Prednisone is a drug that is commonly used to treat many inflammatory conditions. It is often prescribed to treat the two major forms of inflammatory bowel disease (IBD) -- Crohn's disease and ulcerative colitis. The chief barrier to use of prednisone is its long list of potential side effects, many of which are visible or especially bothersome. Some of these effects include: mood swings, increased hair growth, facial swelling or "mooning", increased appetite, night sweats, acne, headaches, and weight gain. In more extreme cases, the long-term use of prednisone can lead to steroid dependency, bone density loss, and other permanent adverse effects. With all of these possible side effects, why would patients ever take this drug, and why would doctors prescribe it?
Prednisone Is A Steroid
Prednisone is part of a class of drugs known as corticosteroids, and is similar to cortisol, a steroid the body produces in the adrenal gland. It reduces inflammation in the body, which is why it is helpful in treating IBD, a condition that is characterized by inflammation of the digestive tract. Prednisone often works quickly to reduce the inflammation and other symptoms of IBD including diarrhea and bleeding.
Discontinuing PrednisoneCare must be taken when lessening the dosage of prednisone -- a patient should not stop taking it suddenly. The body stops or decreases its own production of cortisol, and slowly tapering the amount of prednisone taken daily allows the body to begin producing it again on its own. Tapering the dose of prednisone usually means lowering the dose by a certain amount every few days or even every week. The length of time to taper will depend on the starting dosage, and the amount of time the prednisone has been taken. At a higher dosage that has been taken for a long period of time, it may take months to taper down, while a short course (such as a few weeks) can be tapered down quicker.
Use In Children
Children taking prednisone are of special concern. A child's growth rate may be impaired, ultimately resulting in the delay of puberty. Children who are taking prednisone for any length of time should be monitored very closely for any signs of long-term side effects such as stunted growth.
Reducing Side Effects
Prednisone has been proven to be effective in reducing inflammation, and patients who choose to take it should be aware of a few ways to combat the side effects.
- Bone density loss: Supplementing a healthy diet with calcium will help to keep bones healthy through a course of prednisone.
- Diet: Reducing salt intake can prevent side effects associated with fluid retention. Watching fat and calorie intake can help to prevent weight gain. A nutritionist will be helpful in planning a diet to follow while taking prednisone.
- Dosage: Talking to a gastroenterologist about the best time of day to take prednisone for maximum effectiveness and minimal discomfort could make a big difference. Taking all the doses of prednisone earlier in the day (only on the advice of a physician!) could reduce side effects such as insomnia or night sweats, and taking it with meals could prevent stomach upset.
- Support: Let family and friends know about the side effects of prednisone. They need to know that it's the drug that's causing your mood swings or irritability and that as your disease gets under control, you'll get back to being yourself.
- Tapering as soon as possible: As soon as possible, the dosage of prednisone should be lowered slowly until it is discontinued. A slow progression is necessary and the longer the drug has been taken, the slower the taper must be. However, the goal should be to get the dose down low enough to where side effects are minimal, as quickly and as safely as possible.
Some patients feel that the negative side effects of prednisone far outweigh the benefits that can be derived. It may quickly stop a flare-up of IBD in its tracks, but at the price of altered physical appearance, mental instability, and other serious health risks. It's not an easy choice, but every patient with IBD must make the decision to use prednisone based on his or her own needs in conjunction with a gastroenterologist.