Long term steroid use

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This condition that can result from long term steroid use. It is especially

bad with steroid pulse treatment, 1 gram/day, IV, for 3 days. It is called

avascular necrosis and you should see a doctor immediately if you develop

hip or other joint pain because avascular necrosis can be treated and hip

replacement can be avoided - if it is found early.

http://www.niams.nih.gov/hi/topics/avascular_necrosis/

Prednisone: Good Guy - Bad Guy

Prednisone is a synthetic hormone similar to hydrocortisone, a natural

hormone produced by the adrenal glands. Prednisone belongs to a large group

of similar drugs known as corticosteroids, which are prescribed for

literally hundreds of conditions.

With organ transplants, prednisone stops the body's normal inflammatory

reaction to foreign tissue and infection. It is usually given in tablet form

but can be given intravenously when necessary, such as when someone is too

sick to swallow a pill. The drug usually is used in combination with other

agents to suppress the immune response. It acts by decreasing swelling and

inflammation of tissues.

The downside with prednisone is its many side effects. The higher the dose

or the more times you have been treated for rejection, the more side

effects. As the dose is gradually reduces, side effects diminish. In most

cases, prednisone can be reduced to a maintenance level by the end of about

one year after transplantation. Also, use of combinations of drugs has

allowed physicians to prescribe lower doses of prednisone than in the past.

Regardless of complications, never stop taking prednisone unless you are

instructed to do so by your transplant team. Many problems can occur if

prednisone is stopped suddenly. (See " Why Can't Prednisone Be Discontinued

Suddenly? " http://www.transweb.org/qa/qa_txp/faq_pred_discont.html for

more information.)

Side Effects of Prednisone

The most commonly encountered side effects are:

a.. Sodium retention

b.. Increased appetite

c.. Increased fat deposits

d.. Increased acid in your stomach

e.. Increased sweating, especially at night

f.. Increased hair growth

g.. Acne on the face, back, and chest

h.. Bone and muscle problems

i.. Growth problems in children

j.. Eye problems

k.. Increased sugar in the blood

l.. Increased sensitivity to the sun

m.. Delayed wound healing

n.. Decreased ability to fight infection

o.. Thrush (Candida) growth in the mouth

Why Can't Prednisone Be Discontinued Suddenly?

Prednisone is a synthetic steroid hormone. It cannot be stopped abruptly

because the adrenal gland, which makes natural steroid hormones for the

body, is suppressed by long term prednisone administration. Since some

steroids are necessary for life, abruptly stopping prednisone leaves one

without any steroids at all, a condition known as ian crisis. Given

time, if the adrenal is stimulated to produce steroids by gradual reduction

in the dosage of prednisone, it will eventually begin to wake up and produce

natural steroids in most cases. It is thought that if one becomes ill, more

steroids are needed since the natural response to stress (like trauma, an

operation, an infection, etc) is for the adrenal gland to pour out steroids.

Until one's adrenal gland is up to par though, this is not possible. So

anyone on steroids or recently weaned off steroids needs to be aware of

this. We give all our patients " Medic Alert "

http://www.transweb.org/qa/qa_txp/faq_medicalert.html bracelets that state

they are a transplant patient and have been on steroid supplements. I

recommend all transplant patients have one.

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This article adapted with permission from Encore: Another Chance for Life, a

quarterly magazine published by CHRONIMED Pharmacy. For information about

CHRONIMED pharmacy or a subscription to Encore, call 1-800-888-5753.

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http://www.transweb.org/reference/articles/drugs/drug_index.html