What to discuss with your doctor
 There are a number of issues that need to be discussed with your doctor before starting a course of treatment with Prednisone. If your body is not producing enough cortisone, this drug will help to make up the shortfall. Getting the dose correct is more art than science and the doctor relies on your feedback to adjust the dosage until your condition is stabilized. That means you may have a continuing insufficiency of the hormone, or you may have too much which is more likely to produce adverse side effects. As with any drug, there are benefits and disadvantages.
Make sure you give informed consent by getting all the relevant information before agreeing to the treatment. |
One of the most important issues is the risk of changes of mood. Over time, people can react to steroids with a range of symptoms from a state of euphoria to severe depression. If you have no history of depression, it is unlikely that you will be affected. But people who have experienced episodes of emotional instability are more likely to be affected.
If you are a woman planning a family, there may be possible risks to the development of the fetus. Tests in animals have produced birth defects. There are no comprehensive tests in humans to establish whether the risks are significant, but there are two factors to consider. The first is that giving birth can be stressful and it may be necessary to adjust the dosage. Secondly, if you are taking steroids over a longer period of time, the fetus may not develop fully active adrenal glands. Following the birth, your child should be monitored for any symptoms of adrenal insufficiency, particularly if you breast-feed because that will continue to dose your child through the milk. Because steroids affect the immune system, any infection your baby catches is likely to be more severe. Steroids also slow the rate at which a baby grows and develops. You need to liaise with your local health providers to make sure that your baby reaches the expected milestones of growth.
It is very important to discuss diet. If you are trying to lose weight, you may have reduced your intake of important natural sources of salt, calcium and potassium. You will have to adjust the level of salt in your food and take supplements to make up potential deficiencies in calcium and potassium. Your health professional may recommend you take risedronate or a bisphosphonate such as Fosamax to reduce the risk of osteoporosis. Already high levels of cholesterol in your blood will increase when you start taking a steroid. Further, one of the effects of using steroids is to gain weight. It will therefore be necessary to add extra protein, switch to a low GI diet and reduce your calorie intake. Your doctor will either give you instructions or refer you to a nutritionist. This is particularly important if you are diabetic. Steroids change the level of blood sugars so, depending on how your body reacts, you may have to adjust the quantity of sugar you consume.
Older people are more likely to experience higher blood pressure. This can cause existing cardiovascular problems to worsen. If you have already had a stroke or heart attack, you must discuss the risks with your doctor. There are also issues to discuss if you have ulcers or other problems affecting the esophagus, stomach or colon. The difficulty is that steroids can mask the underlying condition so you have no way of knowing whether it is getting worse. Finally, you should have your eyes tested on a regular basis.
