What is the tax for funding prednisone (corticosteroid) treatment?

Understanding "Tax" in the Context of Prednisone Therapy

I believe you're asking about the physiological "cost" or burden that prednisone places on the body, rather than financial taxation. Here's what the medical evidence shows about the adverse effects and monitoring requirements:

Cardiovascular "Tax"

Prednisone directly elevates blood pressure through mineralocorticoid-like effects and promotes atherosclerosis, diabetes, and ischemic heart disease. 1

• Blood pressure monitoring should be performed at baseline before initiating therapy and frequently during dose changes, even during short courses 1
• The American College of Cardiology recommends avoiding or limiting systemic corticosteroid use when possible, and initiating or intensifying antihypertensive therapy if systemic use is necessary 1

Metabolic "Tax"

• Serum glucose monitoring is essential, as hyperglycemia commonly occurs and contributes to cardiovascular risk 1
• Brittle diabetes can develop, particularly after prolonged therapy exceeding 18 months at doses above 10 mg daily 2
• Alterations in glucose metabolism are common even with low-dose therapy (≤10 mg/day prednisone) 3

Musculoskeletal "Tax"

Osteoporosis with vertebral compression is one of the most serious complications, accounting for 27% of treatment withdrawals. 2

• Patients on long-term corticosteroid treatment should undergo annual bone mineral densitometry of the lumbar spine and hip 2
• Preventive therapies should be introduced including regular exercise, vitamin D and calcium supplementation, estrogen replacement when appropriate, and bisphosphonates 2
• Fracture risk increases significantly: in one study, 21 fractures occurred in corticosteroid users versus 8 in non-users 4
• Steroid myopathy can develop in some patients 2

Cosmetic and Quality of Life "Tax"

Cosmetic changes occur in 80% of patients after 2 years of corticosteroid treatment, regardless of regimen. 2, 5

• Changes include facial rounding, dorsal hump formation, striae, weight gain, acne, alopecia, and facial hirsutism 2
• Intolerable cosmetic changes or obesity account for 47% of premature drug withdrawals 2
• Moon facies and sleeplessness are significantly less common with monthly high-dose dexamethasone compared to daily prednisolone 6
• Cutaneous atrophy is common even with low-dose therapy 3

Ophthalmologic "Tax"

• Cataracts develop in some patients, particularly with prolonged therapy 2, 3
• Glaucoma can occur 2, 3
• Patients receiving prednisone should undergo eye examinations periodically during treatment 2

Infectious Risk "Tax"

• Serious infections occurred in 14 corticosteroid users versus 4 non-users in one cohort study 4
• The odds ratio for developing serious infections with prednisone use was 8.0 (95% CI 1.0-64.0) 4

Gastrointestinal "Tax"

• GI bleed or ulcer occurred in 11 corticosteroid users versus 4 non-users 4
• The odds ratio for GI events with prednisone use was 3.3 (95% CI 0.9-12.1) 4

Dose-Response Relationship

The "tax" increases dramatically with dose: prednisone 10-15 mg/day has an odds ratio of 32.3 for adverse events compared to no treatment. 4

• Average prednisone 5-10 mg/day has an odds ratio of 4.5 for adverse events 4
• Severe complications usually develop only after 18 months of continuous therapy at doses exceeding 10 mg daily 2
• Low-dose long-term prednisone use ≥5 mg/day correlates with adverse events in a dose-dependent fashion 4

Neuropsychiatric "Tax"

• Psychosis can occur, though it's uncommon 2
• Emotional instability and labile hypertension may develop 2
• Insomnia is common, reported by 86% of patients in one study 7
• Mood changes are frequently reported 7

Oncologic "Tax"

• The theoretical risk of malignancy exists with long-term immunosuppression 2
• The frequency of extrahepatic malignancy is 5% in patients with cumulative treatment duration of 42 months 2
• The incidence is 1 per 194 patient-years of surveillance, with 3% probability after 10 years 2

Minimizing the "Tax"

Combination therapy with azathioprine reduces corticosteroid-related side effects from 44% to 10% compared to higher-dose prednisone alone. 2, 5

• Consider steroid-sparing agents if side effects become problematic 5
• Use the lowest effective dose for the shortest duration necessary 1
• Consider alternative routes of administration when feasible 1