Class
- Glucocorticoid, immunomodulator
Prednisone
Commonly Prescribed for
(FDA approved in bold)
- Acute exacerbation of multiple sclerosis (MS)
- Optic neuritis
- Inflammatory myopathies: dermatomyositis (DM) and polymyositis (PM)
- Temporal arteritis (TA)
- Cerebral edema associated with brain tumor or head injury
- Asthma
- Chronic obstructive pulmonary disease
- Rheumatologic disorders: gouty arthritis, rheumatoid arthritis, bursitis (many others)
- Systemic lupus erythematosus
- Neoplastic disorders: Lymphoma and acute leukemia
- Hematologic disorders: hemolytic anemia, idiopathic thrombocytopenia purpura (many others)
- Allergic conditions, such as atopic dermatitis, drug hypersensitivity reactions
- Acute episodes in Crohn’s disease and ulcerative colitis
- Nephrotic syndrome
- Tuberculous meningitis
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Myasthenia gravis (MG)
- Duchenne muscular dystrophy (DMD)
- Migraine headache
- Cluster headache
- Idiopathic intracranial hypertension
- Acute demyelinating encephalomyelitis (ADEM)
- Graves ophthalmopathy
- Ophthalmoplegic migraine
Prednisone
How the Drug Works
- Glucocorticoids have anti-inflammatory effects, modify immune responses to stimuli, and have numerous metabolic effects. Prednisone is a synthetic steroid with glucocorticoid and mineral corticoid activity
Prednisone
How Long Until It Works
- MS, migraine, cluster – days
- MG, DM, PM, CIDP – weeks to months
- TA – days
Prednisone
If It Works
- MS: Use for acute exacerbation that causes significant disability. In relapsing-remitting form, long-term disease-modifying treatments improve prognosis
- Migraine: Usually used for intractable headache or status migrainosus for short periods of time. After resolution, revert to safer preventive and abortive therapy
- Cluster: Start preventive therapy and prednisone at the beginning of a cycle
- MG: Weakness and fatigability improve. Decrease dose cautiously if clinical remission occurs
- DM/PM: Improves strength and mobility. Start a steroid-sparing agent if needed and taper dose cautiously with clinical remission
- CIDP: Improves strength and sensory symptoms and prevents disability. Decrease dose cautiously if clinical remission occurs
- TA: Monitor clinical response and sedimentation rate
Prednisone
If It Doesn’t Work
- MS: If no improvement, question the diagnosis of relapsing-remitting MS
- Migraine: Start preventive therapy. Intravenous neuroleptics or dihydroergotamine may be needed to treat status migrainosus
- Cluster: Start preventive therapy
- MG: Start an adjunctive treatment or change to another modifying therapy. For acute exacerbations, consider plasma exchange or immune globulin
- DM/PM: Reconsider the diagnosis (inclusion body myositis, muscular dystrophy)
- CIDP: Immune globulin or plasma exchange are effective. Consider other less proven immune modulators
- TA: Reconsider diagnosis. Immunomodulatory drugs may be effective
Prednisone
Best Augmenting Combos for Partial Response or Treatment-Resistance
- MS: Use disease-modifying treatments to reduce relapses that require steroids
- Migraine/cluster: Antiemetics and migraine-specific agents may be used with prednisone for acute attacks
- MG: Use a steroid-sparing agent such as azathioprine, cyclosporine, mycophenolate mofetil, or cyclophosphamide. Treat acute exacerbations, usually with plasma exchange or immune globulin, and continue symptomatic treatment, such as pyridostigmine
- DM/PM: Combine with corticosteroid-sparing agents such as methotrexate or azathioprine
- CIDP: Combine with corticosteroid-sparing agent, immune globulin or plasma exchange
- TA: Combine with corticosteroid-sparing agent
Prednisone
Tests
- Monitor blood pressure, blood glucose and electrolytes with long-term therapy
Adverse Effects (AEs)
Prednisone
How Drug Causes AEs
- Most AEs are due to immunosuppression, metabolic or endocrine effects
Prednisone
Notable AEs
- Convulsion, vertigo, paresthesias, aggravation of psychiatric conditions, insomnia
- Amenorrhea, cushingoid state, increased sweating, increased insulin requirement in diabetics, hyperglycemia
- Pancreatitis, abdominal distension, esophagitis, bowel perforation, weight gain
- Cataracts, glaucoma
- Impaired wound healing, petechiae, erythema, hirsutism
- Sodium and fluid retention, hypokalemia, metabolic acidosis
- Muscle weakness, myopathy, muscle mass loss, tendon rupture
- Thrombophlebitis, hypertension
Prednisone
Life-Threatening or Dangerous AEs
- Fractures, aseptic necrosis of femoral or humoral heads
- Hypokalemia may cause cardiac arrhythmias
- Diabetic ketoacidosis, hyperosmolar coma
- May mask symptoms of infection and prevent ability of patient to prevent dissemination. May activate latent amebiasis or tuberculosis. May prolong coma in cerebral malaria
- Adrenal suppression with long-term use
- Psychosis with clouded sensorium, severe depression, personality changes, or insomnia, usually within 15–30 days after starting treatment. Female sex and higher doses are risk factors
Prednisone
Weight Gain
- Problematic
Prednisone
Sedation
- Unusual
Prednisone
What to Do About AEs
- For diseases such as migraine or MS, avoid using for prolonged periods of time and stop for most significant AEs
- In diseases requiring long-term treatment, consider using corticosteroid-sparing agents – often starting these treatments with prednisone to reduce the dose requirement and possibly allow discontinuation as clinical symptoms improve
- Weight-bearing exercises are recommended to promote bone protection and minimize muscle wasting
- Weight gain – avoid other medications that may exacerbate, dietary modification
- Hypertension – convert to a glucocorticoid with less sodium-retaining potency, such as methylprednisolone or dexamethasone
