Why is prednisone prescribed?

Classified as a corticosteroid or a steroid hormone, prednisone is similar to the steroid hormone your body produces naturally. Prednisone might be given along with other immunosuppressive medicines to prevent and treat rejection.

The body’s immune system protects you from infection. Immune cells recognize the transplanted lung as different from the rest of the body and attempt to destroy it. This is called rejection and is your body’s way of not accepting the new organ.

How and when should prednisone be used?

Prednisone is available in many genetic brands and in several dosages. Generally, you will be prescribed the 5 mg tablets, which can be easily broken in half if necessary.

Your prescription label tells you how much to take at each dose and how often to take the medicine. Follow these instructions carefully, and ask your pharmacist or doctor to explain anything you do not understand.

Once prednisone is prescribed, your doctor will gradually decrease the prednisone dosage over a period of time (generally six months) until the permanent dosage is achieved. This type of program is called a taper schedule. Taper schedules are individualized to meet each person’s special needs. Never change the dose of your prednisone without the advice of your doctor.

It is important that you take this medicine regularly as prescribed. Do not stop taking it. You will need to take immunosuppressant drugs every day for the rest of your life to prevent rejection.

Your healthcare provider might reduce or even stop prednisone when you are being treated for certain infections. This allows your body to effectively fight the infection.

What special instructions should I follow while prednisone?

• You must take all of the prescribed amount of prednisone to maintain enough immunosuppression to prevent rejection. Follow your dosage schedule carefully.
• Be sure you always have enough medicine on hand. Check your supply before holidays or other occasions when you might be unable to fill your prescription.
• Keep all appointments with your doctor and the laboratory so your response to the drug can be monitored.
• Do not have any immunizations or vaccinations without your doctor’s approval.
• Do not drink alcohol while taking this medicine. Alcohol can interfere with the effectiveness of prednisone and cause serious side effects.
• Do not take any new medicines (prescriptions or non-prescription) without first telling the Transplant Team. Several drugs might interfere with the effectiveness of prednisone.
• Try to avoid infection while taking this medicine.

What should I do if I forget to take a dose of prednisone?

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and then return to your regular dosage schedule. Do not take a double dose.

What storage conditions are necessary for this drug?

• Store this medicine at room temperature. DO NOT store this medicine in direct heat or light.
• DO NOT store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture might cause it to break down.
• Keep this medicine in the container it came in, tightly sealed.
• Do not use this medicine after the expiration date on the bottle.
• Keep this and other medicines out of the reach of children.

What are the side effects of prednisone?

Even though the side effects of prednisone could be very serious, remember that this drug is necessary to prevent rejection. Precautions will be taken to detect these side effects and treat them before they become harmful.

Please see the guidelines below to reduce side effects while taking prednisone.

Prednisone might cause dose-related side effects, which will subside as your dosage is reduced. If any of the following symptoms occur, report them to your healthcare provider.

• High blood pressure
• Increased appetite, which might result in weight gain. Prednisone alters brain chemicals, which can increase hunger and fluid retention.
• “Steroid-induced diabetes.” This might result from high doses of prednisone. This condition might or might not require treatment. If you currently have diabetes, you might have to adjust your medicine dosage to manage your blood sugar.
• Vision changes, cataracts, or glaucoma.
• Skin changes including acne, easy bruising, thinning of the skin, stretch marks and increased sensitivity to the sun.
• Excess hair growth on the face, back, arms, and legs.
• Increased swelling of the face, hands, or ankles.
• Mouth sores.
• Stomach irritation or ulcers.
• Mood swings and depression.
• Joint pain and muscle weakness.
• Increased risk of infection.
• Increased risk of developing osteoporosis.

Please see the guidelines below for information on what you can do to help treat these symptoms.

What can I do to reduce the side effects of steroid medications?

To reduce troublesome side effects, your dosage might be decreased as soon as it is safe. In the meantime, there are some daily practices that can help you prevent or decrease the side effects of prednisone. Eat well-balanced meals to avoid excess weight gain and to lower your risk of high blood pressure, diabetes, ulcers, and bone and muscle problems, such as osteoporosis. In addition, decrease your salt intake.

In addition, there are other ways you can prevent or decrease the side effects of prednisone:

• Possible Side Effects: High blood pressure
  • What You Should Do: This can be caused by increased fluid retention. Take your medicine as prescribed, and reduce the amount of salt and fluid in your diet. Also, measure your blood pressure and record it every day. Ask your healthcare provider what your blood pressure range should be.
• Possible Side Effects: Increased appetite, excess weight gain
  • What You Should Do: Eat well-balanced, nutritious meals, and visit a dietitian regularly to discuss ways you can maintain a healthy lifestyle.
• Possible Side Effects: Steroid-induced diabetes
  • What You Should Do: If you formerly managed your pre-existing diabetes without medicine, you might now need to take insulin or pills to manage diabetes.
• Possible Side Effects: Vision changes, cataracts, glaucoma
  • What You Should Do: Visit an ophthalmologist yearly.
• Possible Side Effects: Acne
  • What You Should Do: Practice good hygiene. Wash your face with antibacterial soap to manage acne and reduce the risk of infection. Avoid soaps with lanolin or cold cream, which tend to clog pores. Acne might be managed with medicines such as benzoyl peroxide (Clearisil®). Acne subsides when your dosage is lowered.
• Possible Side Effects: Excess hair growth
  • What You Should Do: To remove unwanted hair, use safe bleaching techniques or creams.
• Possible Side Effects: Easy bruising
  • What You Should Do: Avoid accidental bumps and cuts by taking extra safety precautions before beginning any task.
• Possible Side Effects: Increased sensitivity to the sun
  • What You Should Do: Avoid the sun whenever possible. When outdoors, wear a sunblock with an SPF of at least 15. Report any skin changes to your doctor.
• Possible Side Effects: Increased swelling of the face, hands, or ankles
  • What You Should Do: Swelling is caused by fluid retention. Watch weight gain. Swelling will subside in three to four months if weight is maintained.
• Possible Side Effects: Mouth sores
  • What You Should Do: Practice good oral hygiene to prevent mouth sores and oral infections. Report any sores to your healthcare provider. Visit your dentist every six months, and tell your transplant doctor before any dental procedures.
• Possible Side Effects: Stomach irritation, ulcers
  • What You Should Do: Take your medicine after meals (with a full stomach) and use antacids (as directed) between meals. Report any stomach problems to your healthcare provider.
• Possible Side Effects: Mood swings
  • What You Should Do: Try relaxation techniques.
• Possible Side Effects: Increased risk of infection
  • What You Should Do: Avoid anyone who might have an infection, and report any signs or symptoms of infection to your doctor or nurse.
• Possible Side Effects: Joint pain, increased risk of osteoporosis
  • What You Should Do: Avoid gaining excess weight and include low-impact exercises in your daily schedule to avoid a possible need for joint replacement.

When should I call my healthcare provider if I am prescribed prednisone?

Call your healthcare provider right away if you have any of these warning signs of infection:

• Fever over 100°F (38°C)
• Sweats or chills
• Skin rash
• Pain, tenderness, redness, or swelling
• Wound or cut that won’t heal
• Red, warm, or draining sore
• Sore throat, scratchy throat, or pain when swallowing
• Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones
• Persistent dry or moist cough that lasts longer than two days
• White patches in your mouth or on your tongue
• Nausea, vomiting, or diarrhea
• Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy"
• Trouble urinating: pain or burning, constant urge, or frequent urination
• Bloody, cloudy, or foul-smelling urine or black, tarry stools

Also contact your healthcare provider if you have any other symptoms that cause concern of if you have any questions.