Let’s talk a little more about Prednisone. I have a love/hate relationship with it. The fact is…it is a wonder drug.

The Specifics

Prednisone is a synthetic hormonal steroid. It’s produced naturally in the body under the name of Cortisone, which is produced in the adrenal gland and is closely related to Cortisol, also produced in the adrenal gland. Cortisone is mostly inactive in the body until it is converted to Cortisol (known synthetically as hydrocortisone.)

The function of natural Cortisone is to regulate actions in the metabolism of fats, carbohydrates, sodium, potassium, and proteins, as well as being an anti-inflammatory agent. It’s this last feature that has made Prednisone a drug of choice in the treatment not just for IBD, but also for afflictions such as rheumatoid arthritis, slipped or herniated discs, asthma and certain types of allergic reactions, such as bee stings.

Prednisone is the oral medication, Hydrocortisone is the I.V. version. Prednisone (and Hydrocortisone) do work. And probably best of all, it’s a cheap medication.

The problem with the drug is that, back in the day, 30 years ago, they didn’t fully understand the long-term side effects of the medication. For a good 20 years, I was repeatedly pumped either orally or intravenously with this drug.

Short-Term Side Effects

a ravenous increase in appetite

sudden mood swings and magnified emotions

hyperactivity

hot flashes

extreme and sudden weight gain

a rounding of the face (called “moon-face”)

hair loss, sometimes as much as half

swelling of the legs and body from fluid retention

a yeast infection called thrush, which leaves a thick, white coating on the tongue

anti-coagulant action (thinning of the blood) causing unexplained bruising of legs, arms and hips and increased clotting time when cut

masking infections such as urinary tract infections

Long-Term Side Effects

destroys connective tissue in the back and body

decreases bone mass in women

joint pain and deterioration

increased fat deposits around the abodomen

The most serious and dangerous side effect of Prednisone stems from it being a steroidal hormone, which is also produced internally in the body in the adrenal gland. After a patient has been on the oral doses, especially high doses, the body recognizes the increased influx of cortisone. In return, the body practically ceases it’s own production. This action can be dangerous to a user should he suddenly stop taking the oral medicine. When the body is un-expectantly deprived of the external hormone, and the production of the natural cortisone has shut down, the body goes into shock. The patient may end up in a coma. It is prudent that a user never stop taking this medication suddenly. He must be weaned down slowly, usually in 5-10 mg increments.

The good news is that doctors now recognize the long-term side effects and so are much better at keeping doses low and short. Also, because of these problems with long-term use, there have been new medications developed that work in the same way, but cut down on the side effects. These include Remicaid and Endocort.

I will cover these medicines along with other medications used to treat IBD in a future posts.