Prednisone is a synthetic corticosteroid widely used in medicine for over sixty years. In the United States alone, at least a million people are treated with prednisone each year for various diseases. The human body naturally produces steroids from the adrenal gland, and they are essential to cope with stressful situations such as illness or trauma. Steroids have a potent anti-inflammatory effect, which is why they are used to treat inflammatory conditions. Prednisone affects all stages of the immune system and is highly effective in inflammatory diseases of the intestines and liver. About 80%-90% of children with Crohn's disease, colitis, or autoimmune liver inflammation respond well and quickly to prednisone treatment. The medication is highly effective, but its side effects often deter doctors from using it for extended periods. Therefore, after 2-4 weeks of treatment, the doctor usually recommends gradually tapering the dose over two to three months. Sometimes, the doctor may suggest starting another medication to maintain inflammation control after stopping prednisone.
While on prednisone, the body becomes "lazy" in producing its own steroids from the adrenal gland. Therefore, discontinuing the medication should be done gradually and not abruptly. Sudden discontinuation may lead to a deficiency in steroids in the body and pose a life-threatening risk.
At an accepted dosage and for a limited time, significant side effects from prednisone are rare. With high doses or prolonged use (over two to three months), various side effects resulting from the medication's activity may occur. These side effects can be categorized into short-term and long-term.
Short-term side effects include the appearance of pimples or worsening of existing ones, hair growth, transient fluid retention that might lead to facial swelling, elevated blood sugar levels, increased blood pressure, changes in mood or behavior, increased appetite, susceptibility to infections, and occasionally abdominal pain due to irritation of the gut lining. These side effects usually disappear upon discontinuation of treatment.
If steroids are administered in high doses or for an extended period (several months), slower growth in children, osteoporosis (bone weakening), cataracts in the eyes, high blood pressure, high blood sugar, and hip joint problems might occur. To detect and address these complications early, your child should be closely monitored by a doctor. Prednisone should not be taken if hypersensitivity to the drug is known, or in the presence of a depleted fungal infection.
Consuming prednisone, especially in high doses, can affect your child's response to vaccinations. A child receiving high-dose steroid treatment should not be vaccinated with a weakened live vaccine (such as varicella, measles, mumps, or oral polio vaccine). If your child needs a vaccine, inform the pediatrician that your child is taking prednisone.
It's important to highlight two complications resulting from steroid treatment, especially when used for an extended period: suppression of the immune system and adrenal insufficiency. Generally, dealing with infections is not an issue, but some infections (such as chickenpox, rubella, or mumps) may be more severe in children who take large quantities of steroids or take them for a long time. If your child comes into contact with someone with the aforementioned diseases, you should contact a doctor immediately.
The second complication refers to the diminished activity of the adrenal gland, which stops producing steroids on its own due to the medication. Symptoms of this condition include nausea, fatigue, fever, joint and muscle pain, skin changes, low blood pressure, and fainting. This condition can be triggered by stress, illness, trauma, surgery, or abrupt discontinuation of prednisone. Changing the dose or discontinuing the medication should only be done with the approval of the treating doctor.
Prednisone should be taken after a meal to mitigate its negative impact on the stomach lining. It's advisable to take all tablets (or syrup) at once in the morning unless advised otherwise by the doctor. Some children report sleep disturbance if treatment is taken in the evening. Sometimes, adjusting the timing of medication administration to the evening may help alleviate this. Despite the many side effects of prednisone, when taken in a controlled manner and for a relatively short duration (up to three months), significant adverse effects are rare. Due to the high efficacy of the medication in severe inflammatory diseases, the benefit often outweighs the risk. Your doctor will explain the considerations in choosing this medication.