What is Prednisone?
Prednisone is a dehydrated analogue of hydrocortisone, which has an anti-inflammatory, anti-allergic, desensitizing, anti-shock and immunosuppressive effect.
Prednisone increases protein breakdown and causes the induction of the hepatic amino acid metabolizing enzymes. In addition, the drug inhibits synthesis and increases the degradation of proteins in lymphoid, connective and muscle tissues and skin. The long-term use of this drug can lead to degradation of these tissues.
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The drug increases the availability of glucose, stimulating gluconeogenesis in the liver, accelerating protein catabolism (which increases the amount of amino acids involved in gluconeogenesis) and reducing glucose uptake in various tissues. This leads to the accumulation of glycogen in the liver, high glucose concentration and increased insulin resistance.
Prednisone increases lipolysis and mobilizes fatty acids from adipose tissue, which enhances plasma FFA levels. Long-term use of Prednisone can lead to a predominantly upper body fat distribution. The drug also decreases calcium concentration in blood, causes delayed bone growth in children and adolescents and osteoporosis in patients of any age.
Prednisone increases the action of endogenous and exogenous catecholamines.
Glucocorticoids treat many conditions, such as:
- primary and secondary adrenal insufficiency, including Addison’s disease and adrenogenital syndrome;
- non-purulent thyroiditis;
- severe allergic reactions, such as: serum sickness, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis and angioedema;
- rheumatism, rheumatoid arthritis, rheumatic myocarditis, dermatomyositis, systemic lupus erythematosus, granulomatous arteritis, polyarteritis nodosa, relapsing polychondritis, ankylosing spondylitis and psoriatic arthritis;
- vasculitis, severe seborrheic dermatitis and erythema multiforme (Stevens-Johnson syndrome), atopic, contact or exfoliative dermatitis, pemphigus, ulcerative colitis and Crohn’s disease.
Routes of administration and dosages
The dose should be established individually depending on the type of disease and response to treatment. It is important to re-evalute the drug dose from time to time, as the severity of the disease may change, or the complications may develop during the treatment. After achieving the desired result, you should gradually reduce to minimum effective dose.
The drug should be taken orally with a small amount of liquid (after meals).
Adults: the average dose is 5-60 mg/day (depending on the severity of the disease). It is recommended to take Prednisone according to the circadian rhythms (the largest dose should be taken in the morning).
If you’ve been on Prednisone for more than 3 weeks, you should withdraw it gradually to avoid withdrawal syndrome. Abrupt discontinuation of the drug can be fatal.
The dose should be reduced gradually over weeks (or even months) depending on the dosage, duration of treatment, severity of disease and individual response to treatment. If you’ve been on Prednisone for 3 weeks or less, abrupt withdrawal is unlikely to result in clinically significant HPA suppression. However, it should be taken into account that patients may react differently to corticosteroids and their withdrawal.
Thus, patients at risk for adrenal insufficiency should gradually reduce the dose (especially in case of long-term treatment or the use of high doses).
In case of gradual dose reduction, the dosage regimen should be selected individually. 2.5 mg dose reduction of prednisone every 3-7 days is tolerated well by most patients (until a dose of 5-10 mg/day is reached). Patients receiving high doses of Prednisone should reduce the dose gradually over 9-12 months.