a history of malaria;
• tuberculosis;
• osteoporosis;
• glaucoma, cataracts, or herpes infection of the eyes;
• stomach ulcers, ulcerative colitis, or a history of stomach bleeding;
• a muscle disorder such as myasthenia gravis; or
• depression or mental illness.

Long-term use of steroids may lead to bone loss (osteoporosis), especially if you smoke, if you do not exercise, if you do not get enough vitamin D or calcium in your diet, or if you have a family history of osteoporosis. Talk with your doctor about your risk of osteoporosis.

Prednisone can cause low birth weight or birth defects if you take the medicine during your first trimester. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Use effective birth control.

Prednisone can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medicine.

How should I take prednisone?

Take prednisone exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take prednisone with food.

Your dosage needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Do not change your medication dose or schedule without your doctor's advice.

Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not crush, chew, or break a delayed-release tablet. Swallow it whole.

While using this medicine, you may need frequent blood tests at your doctor's office. Your blood pressure may also need to be checked.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using this medicine.

You should not stop using prednisone suddenly. Follow your doctor's instructions about tapering your dose.

Wear a medical alert tag or carry an ID card stating that you take prednisone. Any medical care provider who treats you should know that you are using a steroid.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of prednisone is not expected to produce life threatening symptoms. However, long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid?

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using a steroid.

Do not receive a "live" vaccine while using this medicine. Prednisone may increase your risk of harmful effects from a live vaccine. Live vaccines include measles, mumps, rubella (MMR), rotavirus, yellow fever, varicella (chickenpox), one type of the typhoid vaccine and nasal flu (influenza) vaccine.

Avoid drinking alcohol while you are taking prednisone.

Prednisone side effects

Get emergency medical help if you have any of these signs of an allergic reaction to prednisone: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• blurred vision, eye pain, or seeing halos around lights;
• swelling, rapid weight gain, feeling short of breath;
• severe depression, feelings of extreme happiness or sadness, changes in personality or behavior, seizure (convulsions);
• bloody or tarry stools, coughing up blood;
• pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);
• low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or
• dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Other common prednisone side effects may include:

• sleep problems (insomnia), mood changes;
• increased appetite, gradual weight gain;
• acne, increased sweating, dry skin, thinning skin, bruising or discoloration;
• slow wound healing;
• headache, dizziness, spinning sensation;
• nausea, stomach pain, bloating; or
• changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect prednisone?

Many drugs can interact with prednisone. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with prednisone, especially:

• amphotericin B;
• cyclosporine;
• digoxin, digitalis;
• St. John's wort;
• an antibiotic such as clarithromycin or telithromycin;
• antifungal medication such as itraconazole, ketoconazole, posaconazole, voriconazole;
• birth control pills and other hormones;
• a blood thinner such as warfarin, Coumadin;
• a diuretic or "water pill";
• the hepatitis C medications boceprevir or telaprevir;
• HIV or AIDS medicine such as atazanavir, delavirdine, efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir;
• insulin or diabetes medications you take by mouth;
• a non-steroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
• seizure medications such as carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone; or
• the tuberculosis medications isoniazid, rifabutin, rifapentine, or rifampin.

This list is not complete and many other drugs can interact with prednisone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Corticosteroids - fluid retention

Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.

For the Consumer

Applies to prednisone: oral solution, oral tablet, oral tablet delayed release

Side effects requiring immediate medical attention

Along with its needed effects, prednisone may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking prednisone:

More common

• Aggression
• agitation
• blurred vision
• decrease in the amount of urine
• dizziness
• fast, slow, pounding, or irregular heartbeat or pulse
• headache
• irritability
• mood changes
• noisy, rattling breathing
• numbness or tingling in the arms or legs
• pounding in the ears
• shortness of breath
• swelling of the fingers, hands, feet, or lower legs
• trouble thinking, speaking, or walking
• troubled breathing at rest
• weight gain

Incidence not known

• Abdominal or stomach cramping or burning (severe)
• abdominal or stomach pain
• backache
• bloody, black, or tarry stools
• cough or hoarseness
• darkening of the skin
• decrease in height
• decreased vision
• diarrhea
• dry mouth
• eye pain
• eye tearing
• facial hair growth in females
• fainting
• fever or chills
• flushed, dry skin
• fractures
• fruit-like breath odor
• full or round face, neck, or trunk
• heartburn or indigestion (severe and continuous)
• increased hunger
• increased thirst
• increased urination
• loss of appetite
• loss of sexual desire or ability
• lower back or side pain
• menstrual irregularities
• muscle pain or tenderness
• muscle wasting or weakness
• nausea
• pain in the back, ribs, arms, or legs
• painful or difficult urination
• skin rash
• sweating
• trouble healing
• trouble sleeping
• unexplained weight loss
• unusual tiredness or weakness
• vision changes
• vomiting
• vomiting of material that looks like coffee grounds

Side effects not requiring immediate medical attention

Some side effects of prednisone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Increased appetite

Incidence not known

• Abnormal fat deposits on the face, neck, and trunk
• acne
• dry scalp
• lightening of normal skin color
• red face
• reddish purple lines on the arms, face, legs, trunk, or groin
• swelling of the stomach area
• thinning of the scalp hair

For Healthcare Professionals

Applies to prednisone: compounding powder, oral delayed release tablet, oral solution, oral tablet

General

The most commonly reported adverse effects associated with corticosteroid use include fluid retention, alteration in glucose tolerance, high blood pressure, behavior and mood changes, increased appetite and weight gain. Occurrence is often associated with dose and duration of therapy; long-term effects include HPA suppression, Cushingoid appearance, cataracts and increased intraocular pressure/glaucoma, osteoporosis and vertebral compression fractures

Metabolic

Frequency not reported: Decreased carbohydrate and glucose tolerance, increased requirements for insulin or oral hypoglycemic agents in diabetics, lipid abnormal, negative nitrogen balance caused by protein catabolism, hypokalemia, hypokalemic alkalosis, metabolic alkalosis, potassium loss, sodium retention with resulting edema, increased appetite and weight gain, anorexia and weight loss, hypertriglyceridemia, hypercholesterolemia

Cardiovascular

Frequency not reported: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, ECG changes caused by potassium deficiency, edema, fat embolism, hypotension, hypertension or aggravation of hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, necrotizing angiitis, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

Endocrine

Frequency not reported: Adrenal insufficiency associated symptoms including arthralgias, buffalo hump, amenorrhea, postmenopausal bleeding or menstrual irregularities, development of cushingoid state, hyperthyroidism, hypothyroidism, moon face, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress as in trauma, surgery, or illness), increased or decreased motility and number of spermatozoa

Ocular

Frequency not reported: Blurred vision, cataracts (including posterior subcapsular cataracts) central serous chorioretinopathy, secondary bacterial, fungal, and viral infections, exophthalmos, glaucoma, increased intraocular pressure

Gastrointestinal

Frequency not reported: Abdominal distention, abdominal pain, constipation, diarrhea, gastric irritation, nausea, oropharyngeal candidiasis, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis, vomiting

Immunologic

Frequency not reported: Immunosuppression, aggravation/masking of infections, decreased resistance to infection

Musculoskeletal

Frequency not reported: Arthralgia, aseptic necrosis of femoral and humeral heads, increased risk of fracture, loss of muscle mass, muscle weakness, myalgias, osteopenia, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture (particularly of the Achilles tendon), vertebral compression fractures, suppression of growth in pediatric patients

Hypersensitivity

Frequency not reported: Anaphylaxis, angioedema, allergic reactions

Nervous system

Frequency not reported: Arachnoiditis, benign intracranial hypertension, convulsions, dementia, dizziness, EEG abnormalities, impaired cognition, increased intracranial pressure with papilledema, increased motor activity, ischemic neuropathy, severe tiredness or weakness, meningitis, neuritis, neuropathy, paraparesis/paraplegia, sensory disturbances

Psychiatric

Frequency not reported: Amnesia, anxiety, delirium, depression, emotional instability and irritability, euphoria, hallucinations, severe psychiatric symptoms, insomnia, long-term memory loss, mania, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychiatric disorders including steroid psychoses 

Hematologic

Frequency not reported: Anemia, neutropenia, febrile neutropenia, moderate leukocytosis, lymphopenia, eosinopenia, polycythemia

Dermatologic

Frequency not reported: Acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema, angioneurotic edema, atrophy and thinning of skin, dry scaly skin, ecchymosis and petechiae (bruising), erythema, facial edema, hirsutism, impaired wound healing, increased sweating, lupus erythematosus-like lesions, perineal irritation, purpura, rash, striae, subcutaneous fat atrophy, suppression of reactions to skin tests, telangiectasis, thin fragile skin, thinning scalp hair, urticaria, hypertrichosis

Hepatic

Frequency not reported: ALT, AST and alkaline phosphatase elevations (usually reversible upon discontinuation), hepatomegaly

Respiratory

Frequency not reported: Hiccups, pulmonary edema

Oncologic

Frequency not reported: Kaposi's sarcoma

Other

Frequency not reported: Vertigo, pyrexia, abnormal fat deposits, malaise