of
fatty liver, as may be seen due to long-term prednisone use.
Trichrome stain. Short-term side effects, as with all glucocorticoids, include high blood
glucose levels (especially in patients with
diabetes mellitus or on other medications that increase blood glucose, such as
tacrolimus) and
mineralocorticoid effects such as fluid retention. The mineralocorticoid effects of prednisone are minor, which is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly. It can also cause
depression or depressive symptoms and
anxiety in some individuals. Long-term side effects include
Cushing's syndrome,
steroid dementia syndrome,
truncal weight gain,
glaucoma and
cataracts, diabetes mellitus
type 2, and
depression upon dose reduction or cessation. Long-term steroids can also increase the risk of
osteoporosis, but research has found that few of these people were taking medications to protect bones. Prednisone also results in
leukocytosis.
Major Source: • Unusual
fatigue or
weakness •
Mental confusion • Memory and attention dysfunction (
steroid dementia syndrome) • Muscle atrophy •
Blurred vision •
Abdominal pain •
Peptic ulcer • Painful
hips or
shoulders •
Steroid-induced osteoporosis •
Stretch marks •
Osteonecrosis – same as avascular necrosis • Insomnia • Severe
joint pain •
Cataracts or
glaucoma •
Anxiety •
Black stool •
Stomach pain or
bloating • Severe
swelling •
Mouth sores or
dry mouth •
Avascular necrosis •
Hepatic steatosis •
Hiccups and
burping • Weakening and breakage of
tendons Minor Source: if the patient had been on long-term treatment. Abrupt withdrawal may lead to an
Addisonian crisis. For those on chronic therapy, alternate-day dosing may preserve adrenal function and thereby reduce side effects. Glucocorticoids act to inhibit feedback of both the
hypothalamus, decreasing
corticotropin-releasing hormone (CRH), and
corticotrophs in the
anterior pituitary gland, decreasing the amount of
adrenocorticotropic hormone (ACTH). For this reason, glucocorticoid analogue drugs such as prednisone down-regulate the natural synthesis of glucocorticoids. This mechanism leads to dependence in a short time and can be dangerous if medications are withdrawn too quickly. The body must have time to begin synthesis of CRH and ACTH and for the adrenal glands to begin functioning normally again. Prednisone may start to result in the suppression of the
hypothalamic–pituitary–adrenal (HPA) axis if used at doses 7–10 mg or higher for several weeks. This is approximately equal to the amount of endogenous cortisol produced by the body every day. As such, the HPA axis starts to become suppressed and
atrophy. If this occurs the patient should be tapered off prednisone slowly to give the adrenal gland enough time to regain its function and endogenous production of steroids.
Withdrawal The magnitude and speed of dose reduction in corticosteroid withdrawal should be determined on a case-by-case basis, taking into consideration the underlying condition being treated, and individual patient factors such as the likelihood of relapse and the duration of corticosteroid treatment. Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have: • received more than 40 mg prednisone (or equivalent) daily for more than one week • been given repeat doses in the evening • received more than three weeks of treatment • recently received repeated courses (particularly if taken for longer than three weeks) • taken a short course within one year of stopping long-term therapy • other possible causes of adrenal suppression Systemic corticosteroids may be stopped abruptly in those whose disease is unlikely to relapse who have received treatment for three weeks or less and who are not included in the patient groups described above. During corticosteroid withdrawal, the dose may be reduced rapidly down to physiological doses (equivalent to prednisolone 7.5 mg daily) and then reduced more slowly. Assessment of the disease may be needed during withdrawal to ensure that relapse does not occur. ==Pharmacology==