Prednisone: Good Guy - Bad Guy

Prednisone is a synthetic hormone similar to hydrocortisone, a natural hormone produced by the adrenal glands. Prednisone belongs to a large group of similar drugs known as corticosteroids, which are prescribed for literally hundreds of conditions.

With organ transplants, prednisone stops the body's normal inflammatory reaction to foreign tissue and infection. It is usually given in tablet form but can be given intravenously when necessary, such as when someone is too sick to swallow a pill. The drug usually is used in combination with other agents to suppress the immune response. It acts by decreasing swelling and inflammation of tissues.

The downside with prednisone is its many side effects. The higher the dose or the more times you have been treated for rejection, the more side effects. As the dose is gradually reduces, side effects diminish. In most cases, prednisone can be reduced to a maintenance level by the end of about one year after transplantation. Also, use of combinations of drugs has allowed physicians to prescribe lower doses of prednisone than in the past.

Regardless of complications, never stop taking prednisone unless you are instructed to do so by your transplant team. Many problems can occur if prednisone is stopped suddenly. (See "Why Can't Prednisone Be Discontinued Suddenly?" for more information.)

Side Effects of Prednisone

The most commonly encountered side effects are:

• Sodium retention
• Increased appetite
• Increased fat deposits
• Increased acid in your stomach
• Increased sweating, especially at night
• Increased hair growth
• Acne on the face, back, and chest
• Bone and muscle problems
• Growth problems in children
• Eye problems
• Increased sugar in the blood
• Increased sensitivity to the sun
• Delayed wound healing
• Decreased ability to fight infection
• Thrush (Candida) growth in the mouth

This article adapted with permission from Encore: Another Chance for Life, a quarterly magazine published by CHRONIMED Pharmacy. For information about CHRONIMED pharmacy or a subscription to Encore, call 1-800-888-5753.

Return to TransWeb's index of transplant medications.

Prednisone is a synthetic hormone commonly referred to as a "steroid." Prednisone is very similar to the hormone cortisone, which the body manufactures. Prednisone is used to treat many illnesses.

How does prednisone work?

�?In part, prednisone acts as an immunosuppressant. The immune system protects against foreign bacteria and viruses. In some illnesses, the immune system produces antibodies, which become overactive and cause undesirable effects. These illnesses are referred to as "autoimmune diseases". Prednisone suppresses the production of antibodies. This suppression can make it slightly harder for you to fight off infection but also stabilizes the immune system if it is overactive.

�?Prednisone also works against inflammation to reduce the heat, redness, swelling and pain.

�?When beginning prednisone, there is a small chance that it may cause serious increased weakness for a short period of time. Therefore, it may be necessary for you to be hospitalized for the first few days for observation.

Adverse effects do not occur in all patients and are usually related to the amount and length of time prednisone is used. Potential adverse effects will be monitored by your physician and include:

Insomnia and mood changes. Euphoria or depression may occur. The cause is uncertain. It is best to take prednisone it in the morning to reduce the chances of insomnia at night.Increased appetite and weight gain. Prednisone increases the appetite. Follow a diet to maintain your weight. Develop an eating schedule and stick to it. If you eat when you feel hungry, you will be eating all the time.Susceptibility to infections. Prednisone slightly decreases resistance to infection. Avoid individuals with infectious illnesses if possible. Notify your physician if you develop persistent signs of an infection.Stomach upset (indigestion, stomach burning) or ulcer. Prednisone may cause gastrointestinal irritation. Take prednisone with meals, milk or antacids. Do not take it on an empty stomach.Fluid retention. Prednisone can cause fluid retention. Your physician will monitor this process. Fluid retention can be caused by sodium retention and potassium depletion through frequent urination. A salt-restricted/potassium-rich diet may help reduce fluid retention. Hypertension. Prednisone may cause a rise in blood pressure. Your physician can treat this, if necessary.Hyperglycemia or diabetes (elevated blood sugar). Prednisone may increase the amount of sugar (glucose) in your blood. With periodic blood work, your physician can monitor this. If prednisone is stopped too quickly, serious adverse effects can occur (nausea, vomiting, pain, fever, and/or flare-up of disease). Rapid withdrawal or stopping of prednisone may cause these adverse effects. Never stop or change your prednisone dose without your doctor’s consent. If you are planning a trip, always carry an extra supply.

How long will the adverse effects last?

If adverse effects develop, they will persist usually as long as the medication is continued. As the dose decreases so will the adverse effects. Some adverse effects are permanent and will not reverse after the medication is discontinued.

Patients taking prednisone should be on high-protein, low-salt, low-carbohydrate diets and eat well-balanced meals.

What should I do if I miss a dose of prednisone?

You should try to avoid missing a dose of prednisone. If you do, follow these guidelines.

�?/BIG> If you forget to take your prednisone at the usual time, but remember later on the same day, take the missed dose immediately.