What are the risks and considerations for taking prednisone (corticosteroid) 100 mg daily for 5 days?

From the Guidelines

Taking prednisone 100 mg daily for 5 days is a high-dose, short-term corticosteroid regimen that carries several important risks and considerations, and should only be taken under medical supervision. This dose is typically used for acute inflammatory conditions. Short-term side effects may include increased appetite, mood changes (including irritability, anxiety, or euphoria), insomnia, fluid retention, elevated blood pressure, and increased blood sugar levels 1. People with diabetes should monitor their glucose closely as prednisone can significantly worsen glycemic control. The medication can mask signs of infection and reduce immune function, increasing susceptibility to new infections. Gastrointestinal issues like indigestion or stomach irritation may occur, so taking the medication with food is advisable.

While this 5-day course is unlikely to cause long-term complications like bone loss or adrenal suppression that are associated with prolonged use, patients with certain conditions including hypertension, diabetes, glaucoma, peptic ulcer disease, or psychiatric disorders should be particularly cautious. It's essential to consider the adverse effects of glucocorticoid therapy and discuss them with the patient before initiating treatment 1. The risk of osteoporosis, cardiovascular disease, diabetes, weight gain, renal dysfunction, peptic ulcer disease, and hypertension should be evaluated and managed accordingly 1.

Some key points to consider:

• The adverse effects of glucocorticoid therapy should be considered and discussed with the patient before glucocorticoid therapy is started 1.
• Patients treated with glucocorticoids and concomitant non-steroidal anti-inflammatory drugs should be given appropriate gastro-protective medication 1.
• All patients on glucocorticoid therapy for longer than 1 month, who will undergo surgery, need perioperative management with adequate glucocorticoid replacement to overcome potential adrenal insufficiency 1.
• The use of low-dose GCs is based not solely on disease symptoms, but also on joint sparing effects on the long-term, as GCs can be categorised as disease-modifying antirheumatic drugs (DMARDs) 1.

It is crucial to weigh the benefits and risks of prednisone therapy and to closely monitor patients for potential side effects, especially those with pre-existing conditions. The medication should be taken as directed, and patients should not stop it abruptly without consulting their healthcare provider. By understanding the potential risks and taking steps to mitigate them, patients can safely use prednisone to manage their condition and improve their quality of life.

From the FDA Drug Label

WARNINGS ... Cardio-Renal Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. ... Immunosuppression and Increased Risk of Infection Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection ... The rate of infectious complications increases with increasing corticosteroid dosages.

The risks and considerations for taking prednisone 100 mg daily for 5 days include:

• Increased risk of infection: Prednisone suppresses the immune system, increasing the risk of new or existing infections, including viral, bacterial, fungal, protozoan, or helminthic pathogens.
• Cardio-renal effects: High doses of prednisone may cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.
• Reactivation of latent infections: Prednisone may reactivate latent infections, such as tuberculosis, hepatitis B, or varicella. It is essential to monitor for signs of infection and adjust the dosage or withdraw prednisone as needed 2.

From the Research

Risks and Considerations

The use of prednisone 100 mg daily for 5 days may have several risks and considerations, including:

• Insulin resistance and impaired glucose tolerance, as shown in a study where daily administration of 10 or 25 mg prednisone for one week impaired insulin sensitivity in healthy males 3
• Side effects such as insomnia, mood changes, and increased appetite, which were commonly reported by MS patients taking 1,250 mg of oral prednisone daily for acute relapses 4
• Potential for non-compliance due to the high number of tablets required, although a study found that MS patients had a high compliance rate with oral prednisone therapy 4

Standard Dosage

A study reviewed the medical literature and assessed the awareness of practicing hematologists and oncologists in the U.S. regarding the different dose schedules of prednisone in the published CHOP programs, and found that a prednisone dose of 100 mg/day for five days should be considered the standard dose 5

Comparison to Other Studies

The dosage of 100 mg daily for 5 days is lower than the 1,250 mg daily dosage used in the study of MS patients, but higher than the 10 or 25 mg daily dosages used in the study of healthy males 4, 3

• The study of MS patients found that high-dose oral prednisone is an acceptable therapy with a high rate of compliance, but also reported side effects such as insomnia and mood changes 4
• The study of healthy males found that daily administration of 10 or 25 mg prednisone for one week impaired insulin sensitivity in a dose-dependent manner 3