From the Guidelines
If you have fatty liver disease, you should exercise extreme caution when considering prednisone, as it may exacerbate your condition, and consult with your healthcare provider to weigh the benefits against the potential risks to your liver health. Corticosteroids like prednisone can potentially worsen fatty liver disease in some patients, as they may increase fat accumulation in the liver and potentially contribute to insulin resistance, as noted in the 2020 practice guidance from the American Association for the Study of Liver Diseases 1. However, if prednisone is medically necessary for treating another condition, your doctor may still prescribe it while monitoring your liver function closely. The decision depends on weighing the benefits of the medication against the potential risks to your liver health. Short-term use may be less problematic than long-term therapy.
If prednisone is prescribed, your doctor might recommend regular liver function tests to monitor any changes in your condition. They may also suggest lifestyle modifications such as maintaining a healthy weight, limiting alcohol consumption, eating a balanced diet, and regular exercise to help manage your fatty liver disease while on prednisone therapy. According to the 2021 AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease, weight loss of 5% of total body weight can decrease hepatic steatosis, weight loss of 7% of total body weight can lead to nonalcoholic steatohepatitis resolution, and weight loss of 10% of total body weight can result in fibrosis regression or stability 1.
Some key lifestyle modifications include:
- Following the Mediterranean diet
- Minimizing saturated fatty acid intake
- Limiting or eliminating consumption of commercially produced fructose
- Engaging in regular physical activity, with a target of 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week
- Managing coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease. It is essential to work closely with your healthcare provider to manage your fatty liver disease and monitor the effects of prednisone on your liver health.
From the Research
Prednisone and Fatty Liver Disease
- There is limited information available on the effects of prednisone on fatty liver disease specifically, but studies on liver disease and prednisone can provide some insights.
- A study from 1985 2 developed a therapeutic index to predict the effects of prednisone in patients with cirrhosis, which may be relevant to fatty liver disease.
- However, another study from 2019 3 found that prednisone was not beneficial for the treatment of severe drug-induced liver injury, and may even be detrimental at high doses.
Metabolism of Prednisone in Liver Disease
- A study from 1986 4 found that the metabolism of prednisone and prednisolone is affected by liver function, with decreased metabolic clearance and increased exposure to unbound prednisolone in patients with impaired liver function.
- Another study from 1978 5 found that oral prednisone is effectively absorbed and converted to prednisolone in healthy volunteers and patients with chronic active liver disease.
Pharmacokinetics and Serum Binding
- A study from 1984 6 found that patients with chronic active hepatitis and major side effects from prednisone had higher serum unbound prednisolone levels, which may be due to limited availability of binding sites or displacement of bound steroid by competition.
- The same study found that protein binding of prednisolone increased with increasing albumin concentrations, and that bilirubin could displace some bound prednisolone.
Considerations for Fatty Liver Disease
- While there is no direct evidence on the use of prednisone in fatty liver disease, the available studies suggest that prednisone may be safe but not beneficial for the treatment of liver disease, and may even be detrimental at high doses 3.
- The metabolism of prednisone and prednisolone is affected by liver function, and patients with impaired liver function may have increased exposure to unbound prednisolone 4.
- Patients with fatty liver disease should be closely monitored for signs of liver dysfunction and adjusted doses of prednisone may be necessary to minimize potential adverse effects.