Prednisone

Prednisone is a synthetic corticosteroid drug which is usually taken orally but can be delivered by intramuscular injection and can be used for a large number of different conditions. It has a mainly glucocorticoid effect. Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug and also a steroid.

Uses
Prednisone is particularly effective as an immunosuppressant and affects virtually all of the immune system. It can therefore be used in autoimmune diseases, inflammatory diseases (such as severe asthma, severe poison ivy dermatitis, ulcerative colitis, Rheumatoid Arthritis and Crohn's disease), various kidney diseases including nephrotic syndrome, and to prevent and treat rejection in organ transplantation. This medicine may also reduce the sex drive.

Prednisone tablets are furthermore used in the pharmaceutical industry for the calibration of dissolution testing equipment according to the USP (United States Pharmacopeia).

Usual initial dosage ranges from 20 - 80mg per day (also 1mg / kg in children up to 50mg).

History
Prednisone was invented in the early 1950s when Arthur Nobile at Schering demonstrated that the side effects of cortisone such as water retention, high blood pressure and muscle weakness could be removed by oxidisation of the drug through exposure to microbes. The drug was introduced by Schering in the mid-1960s.

Dependency
Adrenal suppression occurs if prednisone is taken for longer than 7 days, a condition which means the body is unable to synthesize natural corticosteroids and becomes dependent on the prednisone taken by the patient. For this reason, prednisone should not be stopped abruptly if taken for longer than seven days, but needs to be reduced slowly; this reduction may be over a few days if the course of prednisolone was short, but may take weeks or months if the patient has been on long-term treatment. Abrupt withdrawal may lead to an Addisonian crisis, which may be life-threatening. For those on chronic therapy, alternate-day dosing may preserve adrenal function, thereby reducing side effects (see "Dosing Considerations").

Side effects
Short-term side effects, as with all glucocorticoids, include high blood glucose levels, especially in patients who already have diabetes mellitus or are on other medications that increase blood glucose (such as tacrolimus), and mineralocorticoid effects such as fluid retention (although it's worth noting however that the mineralcorticoid effects of prednisone are very minor, this is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly). Additional short-term side effects include insomnia, euphoria and rarely mania. Long-term side effects include Cushing's syndrome, weight gain, osteoporosis, glaucoma, type II diabetes mellitus, and depression upon withdrawal.

Major

 * depression, mania, or other psychiatric symptoms
 * unusual fatigue or weakness
 * blurred vision
 * abdominal pain
 * peptic ulcer
 * infections
 * painful hips or shoulders
 * osteoporosis
 * acne breakouts
 * insomnia
 * reduced libido

Minor

 * weight gain
 * Stretch marks
 * facial swelling
 * nervousness
 * acne
 * rash
 * increased appetite
 * hyperactivity