Prednisone: Dr. Peter J. Rice
The Byrne Clan Reunion and Help from Prednisone
When the biblical character Samson was old and had lost his strength, he found himself praying “strengthen me, I beg you, only this once, O God”. When patients find themselves needing a good day, the drug prednisone can be an answer to prayer.
My mom, who is 91 years old, received her invitation to the Byrne first generation reunion at the end of April. My grandfather, James Byrne of Mallow, Ireland, came to the US about a century ago and was eventually joined in the United States by several brothers and sisters. My mom is among the first generation born to the Byrne clan in Bronx, NY.
My mom is in fairly good shape, relying only on a cane, but when you’re older you’re rarely in good enough shape for those BIG events – like weddings and family reunions – where you want to look good and feel good. Fortunately for many patients, medicines can provide an almost guaranteed “good day” for an important occasion.
The limitation for many patients is inflammation. If you’ve ever found yourself aching all over, you can appreciate the concept that it would sure be nice to feel good, even if only for a short time.
Prednisone is one of the most commonly prescribed anti-inflammatory drugs.
A member of the corticosteroid class of medications, prednisone acts like an adrenal hormone and has several positive and several negative effects. Fortunately, the positive effects occur quickly and the negative effects are most prominent if the drug is used for too long a duration.
Let’s briefly consider prednisone as a steroid.
- To many patients, the term ”steroid” creates confusion between drugs that have a similar chemical structure but markedly different pharmacologic effects.
- “Steroids” refers to a particular chemical structure with four rings; as various chemical groups are added around the rings, they create drugs that can have a variety of pharmacological effects, from cholesterol to sex steroids (estrogens, progestins and testosterones), mineralocorticoids that control fluid balance, vitamin D, and corticosteroids like prednisone, prednisolone, methylprednisolone, triamcinolone, betamethasone, and beclomethasone.
Prednisone is easily absorbed following oral administration; other corticosteroids are formulated as topical, injectable or inhalation medications.
While some effects will be noticeable within an hour or two, other corticosteroid effects may be delayed a day or more. The corticosteroids must diffuse through the cell membrane, combine with intracellular receptors, relocate to the nucleus, and change the proteins that are produced by the cell.
Inflammation is affected by the change in types and amounts of inflammatory mediators called “cytokines.”
As corticosteroids take effect, inflammatory mediators that are already present must degrade or be metabolized. The effects of corticosteroids can extend beyond their presence in the blood stream. Because of their slow onset of action and the nature of their effect, corticosteroids are useful therapy for prevention of inflammation and respiratory problems (e.g., asthma) but are less useful for immediate relief of respiratory problems.
Side effects of corticosteroids can be a direct extension of their pharmacological action, or they can represent nonselective effects that occur because of their chemical similarity to other steroids.
- As part of the body’s response to stress, corticosteroids alter metabolism and increase blood sugar; these drugs worsen diabetes.
- As inhibitors of immune cells that produce inflammatory mediators, corticosteroids like prednisone depress the immune system and increase the likelihood of bacterial or fungal infection.
Corticosteroids can also produce behavioral changes, particularly at high dosages. There is a classic pharmacology movie thriller from 1956, “Bigger Than Life” in which James Mason plays a patient who is prescribed corticosteroids as a lifesaving medication, but takes higher doses than prescribed and experiences psychosis. Patients have also noted extreme hunger while taking these drugs; that may make visiting the Golden Corral™ or other all-you-can-eat buffet either very cost effective or something which you should definitely not tempt yourself with.
Corticosteroids can be miracle drugs for short term use.
- Many patients will receive the 7-day “Dose Pack” with higher initial dosing and tapering doses over seven days.
- In my mom’s case, a small (5mg) dose of prednisone for a day or two made for an enjoyable family reunion at which everyone marveled at her good health.
- And unlike Samson’s “only this once”, prednisone can be used under the guidance of her physician to provide her with that occasional great day when she needs it.
If you have questions about prednisone or any medication, talk with your prescriber or your community pharmacist. Your community pharmacist can help you understand how you can optimize your medications.
NIH PubMed Health – – Prednisone (By mouth)
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