DOSING
Our adrenal glands produce approximately the equivalent of 4mg/day prednisone. A low dose is slightly higher, around 5-15mg/day. A moderate dose is 0.5mg prednisone per kilogram of body weight per day. A high dose 1-3mg prednisone/kilogram body weight per day. A massive dose is 15-30mg prednisone/kilogram body weight per day.
SIDE EFFECTS
The side effects of prednisone are dependent upon dose and duration. Basically, prednisone speeds up the aging process, so the long term side effects are those typically associated with aging.
The adrenal glands make the equivalent of 4mg prednisone every day; pred use suppresses that production, which is why tapering off pred is so important. The adrenal glands need a chance to begin working again. Alternate-day therapy is preferred over daily, as it helps keep the side effects to a minimum and also helps prevent adrenal failure.
Some of the possible effects of long term and/or high dosage use of prednisone and other corticosteroids; some of these can be permanent:
- bone density loss (osteoporosis – which can cause compression and stress fractures)
- weight gain (and it’s not easy to lose)
- cataracts – glaucoma – exophthalmos (eyeball prominence)
- thinning of the skin, fragile skin – plethora (facial redness)
- violaceous striae (stretch marks)
- slow wound healing
- thinning of scalp hair
- increased body hair
- bruising – worsening of existing diabetes, or causing steroid-induced diabetes
- increased blood fat (hyperlipoproteinemia)
- negative balance of calcium, nitrogen and magnesium (catabolic state) – I should mention here that low blood levels of calcium (hypocalcemia) can result in tetany, which is extremely PAINFUL -been there, done that
- salt retention
-suppression of adrenal glands (which is why you must taper off, to give them a chance to start working again)
- menstrual abnormalities
- impotence in guys
- suppression of growth in children
- weak muscles – osteonecrosis of bone ends
- gastritis – peptic ulcer
- thrush – pancreatitis – hypertension
- congestive heart failure in pre-disposed individuals
- alterations in mood – psychosis (rare)
- convulsions (rare)
- increased susceptibility to infections – suppression of immune responses (part of the reason why it suppresses the hives)
- change in white blood cell population, with increase in neutrophils and decrease in in lymphocytes and monocytes
(source: ‘Coping with Prednisone’ by Eugenia Zukerman and Julie R. Ingelfinger, MD, page 64-65)
The long term side effects of pred are also cumulative, meaning that any future pred use will cause further permanent damage. People coming off prednisone often experience a rebound effect where their hives worsen, which sometimes results in them going back on it – and needing higher and higher doses to control their symptoms.
And following long term use and/or high doses, one can go through withdrawals – mainly quite painful muscle cramps and bone pain. It’s best to avoid corticosteroids if at all possible, except in extreme cases of CU, symptoms that cannot be controlled with other meds, or if you have life threatening symptoms (anaphylaxis). It can also be a problem in cases of mastocytosis, since masto destroys your good bone marrow, leading to osteoporosis. Taking pred on top of that may speed up the process.
