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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]
Prednisone was patented in 1954 and approved for medical use in the United States in 1955. [3] [8] It is on the World Health Organization's List of Essential Medicines. [9] It is available as a generic medication. [3] In 2022, it was the 30th most commonly prescribed medication in the United States, with more than 18 million prescriptions. [10 ...
Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. [5] [6] Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, and multiple sclerosis. [6]
Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. [15] Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days' rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy. Delivery-related adverse effects
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Fever, tiredness, unspecific arthralgias, or myalgias are commonly treated with nonsteroidal anti-inflammatory medications (NSAIDs), hydroxychloroquine, or a low dose of prednisone, depending on the severity. [68] Mild joint involvement can be effectively treated with NSAIDs, hydroxychloroquine, and oral prednisone.
In those who are unable to tolerate oral medication or do not respond to stress doses, a low threshold to initiate parenteral hydrocortisone management can be used to guarantee adequate systemic absorption, since gastroenteritis frequently precedes an adrenal crisis [16] and stress dose glucocorticoids may not always avoid an adrenal crisis. [3]
To prevent steroid-induced osteoporosis, the steroid dose and duration should be as low and as short as possible. All patients on long term glucocorticoids (≥3 months) should be encouraged to do weightbearing exercise, avoid smoking and excess alcohol and take fall prevention measures. Daily calcium and vitamin d intake should be sufficient.