Who Should Avoid Prednisone Consumption?

Prednisone is indeed a lifesaving medication in many cases; however, due to excessive and unregulated use of steroids, a number of complications and adverse effects are being reported.

This article entails some of the common conditions in which it is recommended to avoid prednisone intake:

When Should You Avoid Prednisone Consumption?

Impaired immunity:

Individuals who have a history of severe allergic response to prednisone should avoid consumption at all costs. Likewise those who have:

• Active fungal infections (localized or systemic) are recommended to avoid steroid consumption (unless advised by your healthcare provider).
• Active infections (especially those that are associated with fever, like malaria or tuberculosis). Likewise if you have a recent or active history of herpes infection, you should consider other pharmacological options.

This is because steroid medications are capable of further deteriorating the immune functioning of the body, leading to an exaggerated infection.

Active disease or illness:

Other common situations in which prednisone intake should be avoided include:

• Active diarrheal illness
• Kidney disorder
• History of chronic liver disease like cirrhosis
• Serious cardiac illness (or uncontrolled blood pressure)
• Decreased potassium level in blood since prednisone intake further decreases the concentration of potassium in the body.

Endocrinological issues:

• Caution must be exercised if you have uncontrolled diabetes. This is primarily because most of the actions of prednisone are exerted by causing changes in the serum biochemistry (including changes in blood sugar levels). Diabetics who have difficulty in controlling their blood sugar levels with medications should avoid prednisone (unless the potential benefits override the possible complications).
• Individuals with thyroid problems should ideally avoid prednisone consumption.

Others:

• Those suffering from any mental illness or depressive state should ideally avoid prednisone because it is associated with changes in mood and behavior.
• Individuals with neuromuscular disorders like myasthenia gravis.
• Those with ulcerative colitis, history of upper gastrointestinal bleeding or stomach ulcers.
• Individuals who are over 55 years old, due to risk of osteoporosis.

Research data suggests that a dose of more than 8 mg/day for a period of more than 5 years can lead to significant osteoporosis, bone weakening, bone pains and higher risk of fractures. Some interesting trends were noted in the research published in the Journal of Bone and Mineral Research, according to which the risk of vertebral or spinal fractures is highest in prednisone users (who consume a dose of more than 7.5 mg/day).

Previous data and statistics for long-term prednisone users suggest that the risk and severity of side effects increase significantly in individuals who have a low serum albumin concentration. As a result of extensive research conducted by scientists, it has been observed that low serum concentration of albumin (less than 2.5 g/ 100 ml) doubles the chances of adverse reactions to prednisone. This conclusion was drawn from the data collected by serial investigations of 240 admitted patients who were on a prednisone regimen for a variety of indications^[1].

When to See a Doctor?

Contact your healthcare provider if you are experiencing:

• Moderate to severe eye pain, changes in vision quality, blurring or the appearance of haloes. It has been observed that the consumption of prednisone for a period of more than 5 years increases the risk of cataract. Ideally, it is recommended to see your ophthalmologist at least once every 6 months if you are taking prednisone long-term.
• Moderate to severe depression, feelings of extreme sadness or elation, or other significant changes in your behavior and personality also raise concern, suggesting the systemic effects of long-term prednisone intake. See your healthcare provider for dosage adjustment and symptom evaluation at your earliest convenience.
• If you are experiencing moderate weight gain
• Tarry or bloody stools suggest changes in blood cells or may be an opportunistic infection due to long-term immunosuppression by prednisone.
• Significant changes in blood pressure, buzzing in ears, confusion, anxiety and chest pain are some of the other danger signs that require either dosage adjustment or a detailed medical evaluation to check the symptoms.

It is recommended to avoid prednisone intake for long periods (unless therapy is absolutely necessary) and there is a consensus that the risks and side effects can be largely minimized if periodic medical assessment is sought.

References:

1. Lewis, G., Jusko, W., Burke, C., & Graves, L. (1971). Prednisone side-effects and serum-protein levels: a collaborative study. The Lancet, 298(7728), 778-781.
2. McDougall, R., Sibley, J., Haga, M., & Russell, A. (1994). Outcome in patients with rheumatoid arthritis receiving prednisone compared to matched controls. The Journal of rheumatology, 21(7), 1207-1213.
3. Van Staa, T. P., Leufkens, H. G. M., Abenhaim, L., Zhang, B., & Cooper, C. (2000). Use of oral corticosteroids and risk of fractures. Journal of Bone and Mineral Research, 15(6), 993-1000.