Prednisone is a medication that is often used to treat inflammatory bowel disease (IBD) (Crohn’s disease and ulcerative colitis), as well as a host of other diseases and conditions. It can be very effective in getting acute IBD symptoms under control, but the list of potential side effects that this drug can cause is extensive. The good news is that most prednisone side effects will go away as the dose is lowered and then the drug is stopped altogether. One of the goals of treating IBD is to use prednisone sparingly and to get patients off it as soon as possible. Knowing about the potential for side effects goes a long way towards minimizing them and coping with them when they do happen. If your doctor has prescribed prednisone, it's because the benefits of the drug outweigh the risks of the side effects. Below is a discussion of the potential prednisone side effects, when they occur, which are temporary, and which could be permanent. "Steroids" are a family of chemicals normally made within the body. They serve as hormones —chemical signals that help to regulate the body's growth and function. Some steroid hormones, like testosterone, stimulate formation of protein and growth of muscle. Competitive athletes have been known to take illicitly derivatives of these "body-building" steroids in large amounts to improve their athletic performance. A very different group of steroid hormones are the corticosteroids, steroid hormones made in the cortex (hence, "cortico-") of the adrenal glands, which sit adjacent to the kidneys. Corticosteroid hormones have many different affects on body function, including influences on how we use our energy stores (fat, protein, and sugar) and how we adjust the salt and water content of our body. Early in this century it was discovered that corticosteroid hormones, if purified and taken in large amounts as a medicine, have powerful anti-inflammatory effects. 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Ro Actemra, in combination with methotrexate (MTX), is indicated for • the treatment of severe, active and progressive rheumatoid arthritis (RA) in adults not previously treated with MTX. • the treatment of moderate to severe active RA in adult patients who have either responded inadequately to, or who were intolerant to, previous therapy with one or more disease-modifying anti-rheumatic drugs (DMARDs) or tumour necrosis factor (TNF) antagonists. In these patients, Ro Actemra can be given as monotherapy in case of intolerance to MTX or where continued treatment with MTX is inappropriate. Ro Actemra has been shown to reduce the rate of progression of joint damage as measured by X-ray and to improve physical function when given in combination with methotrexate. Ro Actemra is indicated for the treatment of Giant Cell Arteritis (GCA) in adult patients. Treatment should be initiated by healthcare professionals experienced in the diagnosis and treatment of RA and/or GCA. Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime Day 4: 5 mg PO before breakfast, after lunch, and at bedtime Day 5: 5 mg PO before breakfast and at bedtime Day 6: 5 mg PO before breakfast Immediate-release: ≤10 mg/day PO added to disease-modifying antirheumatic drugs (DMARDs) Delayed-release: 5 mg/day PO initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis Take with meal or snack High-dose glucocorticoids may cause insomnia; immediate-release formulation is typically administered in morning to coincide with circadian rhythm Delayed-release formulation takes about 4 hours to release active substances; thus, with this formulation, timing of dose should take into account delayed-release pharmacokinetics and disease or condition being treated (eg, may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis) Allergic: Anaphylaxis, angioedema Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture after recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper- or hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria Endocrine: Abnormal fat deposits, decreased carbohydrate tolerance, development of cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon facies, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in children Fluid and electrolyte disturbances: Fluid retention, potassium loss, hypertension, hypokalemic alkalosis, sodium retention Gastrointestinal: Abdominal distention, elevation of serum liver enzymes levels (usually reversible upon discontinuance), hepatomegaly, hiccups, malaise, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis General: Increased appetite and weight gain Metabolic: Negative nitrogen balance due to protein catabolism Musculoskeletal: Osteonecrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures Neurologic: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri; usually following discontinuance of treatment), insomnia, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, central serous chorioretinopathy Reproductive: Alteration in motility and number of spermatozoa Untreated serious infections Documented hypersensitivity Varicella Administration of live or attenuated live vaccine (Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term ( Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia Prolonged use associated with increased risk of infection; monitor Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders Long-term treatment associated with increased risk of osteoporosis, myopathy, delayed wound healing Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy Methylprednisolone is preferred in hepatic impairment because prednisone must be converted to prednisolone in liver Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts May cause impairment of mineralocorticoid secretion; administer mineralocorticoid concomitantly May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions Monitor for Kaposi sarcoma Pregnancy category: C (immediate release); D (delayed release) Drug may cause fetal harm and decreased birth weight; maternal corticosteroid use during first trimester increases incidence of cleft lip with or without cleft palate Lactation: Of maternal serum metabolites, 5-25% are found in breast milk; not recommended, or, if benefit outweighs risk, use lowest dose Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level; in physiologic doses, corticosteroids are administered to replace deficient endogenous hormones; in larger (pharmacologic) doses, they decrease inflammation The above information is provided for general informational and educational purposes only. 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