Are you suffering from droopy eyes or puffy eyes?

This is a symptom which tells you that your eyes

are tired. Puffiness of the eyes is caused by many reasons including lack of sleep and crying for a
long time. The skin around our eyes is thin and sensitive and contains many blood vessels. Stress,
lack of sleep etc affects the skin and cause excess fluids to get trapped in the skin around the eye
causing an eye bag. Aging is one of the major causes of bags under the eyes. Fat deposition under
the eyes also results in bags under the eye. There are some effective home remedies to treat the
bags under the eye or the Puffy eyes. These home remedies are cheaper and safer than the
alternative methods of treating under eye bags. Here are some of the home remedies to get rid of
puffy eyes.

1.

Chilled Tea Bags

If you get up in the morning with puffy eyes and if you do not want people to see the under eye bags
then chilled tea bags are the best option. Put the tea bags in hot water for a minute and then
refrigerate it for some time. Lie back and place the tea bags over the eyes. Leave it on the eyes for
20-30 minutes. Wash your eyes after 30 minutes in cold water. You will have refreshed eyes. You can
use either green tea bags or black tea bags for this purpose. The caffeine present in the tea
constricts the blood vessels around the eyes and reduces the swelling and redness.

2.

Cucumbers

This is one of the most effective natural remedy for puffiness under the eye. The coolness of the
cucumbers will soothe the eye and the anti-inflammatory properties help to reduce the inflammation
of the skin. Take two slices of refrigerated cucumber and place it over the eyes. Relax with the
cucumbers on the eyes for 25 minutes. This will soothe and refresh your eyes and reduce the
puffiness.

3.

Potato

The potato has antiinflammatory properties and this will help in reducing the swelling under the eye
due to water retention. Refrigerate the potato for some time and slice it into thin circles. Close the
eyes and place the sliced potatoes over the eyes. It should cover the puffed areas of the eye. Leave
the potatoes over the eyes for at least 20 minutes. You will find a great change in puffiness once you
remove the potato slices.

4.

Milk

If you are regularly having puffy eyes in the morning then milk is one of the best remedy to combat
it. Milk will help to cool and soothe the tired eyes and also reduces water retention by the tissues
under the eyes. Take two cotton pads and dip them in chilled milk. Now place the cotton pads over

the eyes and rest for 20-30 minutes. Wash off with cold water to see normal looking eyes. Repeat
this remedy for a few days, if you are constantly having this problem.

5.

Almond Oil

Almond oil reduces puffiness and dark circles around the eye. The vitamins present in the oil
nourish the skin and the oil moisturizes the skin. Take two to three drops of almond oil and apply it
under your eye and massage the area lightly using your ring finger before going to bed. Do not apply
pressure while massaging. Massaging improves the blood circulation around the eyes and reduces
water retention around the eyes.

6.

Vitamin E Oil

Vitamin E is necessary for the skin health and applying vitamin E will help to keep the skin under the
eye healthy. This also helps to reduce the swelling around the eyes. Mix few drops of vitamin E oil in
chilled water taken in a bowl. Mix it thoroughly. Now dip the cotton pads in this and place it on the
eyes. Leave the cotton pads over the eyes for about 20 minutes to reduce swelling under the eyes.

7.

Egg White

Egg White has the ability to absorb water and reduce inflammations in the body. This is a natural
remedy for inflammations in the body. This can be used to get rid of the excess water retained under
the eye. Beat the egg white till it is stiff. Apply this around the eyes using a smooth make up brush or
soft cloth. Leave the egg white over the puffed area for 20 minutes. Rinse the face with cold water
after 20 minutes. You will see that the area under the eye has become less puffy and tighter.

8.

Chilled Spoons

This is another easily available remedy for puffy eyes. Take a glass of chilled water and four
stainless steel spoons. Put the spoons in the chilled water for some time. Take out two spoons and
place the spoons over the eyes. The chillness will help to constrict the blood vessels and reduce the
puffiness. Switch the spoons after some time and take the other two chilled spoons and repeat the
procedure till there is a reduction in puffiness.

9.

Cold Splash

This is the most simple way to reduce the under eye bags. In most of the cases puffiness of the eye
will be caused by the fluid retention under the eyes. This is due to poor circulation of fluids. You can
bring back your eyes to the normal condition by splashing cold water on the puffed areas around the

eye as well as to the rest of the face. The cold splash will help to correct the fluid circulation and to
remove the retained liquid under the eye.
Apart from using these natural remedies, you can do certain things to prevent the under eye
bags or puffy eyes.

Drink plenty of water to remove the toxins from your body.

Reduce the intake of sodium. Excess sodium in the body causes water retention in different
areas of the body.

Do not stay up till late night.

Do not keep the head bend down for a long time

Do exercises to improve blood circulation

PREDNISONE
5-60 mg/day PO in single daily dose or divided q6-12hr
Dosing considerations

When converting from immediate-release to delayed-release formulation, note that delayedrelease formulation takes about 4 hours to release active substances
Note that exogenous steroids suppress adrenal cortex activity least during maximal natural
adrenal cortex activity (between 4:00 and 8:00 AM)

Acute Asthma
40-60 mg/day PO in single daily dose or divided q12hr for 3-10 days
Giant Cell Arteritis
40-60 mg PO qDay (1-2 years usual duration of treatment)
Idiopathic Thrombocytopenic Purpura
1-2 mg/kg/day PO
Allergic Conditions
Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime
Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime
Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime
Day 4: 5 mg PO before breakfast, after lunch, and at bedtime
Day 5: 5 mg PO before breakfast and at bedtime
Day 6: 5 mg PO before breakfast

Rheumatoid Arthritis
Immediate-release: 10 mg/day PO added to disease-modifying antirheumatic drugs (DMARDs)
Delayed-release: 5 mg/day PO initially; maintenance: lowest dosage that maintains clinical response; may
be taken at bedtime to decrease morning stiffness with rheumatoid arthritis

Advanced Pulmonary/Extrapulmonary Tuberculosis

40-60 mg/day PO, tapered over 4-8 weeks
Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)
40 mg PO q12hr for 5 days, then 40 mg PO q24hr for 5 days, then 20 mg q24hr for 11 days
Crohn's Disease (Off-label)
40-60 mg PO qDay until resolution and resumption of weight gain (7-28 days usual duration)
Autoimmune Hepatitis
60 mg PO qDay for 1 week; THEN 40 mg qDay for 1 week; THEN 30 mg qDay for 2 weeks; follow by 20
mg qDay; give half this dose if giving in combinaiton with azathioprine
Administration
Take with meal or snack
High-dose glucocorticoids may cause insomnia; immediate-release formulation is typically administered in
morning to coincide with circadian rhythm
Delayed-release formulation takes about 4 hours to release active substances; thus, with this formulation,
timing of dose should take into account delayed-release pharmacokinetics and disease or condition being
treated (eg, may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis)

PREDNISONE TABLETS, 10 mg
PREDNISONE TABLETS
Rx Only

DESCRIPTION
Prednisone is a glucocorticoid. Glucocorticoids are adrenocortical steroids, both
naturally occurring and synthetic, which are readily absorbed from the gastrointestinal
tract. The molecular formula for prednisone is C21H26O5. Chemically, it is 17,21dihydroxypregna-1, 4-diene-3,11, 20-trione and has the following structural formula:

Prednisone is a white to practically white, odorless, crystalline powder and has a

molecular weight of 358.44. It melts at about 230C with some decomposition.
Prednisone is very slightly soluble in water, slightly soluble in alcohol, chloroform,
dioxane, and methanol.

Each tablet, for oral administration, contains 5 mg or 10 mg of prednisone.

Inactive ingredients:
5 mg: anhydrous lactose, colloidal silicon dioxide, magnesium stearate,
microcrystalline cellulose, sodium starch glycolate, and talc.
10 mg: anhydrous lactose, colloidal silicon dioxide, magnesium stearate,
microcrystalline cellulose, sodium starch glycolate, and talc.

CLINICAL PHARMACOLOGY
Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have
salt-retaining properties, are used as replacement therapy in adrenocortical deficiency
states. Their synthetic analogs, such as prednisone, are primarily used for their potent
anti-inflammatory effects in disorders of many organ systems.
Glucocorticoids, such as prednisone, cause profound and varied metabolic effects. In
addition, they modify the bodys immune response to diverse stimuli.

INDICATIONS AND USAGE

Prednisone tablets are indicated in the following conditions:
Endocrine disorders: primary or secondary adrenocortical insufficiency
(hydrocortisone or cortisone is the first choice; synthetic analogs may be used in
conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid
supplementation is of particular importance), congenital adrenal hyperplasia,
nonsuppurative thyroiditis, hypercalcemia associated with cancer.
Rheumatic disorders: as adjunctive therapy for short-term administration (to tide the
patient over an acute episode or exacerbation) in; psoriatic arthritis; rheumatoid
arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose
maintenance therapy); ankylosing spondylitis; acute and subacute bursitis; acute
nonspecific tenosynovitis; acute gouty arthritis; post-traumatic osteoarthritis; synovitis
of osteoarthritis; epicondylitis.
Collagen diseases: during an exacerbation or as maintenance therapy in selected cases
of: systemic lupus erythematosus, systemic dermatomyositis (polymyositis), acute
rheumatic carditis.

Dermatologic diseases: pemphigus, bullous dermatitis herpetiformis, severe erythema

multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides,
severe psoriasis, severe seborrheic dermatitis.
Allergic states: control of severe or incapacitating allergic conditions intractable to
adequate trials of conventional treatment: seasonal or perennial allergic rhinitis, serum
sickness, bronchial asthma, contact dermatitis, atopic dermatitis, drug hypersensitivity
reactions.
Ophthalmic diseases: severe acute and chronic allergic and inflammatory processes
involving the eye and its adnexa, such as: allergic conjunctivitis, keratitis, allergic
corneal marginal ulcers, herpes zoster ophthalmicus, iritis and iridocyclitis,
chorioretinitis, anterior segment inflammation, diffuse posterior uveitis and
choroiditis, optic neuritis, sympathetic ophthalmia.
Respiratory diseases: symptomatic sarcoidosis, Loefflers syndrome not manageable
by other means, berylliosis, fulminating or disseminated pulmonary tuberculosis when
used concurrently with appropriate antituberculous chemotherapy, aspiration
pneumonitis.
Hematologic disorders: Idiopathic thrombocytopenic purpura in adults, secondary
thrombocytopenia in adults, acquired (autoimmune) hemolytic anemia,
eythroblastopenia (RBC anemia), congenital (erythroid) hypoplastic anemia.
Neoplastic diseases: for palliative management of: leukemias and lymphomas in
adults, acute leukemia of childhood.
Edematous states: to induce a diuresis or remission of proteinuria in the nephritic
syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.
Gastrointestinal diseases: to tide the patient over a critical period of the disease in:
ulcerative colitis, regional enteritis.
Miscellaneous: tuberculous meningitis with subarachnoid block or impending block
when used concurrently with appropriate antituberculous chemotherapy, trichinosis
with neurologic or myocardial involvement.

CONTRAINDICATIONS
Prednisone tablets are contraindicated in systemic fungal infections and known
hypersensitivity to components.

WARNINGS
In patients on corticosteroid therapy subjected to unusual stress, increased dosage of
rapidly acting corticosteroids before, during and after the stressful situation is
indicated.
Corticosteroids may mask some signs of infection and new infections may appear
during their use. Infections with any pathogen including viral, bacterial, fungal,
protozoan or helminthic infections, in any location of the body, may be associated
with the use of corticosteroids alone or in combination with other immunosuppressive
agents that affect cellular immunity, humoral immunity, or neutrophil function.
These infections may be mild, but can be severe and at times fatal. With increasing
doses of corticosteroids, the rate of occurrence of infectious complications increases.
There may be decreased resistance and inability to localize infection when
corticosteroids are used.
Prolonged use of corticosteroids may produce posterior subcapsular cataracts,
glaucoma with possible damage to the optic nerves, and may enhance the
establishment of secondary ocular infections due to fungi or viruses.

USAGE IN PREGNANCY:
Since adequate human reproduction studies have not been done with corticosteroids,
the use of these drugs in pregnancy, nursing mothers or women of childbearing
potential requires that the possible benefits of the drug be weighed against the
potential hazards to the mother and embryo or fetus. Infants born of mothers who
have received substantial doses of corticosteroids during pregnancy should be
carefully observed for signs of hypoadrenalism.
Average and large doses of hydrocortisone or cortisone can cause elevation of blood
pressure, salt and water retention, and increased excretion of potassium. These effects
are less likely to occur with the synthetic derivatives except when used in large doses.
Dietary salt restriction and potassium supplementation may be necessary. All
corticosteroids increase calcium excretion.
While on corticosteroid therapy, patients should not be vaccinated against smallpox.
Other immunization procedures should not be undertaken in patients who are on
corticosteroids, especially on high doses, because of possible hazards of neurological
complications and a lack of antibody response.

Administration of live or live, attenuated vaccines is contraindicated in patients

receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines
may be administered to patients receiving immunosuppressive doses of
corticosteroids; however, the response to such vaccines may be diminished. Indicated
immunization procedures may be undertaken in patients receiving
nonimmunosuppressive doses of corticosteroids.
The use of prednisone tablets in active tuberculosis should be restricted to those cases
of fulminating or disseminated tuberculosis in which the corticosteroid is used for the
management of the disease in conjunction with an appropriate antituberculous
regimen.
If corticosteroids are indicated in patients with latent tuberculosis or tuberculin
reactivity, close observation is necessary as reactivation of the disease may occur.
During prolonged corticosteroid therapy, these patients should receive
chemoprophylaxis.
Persons who are on drugs that suppress the immune system are more susceptible to
infections than healthy individuals. Chickenpox and measles, for example, can have a
more serious or even fatal course in non-immune children or adults on corticosteroids.
In such children or adults who have not had these diseases, particular care should be
taken to avoid exposure. How the dose, route, and duration of corticosteroid
administration affects the risk of developing a disseminated infection is not known.
The contribution of the underlying disease and/or prior corticosteroid treatment to the
risk is also not known. If exposed to chickenpox, prophylaxis with varicella-zoster
immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with
pooled intravenous immunoglobulin (IG) may be indicated. (See the respective
package inserts for complete VZIG and IG prescribing information.) If chickenpox
develops, treatment with antiviral agents may be considered. Similarly, corticosteroids
should be used with great care in patients with known or suspected Stronglyoides
(threadworm) infestation. In such patients, corticosteroids-induced
immunosuppression may lead to Stronglyoides hyperinfection and dissemination with
widespread larval migration, often accompanied by severe enterocolitis and
potentially fatal gram-negative septicemia.

PRECAUTIONS
General
General: Drug-induced, secondary adrenocortical insufficiency may be minimized by
gradual reduction of dosage. This type of relative insufficiency may persist for months

after discontinuation of therapy; therefore, in any situation of stress occurring during

that period, hormone therapy should be reinstituted. Since mineralocorticoid secretion
may be impaired, salt and/or a mineralocorticoid should be administered concurrently.
There is an enhanced effect of corticosteroids on patients with hypothyroidism and in
those with cirrhosis.
Corticosteroids should be used cautiously in patients with ocular herpes simplex
because of possible corneal perforation.
The lowest possible dose of corticosteroid should be used to control the condition
under treatment, and when reduction in dosage is possible, the reduction should be
gradual.
Psychic derangements may appear when corticosteroids are used, ranging from
euphoria, insomnia, mood swings, personality changes, and severe depression, to
frank psychotic manifestations. Also, existing emotional instability or psychotic
tendencies may be aggravated by corticosteroids.
Steroids should be used with caution in: nonspecific ulcerative colitis, if there is a
probability of impending perforation, abscess or other pyogenic infection,
diverticulitis,fresh intestinal anastomosis, active or latent peptic ulcer, renal
insufficiency, hypertension, osteoporosis, and myasthenia gravis.
Growth and development of infants and children on prolonged corticosteroid therapy
should be carefully observed.
Kaposis sarcoma has been reported to occur in patients receiving corticosteroid
therapy. Discontinuation of corticosteroids may result in clinical remission.
Although controlled clinical trials have shown corticosteroids to be effective in
speeding the resolution of acute exacerbations of multiple sclerosis, they do not show
that corticosteroids affect the ultimate outcome or natural history of the disease. The
studies do show that relatively high doses of corticosteroids are necessary to
demonstrate a significant effect. (See DOSAGE AND ADMINISTRATION).
Since complications of treatment with glucocorticoids are dependent on the size of the
dose and the duration of treatment, a risk/benefit decision must be made in each
individual case as to dose and duration of treatment and as to whether daily or
intermittent therapy should be used.

Convulsions have been reported with concurrent use of methylprednisolone and

cyclosporin. Since concurrent use of these agents results in a mutual inhibition of
metabolism, it is possible that adverse events associated with the individual use of
either drug may be more apt to occur.

Drug Interactions
The pharmacokinetic interactions listed below are potentially clinically important.
Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin
may increase the clearance of corticosteroids and may require increases in
corticosteroid dose to achieve the desired response. Drugs such as troleandomycin and
ketoconazole may inhibit the metabolism of corticosteroids and thus decrease their
clearance. Therefore, the dose of corticosteroid should be titrated to avoid steroid
toxicity. Corticosteroids may increase the clearance of chronic high dose aspirin. This
could lead to decreased salicylate serum levels or increase the risk of salicylate
toxicity when corticosteroid is withdrawn. Aspirin should be used cautiously in
conjunction with corticosteroids in patients suffering from hypoprothrombinemia. The
effect of corticosteroids on oral anticoagulants is variable. There are reports of
enhanced as well as diminished effects of anticoagulants when given concurrently
with corticosteroids. Therefore, coagulation indices should be monitored to maintain
the desired anticoagulant effect.

Information for Patients

Persons who are on immunosuppressant doses of corticosteroids should be warned to
avoid exposure to chickenpox or measles. Patients should also be advised that if they
are exposed, medical advice should be sought without delay.

ADVERSE REACTIONS
Fluid and electrolyte disturbances: sodium retention, fluid retention, congestive heart
failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension.
Musculoskeletal: muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, tendon rupture, particularly of the Achilles tendon, vertebral
compression fractures, aseptic necrosis of femoral and humeral heads, pathological
fracture of long bones.
Gastrointestinal: peptic ulcer with possible perforation and hemorrhage, pancreatitis,
abdominal distention, ulcerative esophagitis, increases in alanine transaminase (ALT,
SGPT), aspartate transaminase (AST, SGOT) and alkaline phosphatase have been

observed following corticosteroid treatment. These changes are usually small, not
associated with any clinical syndrome are reversible upon discontinuation.
Dermatologic: impaired wound healing, thin fragile skin, petechiae and ecchymoses,
facial erythema, increased sweating, may suppress reactions to skin tests.
Neurological: convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache.
Endocrine: menstrual irregularities; development of Cushingoid state; suppression of
growth in children; secondary adrenocortical and pituitary unresponsiveness,
particularly in times of stress, as in trauma, surgery or illness; decreased carbohydrate
tolerance; manifestations of latent diabetes mellitus; increased requirements for
insulin or oral hypoglycemic agents in diabetics.
Ophthalmic: posterior subcapsular cataracts, increased intraocular pressure, glaucoma,
exophthalmos.
Metabolic: negative nitrogen balance due to protein catabolism.
Additional reactions: Urticaria, and other allergic, anaphylactic or hypersensitivity
reactions.

DOSAGE AND ADMINISTRATION

Dosage of prednisone tablets should be individualized according to the severity of the
disease and the response of the patient. For infants and children, the recommended
dosage should be governed by the same considerations rather than strict adherence to
the ratio indicated by age or body weight.
Hormone therapy is an adjunct to, and not a replacement for conventional therapy.
Dosage should be decreased or discontinued gradually when the drug has been
administered for more than a few days.
The severity, prognosis, expected duration of the disease, and the reaction of the
patient to medication are primary factors in determining dosage.
If a period of spontaneous remission occurs in a chronic condition, treatment should
be discontinued.

Blood pressure, body weight, routine laboratory studies, including two-hour

postprandial blood glucose and serum potassium, and a chest X-ray should be
obtained at regular intervals during prolonged therapy. Upper Gl X-rays are desirable
in patients with known or suspected peptic ulcer disease.
The initial dosage of prednisone may vary from 5 mg to 60 mg per day, depending on
the specific disease entity being treated. In situations of less severity lower doses will
generally suffice, while in selected patients higher initial doses may be required. The
initial dosage should be maintained or adjusted until a satisfactory response is noted.
If after a reasonable period of time there is a lack of satisfactory clinical response,
prednisone should be discontinued and the patient transferred to other appropriate
therapy. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE
VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE
DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT. After
a favorable response is noted, the proper maintenance dosage should be determined by
decreasing the initial drug dosage in small decrements at appropriate time intervals
until the lowest dosage which will maintain an adequate clinical response is reached.
It should be kept in mind that constant monitoring is needed in regard to drug dosage.
Included in the situations which may make dosage adjustment necessary are changes
in clinical status secondary to remissions or exacerbations in the disease process, the
patients individual drug responsiveness, and the effect of patient exposure to stressful
situations not directly related to the disease entity under treatment; in this latter
situation it may be necessary to increase the dosage of prednisone for a period of time
consistent with the patients condition. If after long-term therapy the drug is to be
stopped, it is recommended that it be withdrawn gradually rather than abruptly.
Multiple Sclerosis
In the treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of
prednisolone for a week followed by 80 mg every other day for 1 month have been
shown to be effective. (Dosage range is the same for prednisone and prednisolone.)
ADT (Alternate Day Therapy)
ADT is a corticosteroid dosing regimen in which twice the usual daily dose of
corticoid is administered every other morning. The purpose of this mode of therapy is
to provide the patient requiring long-term pharmacologic dose treatment with the
beneficial effects of corticoids while minimizing certain undesirable effects, including
pituitary-adrenal suppression, the Cushingoid state, corticoid withdrawal symptoms,
and growth suppression in children.

The rationale for this treatment schedule is based on two major premises: (a) the antiinflammatory or therapeutic effect of corticoids persists longer than their physical
presence and metabolic effects and (b) administration of the corticosteroid every other
morning allows for re-establishment of more nearly normal hypothalamic-pituitaryadrenal (HPA) activity on the off-steroid day.
A brief review of the HPA physiology may be helpful in understanding this rationale.
Acting primarily through the hypothalamus a fall in free cortisol stimulates the
pituitary gland to produce increasing amounts of corticotropin (ACTH) while a rise in
free cortisol inhibits ACTH secretion. Normally the HPA system is characterized by
diurnal (circadian) rhythm. Serum levels of ACTH rise from a low point about 10 pm
to a peak level about 6 am. Increasing levels of ACTH stimulate adrenocortical
activity resulting in a rise in plasma cortisol with maximal levels occurring between 2
am and 8 am. This rise in cortisol dampens ACTH production and in turn
adrenocortical activity. There is a gradual fall in plasma corticoids during the day with
lowest levels occurring about midnight.
The diurnal rhythm of the HPA axis is lost in Cushings disease, a syndrome of
adrenocortical hyperfunction characterized by obesity with centripetal fat distribution,
thinning of the skin with easy bruisability, muscle wasting with weakness,
hypertension, latent diabetes, osteoporosis, electrolyte imbalance, etc. The same
clinical findings of hyperadrenocorticism may be noted during long-term
pharmacologic dose corticoid therapy administered in conventional daily divided
doses. It would appear, then, that a disturbance in the diurnal cycle with maintenance
of elevated corticoid values during the night may play a significant role in the
development of undesirable corticoid effects. Escape from these constantly elevated
plasma levels for even short periods of time may be instrumental in protecting against
undesirable pharmacologic effects.
During conventional pharmacologic dose corticosteroid therapy, ACTH production is
inhibited with subsequent suppression of cortisol production by the adrenal cortex.
Recovery time for normal HPA activity is variable depending upon the dose and
duration of treatment. During this time the patient is vulnerable to any stressful
situation. Although it has been shown that there is considerably less adrenal
suppression following a single morning dose of prednisolone (10 mg) as opposed to a
quarter of that dose administered every 6 hours, there is evidence that some
suppressive effect on adrenal activity may be carried over into the following day when
pharmacologic doses are used. Further, it has been shown that a single dose of certain
corticosteroids will produce adrenocortical suppression for two or more days. Other
corticoids, including methylprednisolone, hydrocortisone, prednisone, and
prednisolone, are considered to be short acting (producing adrenocortical suppression

for 1 to 1 days following a single dose) and thus are recommended for alternate
day therapy.
The following should be kept in mind when considering alternate day therapy:
1) Basic principles and indications for corticosteroid therapy should apply. The
benefits of ADT should not encourage the indiscriminate use of steroids.
2) ADT is a therapeutic technique primarily designed for patients in whom long-term
pharmacologic corticoid therapy is anticipated.
3) In less severe disease processes in which corticoid therapy is indicated, it may be
possible to initiate treatment with ADT. More severe disease states usually will require
daily divided high dose therapy for initial control of the disease process. The initial
suppressive dose level should be continued until satisfactory clinical response is
obtained, usually four to ten days in the case of many allergic and collagen diseases. It
is important to keep the period of initial suppressive dose as brief as possible
particularly when subsequent use of alternate day therapy is intended. Once control
has been established, two courses are available: (a) change to ADT and then gradually
reduce the amount of corticoid given every day or (b) following control of the disease
process reduce the daily dose of corticoid to the lowest effective level as rapidly as
possible and then change over to an alternate day schedule. Theoretically, course (a)
may be preferable.
4) Because of the advantages of ADT, it may be desirable to try patients on this form
of therapy who have been on daily corticoids for long periods of time (eg, patients
with rheumatoid arthritis). Since these patients may already have a suppressed HPA
axis, establishing them on ADT may be difficult and not always successful. However,
it is recommended that regular attempts be made to change them over. It may be
helpful to triple or even quadruple the daily maintenance dose and administer this
every other day rather than just doubling the daily dose if difficulty is encountered.
Once the patient is again controlled, an attempt should be made to reduce this dose to
a minimum.
5) As indicated above, certain corticosteroids, because of their prolonged suppressive
effect on adrenal activity, are not recommended for alternate day therapy (eg,
dexamethasone and betamethasone).
6) The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is
minimal between 4 pm and midnight. Exogenous corticosteroids suppress
adrenocortical activity the least, when given at the time of maximal activity (am).

7) In using ADT it is important, as in all therapeutic situations to individualize and

tailor the therapy to each patient. Complete control of symptoms will not be possible
in all patients. An explanation of the benefits of ADT will help the patient to
understand and tolerate the possible flare-up in symptoms which may occur in the
latter part of the off-steroid day. Other symptomatic therapy may be added or
increased at this time if needed.
8) In the event of an acute flare-up of the disease process, it may be necessary to
return to a full suppressive daily divided corticoid dose for control. Once control is
again established alternate day therapy may be re-instituted.
9) Although many of the undesirable features of corticosteroid therapy can be
minimized by ADT, as in any therapeutic situation, the physician must carefully weigh
the benefit-risk ratio for each patient in whom corticoid therapy is being considered.

Prednisone Side Effects: Deal With

The Devil?
Prednisone is a valuable medication for many serious conditions, but
it can also carry grave consequences including psychological
reactions.
Joe Graedon April 8, 2012 Drug Side Effects 253 Comments
Prednisone (and similar corticosteroids) can be a life saving drug. It saved
my sanity when I developed sudden hearing loss in one ear. That was a
really scary experience for someone who depends on hearing to be able to
do live radio.
The ear, nose and throat specialist diagnosed my deafness as idiopathic
sudden sensorineural hearing loss. In other words, he didnt have a clue
what caused it. He did prescribe high doses of prednisone and within a few
days my hearing returned.

Similar corticosteroids like Prednisone

include

Cortisone

Dexamethasone

Hydrocortisone

Methylprednisolone

Prednisolone

There are many conditions for which such drugs can be extremely valuable,
even life saving. Here are just a few:

Very serious allergic reactions (bad poison ivy for example)

Anaphylactic shock (life-threatening allergic reaction)

Brain tumors

Inflammatory bowel disease (Crohns disease)

Severe asthma (usually to help control acute flare-ups)

Severe nausea of chemotherapy

High altitude sickness (when there is brain swelling)

Traumatic brain injury

Addisons disease

Rheumatoid arthritis, lupus and polymyalgia rheumatica (PMR)

Multiple sclerosis (MS)

Giant cell arteritis

As useful as corticosteroids can be for a wide range of conditions, the drugs

can also cause an extraordinary number of serious side effects. Some people
have likened this to a deal with the devil. Even short-term use can cause
problems.

My personal experience with Prednisone

The week or two that I took prednisone for my hearing loss I couldnt sleep,
became incredibly irritable and hard to live with, and felt as if I had turned
into someone I didnt know or like. A study in the American Journal of
Psychiatry analyzed data from hundreds of thousands of European patients
over an 18 year period.
They discovered that people taking corticosteroids were more likely to
experience neuropsychiatric symptoms including depression, suicidal
thoughts (and actions), delirium, disorientation, confusion, panic and manic
episodes.
The authors conclude that: Glucocorticoids [another term for
corticosteroids] increase the risk of suicidal behavior and neuropsychiatric
disorders. Educating patients and their families about these adverse events
and increasing primary care physicians awareness about their occurrence
should facilitate early monitoring.
I can relate. I certainly felt disoriented and out of control on the relatively
high dose I was taking. The trouble is that patients and their families are not
always warned about such side effects.

Scary Prednisone side effects that have been

reported to us
Years ago I was given prednisone in the emergency room for a severe
anaphylactic reaction that affected my ability to breathe and caused massive

hives. Although the treatment may have been necessary, I too had a severe
psychotic reaction and when I finally went to my own doctor and had blood
tests, my blood chemistry was all over the map. I had to continue the
tapered dose till I was done but I wish someone had warned me of possible
side effects so at least I wouldnt think I was totally crazy.
I questioned my ability to drive, slept constantly, and was quite volatile. I
had to take a day off from work. Knowledge is power! People should be
warned about possible side effects so they have the information should side
effects occur.
AC
I was on 20mg twice a day of prednisone for a sinus infection. Had I known
anything about this horrible drug I would have never taken the meds and let
my sinus infection clear up on its own. That would have been better than
these side effects.
I was not told to taper the dose, so I took as prescribed 20mg twice daily
for 7 days. The day after stopping my whole body hurt to the touch, as if I
was black and blue all over. I was swollen, red and had a lump on my neck,
not to mention being very disoriented. I went back to the doctor and he
insisted this had nothing to do with the drug.
I checked myself into the ER where they put an IV drip with benadryl and
the like. I was discharged that day. No change. Next day, didnt hurt to the
touch anymore. New side effect rash from head to toe and severe
indigestion. Following day, rash subsiding, indigestion getting better. Still
feeling a bit loopy, but I am told by next week I should be back to myself
again.
I am warning everyone i know not to ever take a steroid unless your life is
in danger. It is a very scary feeling all for a sinus infection.
AMS

Im having Prednisone side effects. My doctor prescribed this drug last

Thursday. She prescribed 20mg twice daily for five days. I was sleepless for
three days in row. On day 4 after a short nap I awake feeling so nervous. I
am crying, my hands are shaking, and my heart is beating so hard. These
are awful feelings.
My doctor told me I will feel that way for about nine days. She didnt show
any care about me. She also said I can go back to work (and drive a long
way) the next day. But the way I was and am feeling Im not daring to drive
even one block.
I do not understand why she prescribed that medicine, without any
warning, for a small allergy I had. I mean the medicine was worse than my
illness.
ELY
My wife had sleepless nights when on prednisone and the doctor said that
she might do some odd things that she normally wouldnt do. He was right.
One night she got up and tore down the wall paper in our bathroom
We still get a laugh over this one.
Bob K.
I am experiencing high blood pressure, agoraphobia, panic attacks, light
headedness, confusion, weakness, intolerance to heat, IBS, shaking, etc.
These side effects all started the day I stopped the drug. It has been 7 days
with not much improvement. I was hospitalized for 3 days. I pray I do not
EVER have to take prednisone again EVER.
I am hoping I get past this. My quality of life stinks. I took 30mg 1 day
20mg 2 days and 1 mg 2 days. Absolutely HATE this.
SKF

These are just some of the messages that have been posted to our website.
Feel free to add your story or comment below. We find it astonishing that
some prescribers do not warn patients about the possibility of psychological
side effects brought on by prednisone and friends. Even a short-course of
high-dose steroid can precipitate symptoms. And not warning about gradual
tapering borders on bad medicine. To protect yourself and your loved ones
from such medical mistakes we suggest our latest book, Top Screw-ups
Doctors Make and How to Avoid Them.
We want to emphasize that corticosteroids can be very valuable. Some
people must take them for the rest of their lives because of a very serious or
life-threatening condition. And NO ONE should ever stop taking a drug like
prednisone suddenly. It must be phased off gradually under medical
supervision.

Other side effects associated with

corticosteroids like Prednisone

Fluid retention, edema

Insomnia

Irritability, nervousness, mood swings, mania, depression, psychosis

Disorientation, confusion

Hypertension

Loss of potassium

Headache

Dizziness, vertigo

Muscle weakness

Blood sugar elevation (diabetes)

Irregular menstrual cycles

Swollen face

Hair growth (including on the face)

Itching, rash, hives

Increased susceptibility to infection

Weakened bones (osteopenia, osteoporosis)

Tendon rupture

Glaucoma

Cataracts

Ulcers

The higher the dose and the longer someone takes a drug like prednisone
the more likely there will be side effects. Make sure your physician is
monitoring things like potassium, blood sugar, bone density and
psychological well being. And never stop a corticosteroid suddenly!

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253 Thoughts Shared

ADD MY THOUGHTS

1.
JILL
CARIBBEAN
NOVEMBER 12, 2014 AT 6:04 AM

Reply

After contracting Chicangunya, with one week of fever and

agonizing joint pain, followed by 4 weeks of debilitating,
persistent joint pain, making it very painful to walk, stand up,
roll over in bed, etc.
All the literature indicates there is no cure for Chikangunya,
only pain relief with aspirin and Ibuprofen. These helped my
pain, but gave no improvement to range of movement or
severe joint swelling.
After 5 weeks I went to my Dr. and he prescribed a 15 day
course of Prednisone. Within hours of the first tablet, I
experienced profound and complete relief from all joint
symptoms, feel like a woman reborn.
Now, reading of possible side effects I am concerned about
what will happen after I am off the drug. For now, I am pain
free, energetic, feeling great, though suffering insomnia.

2.
DONIS M.
WILDWOOD, FL
NOVEMBER 10, 2014 AT 10:10 PM

Reply

This is my 2nd. Round of this medicine ( first time to repair my

hearing that was damaged due to Encephilits in 2002). I am on
the 20mg doseage for Tenfinitis on my left elbow. I have 2
more days left & a horrible cough.

3.
HANK
NOVEMBER 6, 2014 AT 2:30 PM

Reply

Have been diagnosed with chronic pericarditis, inflammation of

the sack around the heart. Very painful! The only relief is
prednisone in a high dose. WORKS UNBELIEVABLE! Within
hours full relief. Been on different doses for 8 months. The bad
was, once weaned off the drug I would have an attack of
pericarditis I am down to 12mg a day and 800 -1600 mg a
day of ibuprofen.
I have gained about 15 pounds and my wife says I am very
irritable when I was on 50 mg a day. I am looking forward to
being off the prednisone in the coming months. Without the
drug I would have missed much more work and suffered
horribly. My wife and I are still together.

4.
T.E. VAN HEERDEN
SOUTH AFRICA

NOVEMBER 5, 2014 AT 3:13 PM

Reply

I have shared my thoughts previously. Landed in hospital near

death with an abscess. (Was diagnosed with Sjogrens disease.)
The best advice I can give is to check if they are giving the
correct medication. I was given Panafcort 2 months ago, a
generic, and I had really nasty side effects. Much worse than
on Prednisone. My hair was falling out excessively, itchiness
very bad from head to toe, rapid heartbeat, very depressed,
total lack of concentration, mood swings, no concentration and
could not work at all and I had excessive muscle pains. I
thought I was busy dying until I realized what it was. The
Prednisone has side effects for me but not as bad as the
Panafcort.

5.
ELENA
SAN DIEGO, CA.
NOVEMBER 2, 2014 AT 3:20 PM

Reply

Thank you to the brave people sharing on their use of

prednisone 20mg. When I go to the doctor I always obey and
buy the prescribed medicine.BUT.first I research the side
effects! And you convinced me NOT to take! I will let my body
Heal slowly. ( My symptoms, back from traveling were flu like,
stomach, throat, general ill feelings, serious, but getting
better).

6.
MACK
CHICAGO
NOVEMBER 2, 2014 AT 2:35 AM

Reply

I am in high school, and I have been put on prednisone more

than five times that I can remember. While on prednisone for
asthma I could not sleep and I felt very jittery. It also made
me very anxious and hyper. I do not recommend prednisone
unless you really need it.

7.
EILEEN
CANADA
OCTOBER 29, 2014 AT 11:00 AM

Reply

I have PMR (polymyalgia rheumatica)..a very painful

condition. I suffered for a few months before being diagnosed.
Had a useless life; couldnt enjoy my grandchildren or continue
any physical activities. I was diagnosed 2 months ago and my
doctor prescribed 25 mg. of prednisone a day; taken in the
morning only. It was a life saver! I have no more pain, am
active. Was warned of all the side effects, but fortunately so
far only small weight gain and a puffy face, and a dry mouth
and throat (cant sing anymore). I sleep well at night (because
I dont take it before bed). Maybe I am one of the lucky ones

from the comments I have read. But for some conditions, like
PMR, Prednisone is a necessity if you want a pain free life. My
Dr. has said I would probably be on it for a year maybe longer.
PMR could be a part of my life..it can go into remission but it
can also return any time. Thought I would post this as it is
kind of positive. Usually see a lot more negative comments
posted.

8.
TRACY D.
UNITED STATES
OCTOBER 26, 2014 AT 12:36 AM

Reply

I had been prescribed 3 consecutive scripts for prednisone 60

mg with a 9 day taper (40, 20) to stop my sciatica pain til I
could have a nerve block, epidural. I have gained 10 pounds in
27 days, was suicidal, depressed beyond belief,.blurry vision,
audio and visual hallucinations and basically unable to work
the final week.
I have never had such a terrible month in my life. Yes, the
physical pain stopped, but I am just now starting to feel
almost human. My doc prescribed xanax, half mg 3 times a
day which has helped with the rapid heartbeat and panic
attacks. Please speak with your doctor about all these side
effects. In a million years I would NEVER take it again!