(This guide is for specific clients, to help guide them on how to safely navigate the benefits and perils of prescription steroids)
Introduction
Steroids are an over-prescribed class of drug. While they are a life-saver in many circumstances, they are also the facilitator of what I call "lazy medicine". If the doctor or specialist is unsure of the root cause of an illness, which is usually the case, and time is short, then, rather than do more investigation to identify the root causes of the patient's woes, a handful of drugs are reached for. These lazy remedies only cover up the patient's symptoms. This means there is no cure and, worse, they weaken the patient even more while the disease keeps getting worse. Ultimately, with disastrous consequences. These include immune-suppressing drugs such as Methotrexate, but the most common family of drugs are steroids, of which Prednisone is the most used. If these do not work, and I use the word "work" liberally, then additional drugs such as Amitriptyline, and various other anti-anxiety and pain-killer medications are added. The patient progressively becomes a victim of polypharmacy.
Polypharmacy refers to the use of multiple medications by a patient. This practise is common among older adults and individuals with multiple chronic conditions. While polypharmacy can be necessary for managing complex health issues, it increases the risk of adverse drug interactions, side effects. Read what I have written about polypharmacy here: https://www.garymoller.com/post/are-you-trapped-by-polypharmacy
Additionally, steroids are addictive if abused, as they often are in medicine. If they are used for longer than a few weeks without and extended break, then addiction is a possibility. I see this often. These words of caution include inhaled steroids for conditions like asthma, which are driving an echelon of chronic diseases, many of which are outlined in this guide for patients.
What also alarms me is the lackadaisical attitude of medical experts to the long-term use of steroids. While they recognise that steroids are addictive, few have anything other than a rudimentary knowledge of how to get an addicted patient off steroids, other than to titrate the dose downwards over a few weeks and to "see how it goes"! This is not good enough. Steroids reduce adrenal and other glandular functions, including the thyroid, and they are toxic on the liver. These organs need careful and progressive support as the dose of exogenous steroids is reduced, so that the patient can produce what is being reduced — to take up the slack. Without help from nutritional support and other ways, this is risky and often fails. The patient has terrible symptoms of withdrawal, including the original reasons for the steroids coming back strongly — on steroids, you could say — that they are put back on steroids and probably other medications, like Methotrexate. Methotrexate has its own problems, by the way, including liver toxicity, but that is a topic on its own for another time. In this guide, I refer to Prednisone because it is the most widely prescribed steroid, although we must not overlook the steroids in asthma medication. We will deal with these in another article.
Note: While I have used AI to help produce the following information and guidance, it is heavily influenced and edited to include my knowledge, experience, and opinion. Bear that in mind.
Prednisone - The Money-Maker!
Prednisone is a widely used corticosteroid prescribed to treat a variety of conditions, including autoimmune diseases, inflammatory disorders, and certain types of cancer. Its extensive use contributes to its status as a significant revenue generator in the healthcare sector for both pharmaceutical companies and medical practitioners. Medicine is no longer the profession and art that it used to be, led by the independent general practitioner. It now is Big Medicine and Big Pharma, where the doctor is just a salesperson for high-value products that may or may not be good for the patient. In this model, where profit is everything, the best patient is one that is always ill from the womb to the coffin. Here is how Prednisone fits into this unfortunate for-profit model that dominates medicine, and beautifully so:
For Pharmaceutical Companies:
High-Volume Sales:
Widespread Use: Prednisone is prescribed frequently across diverse medical conditions, leading to high sales volumes. Even though it is available as a generic drug, the sheer number of prescriptions ensures steady revenue.
Low Production Costs:
Generic Manufacturing: As a generic medication, Prednisone is inexpensive to produce. This allows pharmaceutical companies to maintain profitability through economies of scale despite lower per-unit prices compared to branded drugs.
Market Penetration:
Essential Medication: Being a staple in many treatment protocols ensures that Prednisone remains consistently in demand, reducing the volatility often seen with newer or specialised medications.
For Healthcare Providers:
Ongoing Patient Management:
Chronic Conditions: Many conditions treated with Prednisone, such as rheumatoid arthritis or lupus, require long-term management. This necessitates regular follow-ups, ongoing consultations, and periodic adjustments to treatment plans, which can contribute to a healthcare provider's revenue stream.
Comprehensive Care:
Monitoring and Side Effects Management: Prednisone use often requires monitoring for side effects and managing associated health issues. This comprehensive care approach ensures continued patient engagement and visits to the healthcare provider.
Bundled Services:
Additional Treatments: Patients on Prednisone may also require additional medications or therapies to manage side effects like osteoporosis or hypertension, leading to further opportunities for healthcare providers to offer and bill for ancillary services.
Economic Impact:
Insurance Reimbursements: Both generic drugs and the associated medical services are typically covered by insurance plans, ensuring that pharmaceutical companies and healthcare providers receive reimbursements that contribute to their financial health.
Bulk Purchasing and Contracts: Pharmaceutical companies often engage in bulk sales and long-term contracts with healthcare institutions, stabilising their revenue streams from essential medications like Prednisone.
Conclusion:
While Prednisone itself is a generic and relatively inexpensive medication, its pervasive use across a multitude of medical conditions ensures that it remains a substantial revenue source within the pharmaceutical industry. For healthcare providers, the need for ongoing patient management and comprehensive care related to Prednisone therapy contributes to their practises financial stability.
Prednisone Also Known As
Brand Names: Decortisyl, Deltacortisone, Deltasone, Metacortandracin, Panafcort, Retrocortine, Sone
What Is Prednisone?
Prednisone is a synthetic corticosteroid medication that mimics the effects of cortisol, a hormone naturally produced by the adrenal glands. It is approximately four times as potent as cortisol in its glucocorticoid effects. Prednisone is widely used for its anti-inflammatory and immunosuppressive properties.
Common Conditions Treated with Prednisone
Prednisone is prescribed for a variety of conditions due to its ability to reduce inflammation and suppress the immune system.
Immune System and Inflammatory Conditions
Autoimmune Diseases:
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Polymyalgia Rheumatica
Vasculitis
Myasthenia Gravis
Temporal Arteritis
Allergic Reactions:
Severe Allergies
Anaphylaxis
Asthma
Allergic Rhinitis
Dermatological Conditions:
Eczema
Psoriasis
Contact Dermatitis
Respiratory Diseases:
Chronic Obstructive Pulmonary Disease (COPD)
Sarcoidosis
Gastrointestinal Disorders:
Inflammatory Bowel Disease (IBD)
Neurological Conditions:
Multiple Sclerosis
Bell's Palsy
Cancer Treatment
Haematological Malignancies:
Leukaemia
Lymphoma
Multiple Myeloma
Organ Transplants
Prevention of Rejection: Suppresses immune response to prevent organ rejection.
Endocrine Disorders
Adrenal Insufficiency (Addison's Disease)
Kidney Diseases
Nephrotic Syndrome
Eye Diseases
Uveitis
Optic Neuritis
Other Conditions
Blood Disorders:
Immune Thrombocytopenic Purpura (ITP)
Autoimmune Hemolytic Anaemia
Musculoskeletal Disorders:
Gout
Bursitis and Tendonitis
Severe Infections:
Pneumocystis Pneumonia
How It Works
Prednisone reduces inflammation and suppresses the immune system by:
Inhibiting the production of inflammatory chemicals (cytokines).
Decreasing the activity and proliferation of immune cells that cause inflammation.
Stabilising lysosomal membranes to prevent the release of inflammatory enzymes.
Dosage and Administration
Forms: Tablets, liquid solutions, injectable forms.
Dosage: Varies widely based on the condition, from low doses (5 mg/day) to high doses (60 mg/day or more).
Administration:
Take with food to reduce stomach irritation.
Often given in the morning to mimic natural cortisol rhythm.
Tapering Off: Do not abruptly stop— dosages should be gradually reduced under medical supervision.
Equivalence Between Prednisone and Natural Cortisol
Conversion: Prednisone is converted in the liver to prednisolone, mimicking cortisol's effects.
Potency Comparison: Prednisone is approximately four times more potent than cortisol.
Dosage Equivalence:
5 mg of Prednisone ≈ 20 mg of Cortisol
Natural Cortisol Production: Healthy adults produce about 5 to 10 mg of cortisol daily, increasing during stress.
Importance of Gradual Tapering
Why Taper Gradually? Long-term prednisone use suppresses the hypothalamic-pituitary-adrenal (HPA) axis, reducing natural cortisol production. Abruptly stopping can lead to adrenal insufficiency.
Risk of Dependency: The body can become dependent on external steroids.
Goal of Tapering:
Gradually reduce prednisone to allow adrenal glands to resume normal cortisol production.
Continue until the dose is below natural cortisol production levels, eventually reaching zero.
Alternative Approaches to Tapering
Switching to Natural Cortisol (Hydrocortisone):
Benefits:
Less potent, allowing finer dosage adjustments.
Naturally recognised by the body, easing hormonal adjustment.
Availability:
Can be prescribed by doctors.
In regions like New Zealand, obtainable through compounding pharmacies such as Compound Labs in Auckland.
Patient Advocacy:
Discuss with your healthcare provider if interested.
Guidelines for Safely Weaning Off Prednisone
Consult Your Healthcare Provider: Personalised tapering schedules are essential.
Slow Reduction: Decrease the dose gradually over weeks or months.
Monitor Symptoms: Watch for signs of adrenal insufficiency.
Regular Testing: Blood tests may be performed to assess adrenal function.
Monitor Your Health and Vitality:
Establish a Baseline: Track sleep, pulse, blood pressure, and well-being before tapering.
Wearable Devices: Smartwatches can help monitor health indicators.
Goal During Tapering: Reduce medication while maintaining health within acceptable margins.
Lifestyle Support:
Balanced Diet
Stress Management
Adequate Sleep
Nutritional Support:
Adrenal Support:
As tapering continues, adrenal support is often increased to help the adrenal glands recover.
Duration: It is important to maintain adrenal support for at least three months after the last dose of external steroids.
Tapering Support: Do not abruptly stop adrenal support— it may be gradually reduced but is often best retained at a maintenance level.
Long-term Consideration: Given the stressful times many people experience, ongoing adrenal support may be beneficial.
Common Nutrients:
Vitamin C
B Vitamins (especially B5 and B6)
Magnesium
Herbal Supplements:
Adaptogens like ashwagandha or rhodiola (under medical supervision).
Considerations Regarding Prednisone Use
Effective but Requires Careful Use: Should be used judiciously.
Potential Overuse:
Concerns about prednisone being prescribed too frequently.
Over-reliance may impact long-term health.
Risk of Dependency and Withdrawal:
Habit-forming if used longer than several days.
Abrupt cessation can lead to withdrawal symptoms.
Importance of Medical Supervision:
Explore alternative treatments.
Use the lowest effective dose for the shortest duration.
Potential Side Effects
Short-Term Use
Increased appetite
Mood swings
Elevated blood sugar
Fluid retention
High blood pressure
Nausea
Insomnia
Long-Term Use
Metabolic Effects: Weight gain, diabetes
Musculoskeletal Effects: Osteoporosis, muscle weakness
Immune System Effects: Increased infection risk
Eye Effects: Cataracts, glaucoma
Skin Effects: Thinning skin, bruising
Cardiovascular Effects: Hypertension
Gastrointestinal Effects: Ulcers, bleeding
Endocrine Effects: Adrenal suppression
Neuropsychiatric Effects: Depression, anxiety
Interactions with Vitamins and Minerals
Potential Depletions:
Potassium
Calcium and Vitamin D
Folic Acid (Vitamin B9)
Vitamin B6
Vitamin B12
Impact on Other Substances:
Blood Sugar Levels
Electrolyte Balance
Substances That May Affect Prednisone's Impact
Amino Acids:
Arginine and Glutamine (consult your doctor)
Hormones:
DHEA (medical supervision required)
Precautions
Medical History: Inform your doctor about existing conditions.
Vaccinations: Avoid live vaccines.
Pregnancy and Breastfeeding: Consult your doctor.
Drug Interactions: Be aware of interactions with NSAIDs, blood thinners, etc.
When to Contact a Doctor
Signs of infection
Severe mood changes
Vision problems
Shortness of breath
Unusual weight gain
Muscle weakness
High blood pressure symptoms
Gastrointestinal bleeding
Bioavailability
Conversion in the Liver: Prednisone is inactive until converted to prednisolone.
Liver Function: Impaired liver function may affect this conversion.
Pharmaceutical Availability
Panafcort (prescription required):
1 mg tablets
5 mg tablets
25 mg tablets
Other Forms: Oral solutions, injectables
Storage
Store at room temperature, away from moisture and heat.
Keep out of reach of children and pets.
Summary
Prednisone Potency: 5 mg of prednisone ≈ 20 mg of cortisol.
Natural Cortisol Levels: 5–10 mg daily in healthy adults.
Tapering Goal: Gradually reduce prednisone to allow adrenal recovery.
Alternative Tapering Approach: Switching to hydrocortisone (discuss with your doctor).
Monitoring Health: Use wearable devices— maintain health indicators.
Nutritional Support:
Increase adrenal support during tapering.
Maintain support for at least three months after stopping steroids.
Do not abruptly stop adrenal support— consider gradual tapering or maintaining a baseline level, indefinitely.
Medical Supervision: Essential throughout the process.
Disclaimer
This guide is intended for informational purposes and should not be construed as professional medical advice. Always consult your healthcare provider for guidance tailored to your health situation.
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