At the age of fifteen I was first introduced to Prednisone. Having been diagnosed with Crohn’s, an intestinal disease, Prednisone was the first and main method of attack. I knew nothing of the drug or any of its side effects. My doctor, at the time, didn’t bother to inform me of what to expect. The doctors themselves may have known what to expect as far as short-term effects, but I believe, back then, they didn’t fully understand the consequences of long-term use, as they do now.
For those who’ve never heard of the drug, Prednisone is a synthetic hormonal steroid. It’s produced naturally in the body under the name of Cortisone, which is produced in the adrenal gland and is closely related to Cortisol, also produced in the adrenal gland. Cortisone is mostly inactive in the body until it is converted to Cortisol (known synthetically as hydrocortisone.)
The function of natural Cortisone is to regulate actions in the metabolism of fats, carbohydrates, sodium, potassium, and proteins, as well as being an anti-inflammatory agent. It’s this last feature that has made Prednisone a drug of choice in the treatment not just for Crohn’s disease, but also for afflictions such as rheumatoid arthritis, slipped or herniated discs, and asthma.
Prednisone is cheap and widely used. It may also be used for jumping starting menses in teen-aged girls, and to treat allergic reactions such as those associated with bee stings. When used for these purposes, it is usually given for a briefer duration. However, two week treatments won’t stop the short-term side effects, of which there are many.
Prednisone users may experience one or more of the following effects: a ravenous increase in appetite, sudden mood swings and magnified emotions, hyperactivity, hot flashes, extreme and sudden weight gain, a rounding of the face (called “moon-face”), hair loss, sometimes as much as half, swelling of the legs and body from fluid retention, a yeast infection called thrush, which leaves a thick, white coating on the tongue, and because Prednisone thins the blood and works as a kind of anti-coagulant agent, numerous and unexplained bruising of legs, arms and hips will appear under the skin. When cut, a wound will take a long time to stop bleeding no matter how much pressure is applied. Also, Prednisone has the nasty habit of masking infections, so a user may, for example, be harboring a urinary tract infection and not know it. The good news is that these side effects are short-lived and will, after some weeks or months, disappear when off the medication.
The most frightening and dangerous side effect is because it is a steroidal hormone, which is also produced internally. The patient takes not only outside dosages of the hormone, but receives the naturally converted cortisone from the adrenal gland. However, after the patient has been on the oral doses, especially high doses, the body recognizes the increased influx of cortisone. In return, the body practically ceases it’s own production. This action can be dangerous to a user should he suddenly stop taking the oral medicine. When the body is un-expectantly deprived of the external hormone, and the production of the natural cortisone has shut down, the body goes into shock. The patient may end up in a coma. It is prudent that the patient never stop taking this medication suddenly. He must be weaned down slowly, usually in 5-10 mg increments.
The irony of Prednisone comes in the long-term side effects of chronic use. Long-term use may be necessary in the treatment of rheumatoid arthritis and IBD (the collective term for Crohn’s and Colitis—intestinal diseases.) However, if used for extended durations over many years, it will, in fact, destroy connective tissue in the back and body, decrease bone mass in women, and cause joint pain and deterioration.
In recent years, other drugs such as Remicaid and Advair, just to name a few, have been developed for these ailments, slowing down the prescribing of Prednisone, especially for long term treatments. It is important that every patient knows and understands both the short and long-term side effects of any medication they are prescribed. All possible side effects should be discussed with the physician to determine if the benefits out-way possible adverse reactions.
The Patient’s Bill of Rights guarantees every patient an active say in their health care.