Prednisone / Prednisolone

(for veterinary information only)

AVAILABLE IN   
5 mg, 10 mg & 20 mg
TABLETS         

USES OF THIS MEDICATION

Prednisone and prednisolone are members of the glucocorticoid class of hormones. This means they are steroids but, unlike the anabolic steroids that we hear about regarding sports medicine, these are "catabolic" steroids. Instead of building the body up, they are designed to break down stored resources (fats, sugars and proteins) so that they may be used as fuels in times of stress. Cortisone would be an example of a related hormone with which most people are familiar. Glucocorticoids hormones are produced naturally by the adrenal glands to prepare us metabolically for physical exercise and stress.

Despite the body's natural use for glucocorticoids, we rarely use these hormones for their influences on glucose and protein metabolism; we use them because they are also the most broadly anti-inflammatory medications that we have. Their uses fit into several groups:

  • Anti-inflammatory (especially for joint pain and itchy skin).
     
  • Immune-suppression (treatment of conditions where the immune system is destructively hyperactive. Higher doses are required to actually suppress the immune system).
     
  • Cancer Chemotherapy (especially in the treatment of lymphoma and mast cell tumors.)
     
  • Central Nervous System Disorders (usually after trauma or after a disc episode to relieve swelling in the brain or spinal cord or more chronically in the event of a brain tumor.)
     
  • Shock (steroids seem to help improve circulation).
     
  • Blood Calcium Reduction (in medical conditions where blood calcium is dangerously high treatment is needed to reduce levels to normal).

Prednisone is activated by the patient's liver into Prednisolone.

Prednisolone may be administered in tablet form or produced by the body from prednisone. These medications are considered to be interchangeable though it seems that some cats are not efficient at the conversion and do better on prednisolone.

Prednisone can also be used for its ability to mobilize sugar in treatment of insulin secreting tumors or metabolic conditions associated with low blood sugar.

Prednisone is also involved in the treatment of Addison's Disease, where there is a natural deficiency of glucocorticoid hormones (as well as mineralocorticoid hormones).

SIDE EFFECTS

Prednisone & prednsolone have activity in the kidney leading to the conservation of salt. This creates the classical side effects of prednisone/prednisolone use: excessive thirst and excessive urination. If this occurs, another steroid can be selected or the predisone/prednisolone dose can be dropped. The increased salt retention could be a problem for patients with congestive heart failure.

Prednisone/prednisolone are commonly used for several weeks or even months at a time to get a chronic process under control. It is important that the dose be tapered to an every other day schedule once the condition is controlled. The reason for this is that body will perceive these hormones and not produce any of its own. In time, the adrenal glands will atrophy so that when the medication is discontinued, the patient will be unable to respond to any stressful situation. An actual circulatory crisis can result. By using the medication every other day, this allows the body's own adrenal glands to remain active.

Any latent infections can be unmasked by prednisone use. (Feline upper respiratory infections would be a classical example. When a cat recovers clinically, the infection simply goes dormant. Glucocorticoid use could bring the infection out again.) Long term prednisone/prednisolone use is associated with increased risk for latent bladder infection, especially in dogs.

Glucocorticoid hormone use can be irritating to the stomach at higher doses.

At high enough doses prednisone/prednisolone creates a state of higher than normal blood sugar levels. It is possible for a patient on the verge of developing diabetes mellitus to be tipped into a diabetic state. This is usually a problem though for stronger steroid hormones and one reason to select prednisone/prednisolone for long term use is to attempt to minimize the risk of developing diabetes mellitus. Still, one would avoid using prednisone/prednisolone in a patient with existing diabetes mellitus if it is at all possbile to do so.

INTERACTIONS WITH OTHER DRUGS

Glucocorticoid hormones should not be used in combination with medications of the NSAID class (ie aspirin, carprofen, deracoxib etc.) as the combination of these medications could lead to bleeding in the stomach or intestine. Ulceration could occur.

CONCERNS AND CAUTIONS

Prednisone and prednisolone are considered to be intermediate acting steroids, meaning that a dose lasts about a day or a day and a half. After two weeks or more of use, it is important to taper the dose to an every other day schedule so as to keep the body's own cortisone sources able and healthy.

The same salt retention that accounts for the excessive thirst and urination may also be a problem for heart failure patients or other patients who require sodium restriction.

  • Diabetic patients should never take this medication unless there is a life-threatening reason why they must.
     
  • Glucocorticoid hormones can cause abortion in pregnant patients. These hormones should not be used in pregnancy.

Prednisone/Prednisolone use is likely to change liver enzyme blood testing and interfere with testing for thyroid diseases.

When prednisone/prednisolone is used routinely, serious side effects would not be expected.

When doses become immune-suppressive (higher doses) or use becomes "chronic" (longer than 4 months at an every other day schedule), the side effects and concerns associated become different.

In these cases, monitoring tests may be recommended or, if possible, another therapy may be selected.

Click here for more information about Chronic Steroid Use.

Click here for information on Steroid Alternatives for Itchy Skin.

Page last updated: 4/25/10