Prednisone

By The Myasthenia Gravis Association of Western PA

An Overview

Prednisone is a man-made steroid that resembles the natural corticosteroid produced by the adrenal glands.  It is used in the treatment of many different illnesses.  The brand most frequently dispensed is DeltasoneŽ.  The generic name is prednisone.

Prednisone works in myasthenia gravis (MG) by changing the normal action of the body's immune system.  This changed action limits the production of antibodies which may lead to improved muscle strength.  Prednisone also acts as an anti-inflammatory as it does in the treatment of other illnesses.

It is recommended that prednisone be taken:

Taking the medication all at one time in the morning most resembles the body's natural release of the corticosteroid from the adrenal glands.  If prednisone causes an upset stomach, take it with milk or food.

When prednisone is first prescribed for MG, it may cause increased muscle weakness.  Therefore, admission to the hospital before starting prednisone may be advised.

Side Effects

Side effects are usually dependent on the amount and length of time the medication is taken.

Side effects may include:

Close supervision by the neurologist is required while taking this medication.  Additional specialists may be needed to follow and to treat specific side effects.  Some side effects will decrease as the medicine is reduced and disappear when it is stopped.  Other side effects are permanent and need to be treated by a physician.

Dosage

Prednisone may be started at a low dose and increased or it may be started at a high dose.  Either way, muscle strength should eventually improve.  Once increased muscle strength is achieved and maintained, a tapering or reduction of the medication under the physician's supervision may start.  To maintain strength, reduction should be done on a very slow schedule - usually over one year or more.  Reduction is continued until muscle strength is maintained at the lowest possible dose.  This dose is known as the maintenance dose.

Shortly after prednisone has been started, the physician man change the daily dose to an every other day schedule.  When going to an every other day schedule, the dosage may also be changed.  Every other day therapy may lessen side effects.

In alternate or every other day therapy, there is an 'on' day and an 'off' day.  Prednisone is taken on the 'on' day and not taken on the 'off' day.  It may be helpful to decide at the beginning of the month to take the medicine on the even days or the odd days of that particular month.  Marking these days on a calendar will help to prevent missed doses.

If a dose is missed in the morning, take it later in the day.  When on a daily dose schedule and the previous days' dose is missed, skip the dose.  The dose should never be doubled.  If on every other day therapy and yesterdays' 'on' day dose is missed, take the dose immediately.  That day then becomes the 'on' day and the following day becomes an 'off' day.  Remember to change the 'on/off' markings on the calendar.

Prednisone treatment may change from an 'on/off' day schedule to a 'high' day/'low' day schedule.  In this situation, a larger dose of prednisone is taken on the 'high' day and a lesser amount is ordered for the 'low' day.

Conclusion

The choice to start prednisone is a long-term commitment.  This medication cannot be stopped suddenly.  A sudden stop could lead to adrenal failure and death.  All changes in prednisone dose or schedule must be made by the physician.

Tips / Things to Remember

When taking prednisone:

  1. Notify all physicians, dentists, nurses, and pharmacists that you are taking prednisone.

  2. Check with the neurologist or pharmacist before taking any over the counter medication.

  3. Check with the neurologist before taking aspirin or products containing aspirin.  Aspirin may irritate the stomach and intestines and even cause bleeding.

  4. Talk with the physician about taking calcium, Vitamin D or prescription medications, to help prevent or to treat osteoporosis.

  5. Check with the neurologist before taking any vaccinations.

  6. Talk with the neurologist before becoming pregnant.

  7. Know the dosage of the tablets so proper dosage is taken especially during tapering periods.

  8. Notify the neurologist of any illnesses during the tapering periods.

  9. Notify the neurologist if decreased muscle strength occurs during the tapering period.

  10. There may be less muscle strength on 'off' days.

  11. Follow a low sodium/salt diet.

  12. Blood tests such as fasting blood sugars or potassium levels may be ordered.

  13. The immune system is weakened.  It is easier to catch colds, flu and all types of infections.

  14. Avoid changing a stool-soiled diaper of an infant who has received the oral polio vaccine for six to eight weeks following the child's vaccination.

  15. Wear a Medic Alert bracelet or necklace.

  16. Carry a list of all medications and dosages at all times.

  17. On vacation, carry a prescription in case your medicine is lost or stolen.

  18. If on vacation outside the United States, carry a sufficient quantity of medicine in two separate areas in case one is stolen or lost.  It may be impossible to have a prescription filled.

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This is an excerpt from a publication that was written by the Myasthenia Gravis Association of Western Pennsylvania.  For more information on this topic or for a free copy of the entire publication, please contact the MGA of WPA office at (412) 566-1545 or via email at mgaoffice@mgawpa.org.  Please do not copy or reproduce this article without the written permission is of MGA of WPA.

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