Prednisone

Brand names are Deltasone, Kedral, Medrol, Orasone, Prelone, Sterapred DS

Approved by the FDA in 1955, prednisone is the synthetic form of a hormone made by the human adrenal gland, called a steroid. Absorbed through your intestines, prednisone is changed in the liver to its active form, called prednisolone. It quickly travels into the kidneys, skin, and muscle. Prednisone reduces inflammation and supresses the immune system. It comes as tablets or syrup, and also in a liquid form for injections and IV use. Prednisone's actions are complex, and include reducing white blood cell activity.

Prednisone Dose

This is highly individual. Your dose depends in part on how close a match your new heart is to your own body. Prednisone is usually started at very high dose and gradually reduced until you reach about 10mg twice a day. A usual maintenance dose is 5 to 10mg twice a day.
     Because long-term prednisone stops your adrenal gland from functioning properly, you must never just skip a dose or stop taking it on your own. Prednisone should be stopped after gradually reducing your dose over time. Because your adrenal glands are no longer working normally, you will need more of this drug when under stress, such as after the death of a loved one or during serious illness or injury. Your doctor will need to adjust your prednisone dose at these times.
     You will be closely monitored through blood testing to keep your blood levels in that narrow range between effectiveness and poison. Don't get too scared by this - remember that many of the drugs you took for heart failure had the potential to really mess you up but they didn't.
     After your transplant surgery, your blood will be tested at least every 2 to 3 days. After you go home, your blood levels of transplant drugs - including prednisone - will be measured at every clinic visit, which is usually twice a week for the first 2 months, once a week for 2 more months, and once a month for the rest of your first year after transplant.

Possible Side Effects

You will not get all, or even most, of these side effects, but they are possible. This is not a complete list.

a weakened immune system in general, leaving you open to infection
sensitivity to sunlight - avoid too much sun
"moon face" - a swollen, rounded facal shape
sodium retention, fluid retention, edema (swelling)
congestive heart failure, from "steroid myopathy"
potassium loss, alkalosis (increased alkalinity such as sodium, in the blood)
hypertension - high blood pressure
muscle weakness, loss of muscle mass
osteopenia - loss of bone density, osteoporosis - extreme loss of bone density
tendon rupture, especially of the Achilles tendon
spinal compression fractures
aseptic necrosis of femoral and humeral heads - severe knee and hip joint problem, possibly requiring replacement joints
chronic fractures of your long bones
peptic ulcer with possible perforation and hemorrhage
nausea, vomiting
anorexia, weight loss
increased appetite, weight gain
diarrhea or constipation
pancreatitis - inflamed pancreas
abdominal distention - swelling of the stomach
ulcerative esophagitis - inflammation of the esophagus (tube that leads to your stomach), with sores
slow wound healing
thin, fragile skin
petechiae - blood spots on the skin
ecchymoses - black and blue pools of blood under the skin from ruptured blood vessels
facial erythema - abnormal redness of the facial skin
hirsutism - abnormal hair growth
acne
urticaria - hives
heavy sweating
headache
convulsions
vertigo
neuritis - impaired or lost reflexes
paresthesias - sensation of numbness, tingling or burning
menstrual irregularities
Cushingoid state
failure of adrenal gland to produce enough hormones in times of stress
stunted growth in children
hypercholesterolemia - high cholesterol
low carbohydrate tolerance
adult onset diabetes
increased need for insulin in diabetics
hypoglycemia - low blood sugar
cataracts
increased pressures in the eye
glaucoma, with possible damage to the optic nerves
secondary eye infections due to fungi or viruses
exophthalmos - abnormal bulging out of the eyeballs
hallucinations
psychosis
euphoria, mood changes
accelerated atherosclerosis - coronary artery disease
heart arrhythmias due to potassium deficiency
syncope - fainting
necrotizing angiitis - serious inflammation of blood vesssels or lymph ducts
insomnia

Drug Interactions With Prednisone

This is not a complete list. Drug interactions are no joke to the heart transplant recipient. You must never take any drug or over the counter medicine without checking first with your transplant cardiologist. Period. Prednisone may cause your body to get rid of aspirin faster, so your aspirin dose may need to be raised. There are reports of enhanced, as well as diminished, effects of blood thinners when taking prednisone. Blood testing should be done often to maintain the desired anticoagulant effect.

acetazolamide
amphotericin B
anti-inflammatory drugs - NSAIDs, such as ibuprofen
barbiturates for sleep or to prevent seizures - phenobarbital, phenytoin and rifampin
blood thinners
cyclosporine - convulsions have been reported with combined use of methylprednisolone and cyclosporin
digoxin, Lanoxin
diuretics (water pills like Lasix and Demadex)
female hormones, including birth control pills
ketoconazole
some diabetes medicines
phenytoin
rifabutin
rifampin
troleandomycin

Children, Side Effects and Other Notes

Infections Steroids may cover up signs of infection, and make you prone to new infections. These infections may be mild, but can be severe and at times fatal. Chicken pox and measles, for example, can be fatal in non-immune children or adults on prednisone. If you have not had these diseases, great care should be taken to avoid exposure. If you are exposed to such an infection, see your doctor immediately!
Diet and bones Prednisone raises blood pressure, salt and water retention, and speeds up your body's loss of potassium. A very low sodium diet is a must, and potassium supplements may be necessary. Prednisone also increases your body's loss of calcium, which damages your bones. It is possible to offset some of this loss/damage through resistance training with weights after transplant.
Vaccines and latent disease Do not get vaccinated after a heart transplant. Live vaccines in any form are dangerous to you now. Other vaccines probably will not work anyway, so just avoid them all. If skin tests showed tuberculosis reaction, prednisone therapy may activate the disease. In such a case, you may need extra drugs to prevent tuberculosis. People with hypothyroidism or cirrhosis may react badly to prednisone. It should be used cautiously in patients with ocular (of the eye) herpes simplex because of possible corneal perforation.
Mothers and children Thorough studies of human reproduction on prednisone have not been done. Some animal studies have shown that when given to the mother at high doses, prednisone can cause birth defects. Steroids appear in breast milk and could stunt growth or cause other side effects, so mothers taking prednisone should not breast feed their babies. Prolonged prednisone therapy in infants and children should be avoided if at all possible since the drug may stunt growth.
Mood Psychic derangements can happen on prednisone. These may range from euphoria, insomnia, mood swings, personality changes and severe depression, to actual psychotic epsiodes. Existing emotional problems may be aggravated by prednisone.
Cancer and parasites Kaposi's sarcoma (cancer of the connective tissue) has been reported in patients taking steroids. Prednisone may activate latent amebiasis (intestinal parasites, as in certain tropical diseases).
Cushing's disease is a syndrome of adrenal gland overactivity which causes symptoms like obesity in the body's trunk but thinness in the arms, thinning of the skin with easy bruising, muscle wasting and weakness, high blood pressure, uncontrolled blood sugar, osteoporosis and more.
Injections Because prednisone injections can cause wasting at the site of injection, injections into muscle should be made deeply into the butt muscle. The same site should not be used for repeat injections. Avoid injection into the shoulder and upper arm.