Prednisone: Villain or Hero?
Last updated: February 2022
If you have experienced a COPD exacerbation at one point during your health journey, chances are, you are familiar with the drug prednisone. To some people, prednisone has earned a bad reputation given its side effects and classification as a corticosteroid. For others, the side effects are worth the relief the drug provides. The following article will outline the benefits and potential adverse effects of prednisone, and provide tips on how you can minimize these side effects.
What is prednisone?
Prednisone is a widely used drug for its anti-inflammatory properties. It is not solely used for the treatment of COPD: it can also be used for allergic reactions, myasthenia gravis, bell palsy, gout, and several other conditions. Its use in COPD is considered off-label, meaning that the original trials of the drug did not study it in people with COPD; rather, a benefit has been demonstrated in that population after the fact.1
How is it dosed?
For COPD exacerbations, most people are prescribed 40-60 mg of prednisone for a duration of 5-14 days. For shorter courses, prednisone is often not tapered down. Prednisone is available as a liquid formulation and also as 1, 5, and 50 mg tablets. You may notice that you have to take several tablets to make your target dose; for example, a 40 mg dose would require 8 of the 5 mg tablets to be taken at once.1
While the prednisone information leaflet comes with a significant number of side effects, it is worthwhile to note that most of the side effects are associated with long-term and high-dose steroid use. For most people with COPD on a short course of therapy, these side effects will most likely not be drastic and may not be experienced at all:1
- Heart: prednisone can increase blood pressure and fluid retention.
- Brain: some people may experience depression, anxiety, poor sleep, and agitation. Most cases of this happen within the first 5 days of use, and are more likely to happen in doses greater than 80 mg and in those with a history of psychiatric conditions.
- Physical: steroids are associated with the classic “cushingoid appearance”, in which people may retain fluid and fat in their face. This is more likely with long-term use.
- Stomach: some people may be at risk of stomach ulcers with prednisone use; people who use aspirin and/or drugs such as ibuprofen (Advil) are at a higher risk.
- Bone: people who take the medication for several months are at a higher risk of fractures. This is more likely in females who are over the age of 55 and are of low body weight.
Tips to reduce side effects
While many of these side effects cannot be prevented, some of them can be alleviated:1
- Take prednisone right after meals to reduce the risk of stomach upset. Your doctor may prescribe an antacid to reduce the risk of ulcers if you are at high risk of stomach bleeds.
- Ensure that you follow your taper schedule, if prescribed, which can help reduce some withdrawal side effects.
- Take your dose in the morning to avoid sleep disturbances.
Overall, prednisone can be an effective medication to treat COPD exacerbations.
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