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In a prospective study, the cumulative incidence of CIL with high-dose prednisone therapy was found to be 61% after 3 months, 65% after 6 months, 68% after 9 months, and 69% after 12 months. [1] One study found that even a very low dosage of prednisone of 5 mg/day was associated with symptoms of "Cushing's syndrome". [1]
Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. [4] [5] [6] It is either used at low doses for chronic illnesses or used concomitantly at high doses during acute flares.
Common side effects may include cataracts, bone loss, easy bruising, muscle weakness, and thrush. [3] Other side effects include weight gain, swelling, high blood sugar, increased risk of infection, and psychosis. [4] [3] It is generally considered safe in pregnancy and low doses appear to be safe while the user is breastfeeding. [5]
In general, use a potent preparation short term and weaker preparation for maintenance between flare-ups. While there is no proven best benefit-to-risk ratio, [11] if prolonged use of a topical steroid on a skin surface is required, a pulse therapy should be undertaken.
[7] [8] [6] It differs from the similarly named prednisone in having a hydroxyl at the 11th carbon instead of a ketone. Common side effects with short-term use include nausea, difficulty concentrating, insomnia, increased appetite, and fatigue. [5] More severe side effects include psychiatric problems, which may occur in about 5% of people. [9]
Then change to oral hydrocortisone or cortisone as a single morning dose, and gradually decrease by 2.5 mg each week. When the morning dose is less than replacement, the return of normal basal adrenal function may be documented by checking 0800 cortisol levels prior to the morning dose; stop drugs when 0800 cortisol is 10 μg/dl.
In pharmacologic (supraphysiologic) doses, glucocorticoids, such as prednisone, dexamethasone, and hydrocortisone are used to suppress various allergic, inflammatory, and autoimmune disorders. They are also administered as posttransplantory immunosuppressants to prevent the acute transplant rejection and graft-versus-host disease .
Large dosage variations in the patient's medication (including a self-increased dosage from 10 mg/day to as much as 100 mg/day for at least 3 months) produced extreme behavioral changes, from missed appointments to physical altercations, and eventually admission to a psychiatric ward and later to a locked Alzheimer facility.
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