Prednisone is prescribed for everything from very severe poison ivy to asthma to kidney disease and everything in between. Patients frequently panic when they read the long list of side effects and often seriously consider not taking the drug---often because of side effects directly related to the adrenal glands. While it may not be possible to avoid prednisone side effects altogether, these are easier to handle if you understand what is happening in your body.
Adrenal Glands
The adrenal glands make a class of compounds called corticosteroids. The chief corticosteroid is cortisol, also called hydrocortisone. In addition to being the body's chief anti-inflammatory agent, cortisol also affects the immune system, the circulatory system, the nervous system, metabolism and the stress response. Understanding cortisol is central to understanding the effects of prednisone on the adrenal glands because prednisone inhibits production of cortisol.
Corticosteroids
Prednisone acts as an adrenal corticosteroid. However, whereas the adrenals make roughly 5mg of cortisol per day. a dose of prednisone can be as high as 60mg or 80mg---or even higher if given intravenously. These high doses of prednisone trick the body into stopping production of natural corticosteroids.
Side Effects
The side effects of prednisone include developing moon face, weight gain, altered fat distribution, bone pain, high blood sugar, immune depression, muscle weakness, osteoporosis, diabetes and thinning of the skin, to name a few. Many of these side effects are directly related to prednisone's shutting down the adrenal glands.
Modulating Adrenal Suppression
Doctors often try to combat the side effects of adrenal suppression by indicating that the dose of prednisone be taken every other day. This kind of dosing allows downtime so that the adrenal glands can kick back in. Every other day dosing is more commonly ordered when the drug is to be given over several months or when the dose is high.
Tapering
Patients should never abruptly stop taking prednisone because they can go into withdrawal. This is not like withdrawal from narcotics or other recreational drugs. Rather, it reflects the inability of the adrenals to quickly start making cortisol. This state is called adrenal insufficiency. Gradually tapering down the dose is gentle on the body and allows the adrenals to "wake up" and start making cortisol again.
Some patients get side effects when they are tapering the dose. Often this takes the form of ravenous munchies, bone pain or the shakes. If this occurs, talk to your doctor because the tapering schedule can be adjusted to minimize these symptoms.
