Prednisone and prednisolone are members of the drug family commonly known as steroids. They are not like anabolic steroids that we hear about in sports medicine. Steroids are produced naturally by the adrenal glands to prepare us for stress. This group of medications is rivaled only by antibiotics in lives saved and they are widely used.
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)
- Cancer chemotherapy
- Central nervous system disorders (disc, brain swelling, trauma, tumours)
- Other uses such as Addisons disease and shock.
However potential side effects from the glucocorticoid group are numerous.
Short term side effects:
- Increased hunger
- Increased thirst (and therefore commonly increased urination, and possibly urinary incontinence)
- Panting (dogs)
- General loss of energy
- Recrudescence of latent infection (hidden infection being unmasked)
- Pre-diabetic animals may be tipped into a diabetic state
- Sensitive individuals may experience stomach upsets
Steroids are commonly given at higher doses initially for control of the problem, and then tapered down to every other day or intermittent dosing. By using the medication every other day the body’s own adrenal glands remain active.
Should any of the above side effects become problematic, adjusting to a lower dose of medication often solves the problem. The goal with steroid use is to find the lowest dose of medication that is still effective.
Long term Side Effects
There are many conditions that may require long-term suppression of the immune system (longer than 4 months). In addition to the above side effects, chronic steroid use may result in any of the following:
- Latent urinary tract infections- monitoring for these is often required as a patient may not have the usual symptoms of urinary tract infection as steroids will suppress the inflammation associated with infection
- Development of thin skin, blackheads, poor ability to heal wounds or grow hair
- Obesity and muscle weakness
- Hard plaques of diseased skin called calcinosis cutis (calcium deposits in the skin)
- Predisposition to infection of any kind, weakening of immune defenses
- Development of cushings syndrome (excess steroid in body)
When long term therapy is required, monitoring tests become especially important. Timely recheck consultations, urine cultures and blood testing are part of responsible on-going steroid use.
- Steroids should not be used in combination with medications of the NSAID class (aspirin, rimadyl, metacam, trocoxil etc).
- Diabetic patients should also never take these medications unless advised by their veterinarian.
- Steroids can cause abortion in pregnant patients and thus should not be used in pregnancy unless otherwise advised.