The Pemphigus & Pemphigoid Society

Prednisone or prednisolone are synthetic chemicals created to mimic our bodies naturally occurring glucocorticoids. Glucocorticoids administered at pharmacological doses prevent or suppress inflammation and immune response. Prednisone is the most commonly prescribed oral corticosteroid and is the used to treat pemphigus with the aim to prevent the eruption of new lesions and suppress current ones.

Dosage of prednisone if highly variable and must be individualized depending of the severity of the patient's disease and on patient response. Oral dosage forms of prednisone should be administered with meals to minimize stomach irritation or indigestion. If one frequently uses alcohol, smokes, drinks caffeine, or uses illegal drugs, it is important to alert the prescriber since these may affect the way the medication works. If the dose is given daily, morning administration is ideal to coincide with the normal cortisol secretions of the body.

Since prednisone is usually administered at prolonged pharmacological doses, rather than physiologic replacement doses, adverse side effects are common. It is important to note that the severity of the adverse effect increases with dose and duration of therapy.

Highlighting some notable adverse reactions, glucocorticoids play a major role in protein metabolism, therefore prolonged therapy may result in musculoskeletal effects. These include impaired wound healing, bone fracture, osteoporosis, muscle wasting and weakness. It is important for postmenopausal woman to be monitored for signs of osteoporosis.

Bone mineral density (BMD) testing* and calcium with vitamin D supplementation is recommended. The endocrine system can be affected by long term prednisone therapy. Menstrual irregularity, hyperglycemia, and aggravation of diabetes mellitus may occur.

Patients may experience HPA suppression from physiological dependence of pharmacological doses. HPA suppressive patients require increased doses of corticosteriod therapy during periods of physiologic stress. Prednisone should never be abruptly discontinued due to acute adrenal insufficiency from the HPA suppression. Withdrawal from prednisone must be gradual and HPA suppression can last up to 12 months after the drug is discontinued. During this time patients still may need supplementation during times of stress (i.e. surgery).

*New patients are commonly given a dexa-scan (not just an x-ray) to use as a benchmark for evaluating bone health later.

Reminder for prescription drug users The best way to stay out of trouble is to prepare for it. Consider these suggestions for all pemphigus and pemphigoid patients. Take all medication as directed. Read the literature that comes with prescription medications. Be sure you understand what symptoms to watch for and know what to do in emergency situations. Wear emergency notification jewelry is recommended during systemic treatment and for a full year after the last dose at least. Carry a current list of medications and amounts taken. Have enough medication and other necessities on hand to last through a possibly lengthy emergency. See also: Common pharmacy abbreviations
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	> Prednisone (prednisolone) The reluctant drug of choice most often works to control symptoms
	Prednisone or prednisolone are synthetic chemicals created to mimic our bodies naturally occurring glucocorticoids. Glucocorticoids administered at pharmacological doses prevent or suppress inflammation and immune response. Prednisone is the most commonly prescribed oral corticosteroid and is the used to treat pemphigus with the aim to prevent the eruption of new lesions and suppress current ones. Dosage of prednisone if highly variable and must be individualized depending of the severity of the patient's disease and on patient response. Oral dosage forms of prednisone should be administered with meals to minimize stomach irritation or indigestion. If one frequently uses alcohol, smokes, drinks caffeine, or uses illegal drugs, it is important to alert the prescriber since these may affect the way the medication works. If the dose is given daily, morning administration is ideal to coincide with the normal cortisol secretions of the body. Since prednisone is usually administered at prolonged pharmacological doses, rather than physiologic replacement doses, adverse side effects are common. It is important to note that the severity of the adverse effect increases with dose and duration of therapy. Highlighting some notable adverse reactions, glucocorticoids play a major role in protein metabolism, therefore prolonged therapy may result in musculoskeletal effects. These include impaired wound healing, bone fracture, osteoporosis, muscle wasting and weakness. It is important for postmenopausal woman to be monitored for signs of osteoporosis. Bone mineral density (BMD) testing* and calcium with vitamin D supplementation is recommended. The endocrine system can be affected by long term prednisone therapy. Menstrual irregularity, hyperglycemia, and aggravation of diabetes mellitus may occur. Patients may experience HPA suppression from physiological dependence of pharmacological doses. HPA suppressive patients require increased doses of corticosteriod therapy during periods of physiologic stress. Prednisone should never be abruptly discontinued due to acute adrenal insufficiency from the HPA suppression. Withdrawal from prednisone must be gradual and HPA suppression can last up to 12 months after the drug is discontinued. During this time patients still may need supplementation during times of stress (i.e. surgery). *New patients are commonly given a dexa-scan (not just an x-ray) to use as a benchmark for evaluating bone health later.	Contraindications for prednisone include: abrupt discontinuation, Cushing's syndrome, fungal infection, measles, and Varicella. Since prednisone therapy may mask symptoms of infection it should not be used in bacterial or viral infections which are not controlled by anti-infectives Infections secondary to prednisone are common. Patients should notify their physician immediately about symptoms of infection during therapy or up to one year after stopping treatment. Depression can be a natural response in a patient coping with a disease state. Prednisone therapy may have adverse neuroligic effects including insomnia, mental disturbance, depression, anxiety, and personality changes. It is important to discuss these possibilities with one's family and physician. Note that these generally are alleviated when therapy is discontinued. Adverse reactions that should be reported as soon as possible to your prescriber or health care professional include: bloody or black tarry stools, confusion, eye pain or visual disturbances, fever or signs of infection, increases thirst, irregular heartbeat, menstrual problems, muscle cramps/weakness, nausea/vomiting, pain in the hips; arms; shoulders; or legs, rounding out of face, skin problems, swelling of feet or lower legs, unusual bruising, unusual tiredness or weakness, weight gain or loss. Other adverse effects usually do not require medical attention unless the become bothersome. These include diarrhea/constipation, increased sweating, difficulty sleeping, upset stomach, increased hair growth. Patients are urged to drink plenty of water to flush excess prednisone from the body to help reduce side effects. Related articles: Monitoring your blood Understanding prednisone Free or discounted medications
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Prednisone (prednisolone)

The reluctant drug of choice most often works to control symptoms