prednisolone

• You should not stop taking prednisolone suddenly or increase or reduce the dose you have been prescribed unless your doctor tells you to.
  • Your adrenal glands, which are just above the kidneys, normally make glucocorticoids in small amounts. These are important for many normal body functions.
  • If prescribed glucocorticoids are taken, the body begins to make less than usual or even stops making glucocorticoids completely.
  • If the medicine is then suddenly stopped there may be a problem as the adrenal glands won’t have had time to make the glucocorticoids needed. This problem is called adrenal insufficiency.
  • Signs of adrenal insufficiency include weakness, fatigue, fever, weight loss, vomiting, diarrhoea and abdominal pain. If you experience any of these problems, seek medical help.

If prednisolone is taken in high doses or for a long time certain predictable side effects can occur, which could be reversible if stooped.

1) Weight gain: There could be rounding of the face and weight gain around the stomach. These are due to increased appetite and salt retention.

2) Osteoporosis (thinning of the bones): This is more likely with moderate and high doses taken
for long periods. Your doctor will tell you if you need a bone density (BMD) test to check your risk of osteoporosis. To reduce the risk it is recommended that you:

• Have 1000mg of calcium each day (e.g. milk, or calcium tablets)
• Oral Vitamin D in case the levels are low
• Take 30 minutes of weight bearing exercise each day (e.g. walking)
• Avoid smoking and avoid drinking more than 2 standard drinks of alcohol a day
• Get some sunlight exposure each day to maintain vitamin D levels.

3) Skin: The skin, especially on the arms and legs, can become thin, easily bruised and slow to heal. This occurs particularly after long term use, on higher doses and in older people with skin problems related to aging. In younger people acne may be a problem.

4) Diabetes: Prednisolone can cause new onset diabetes in patiens at risk of diabetes, and in diabetics; there could be a rise in blood sugar.  This may require a change in their diabetes medicine.
5) Blood pressure: Prednisolone may cause an increase in blood pressure or make it more difficult to control. This can be monitored and changes can be made to your blood pressure medicine if required. Your doctor will advise about frequency of monitoring.
6) Cholesterol: Prednisolone can cause a rise in blood cholesterol. This can be monitored and changes can be made to your treatment if required.
7) Psychological effects: Prednisolone can cause euphoria (feeling high) and/or other mood or personality changes such as irritability, agitation or depression. While some psychological effects are quite common, they rarely cause significant problems.
8) Trouble sleeping may also occur but can be minimized by taking prednisolone in the morning.
9) Infections: There may be an increased risk of some infections, including mouth infections (such as thrush), shingles and lung infections. Pre-existing infections such as tuberculosis (TB) may become active again. It is important to tell your doctor if you have a chronic infection or if you have been exposed to TB earlier in your life.
10) Indigestion or heartburn can occur. Taking prednisolone with food can reduce this.
11) Ulcers: If taken with nonsteroidal anti-inflammatory medicines (NSAIDs) prednisolone can further increase the risk of stomach or duodenal ulcers. Your doctor will advise you about how to reduce this risk and about what symptoms to look out for.

• Eyes: With long term high dose treatment prednisolone may increase development of cataracts.
  • Other: Facial flushes, constipation and avascular necrosis (a painful bone condition usually seen in the hip or knee) can occur very rarely.

Many of the above side effects can be managed or prevented by close medical supervision and by following your doctor’s recommendations.

Tests
• Blood sugar and cholesterol levels can be increased by prednisolone, so you will need to have blood tests to check these levels as advised by your doctor.
• You will need to check your blood pressure frequently.

Use in pregnancy and breastfeeding
• Prednisolone may be used safely in pregnancy and breastfeeding. It is important to tell your doctor if you are, or intend to become pregnant or if you are breastfeeding.

Use with other medicines
• Prednisolone can affect how other medicines work. This includes over the counter or herbal/naturopathic medicines.
• When you visit any other doctor for any unrelated condition (even up to 12 months of discontinuing steroids), it is important to mention you were on steroids, as the doctor will prescribe accordingly.