What precautions should you take?
Because of its ability to modify your immune system, it is very important that your doctor has a full medical history before taking the decision to begin a treatment with Prednisone. For example, if you have recently had an infection such as TB, chickenpox or measles, the infection may return if you begin taking a steroid. Should there be a history of diabetes, you will need careful adjustment of medication because the steroid will change the level of blood sugar in your bloodstream. There are comparable problems if you have more serious liver or thyroid problems, or less apparently threatening conditions such as ulcers or cold sores (the herpes virus can affect the eyes and is more likely to do so if your immune system is compromised). Indeed, there are many potential difficulties to manage if you are to take this medication over any significant period of time. You will need to establish new routines in diet, adjusting the level of salt, potassium and calcium either in the food itself or with supplements. Because of calcium loss, there is a risk of osteoporosis so replacing the calcium and taking vitamin D is essential.
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If you are taking the decision to treat a child or teenager, the steroid affects the growth rate and you will need to have formal checks made to ensure that the Prednisone does not slow or restrict physical development. It is also necessary to monitor for any sign of injury or infection. Because the immune system is affected, people taking Prednisone are more prone to infections. If you detect any symptoms, e.g. an increase in temperature, a sore throat, muscle pain, discomfort or pain when urinating, etc., you should seek medical attention immediately. This need for vigilance is not limited to the period during which you or you children take Prednisone. It is necessary for at least one year after the treatment ends. Your doctor may well either adjust the dose or advise resumption of the steroid, depending on the extent of the problem.
Because of the risk of infection following a cut or wound, you should tell a new doctor or dentist before you have any treatment involving an injection or surgery. There is also a clinical practice followed by many to increase the dosage if your stress levels increase, say, following surgery. Many doctors advise their patients to wear a bracelet warning that you are taking or have recently taken steroids so that, if you are involved in an accident and emergency treatment is appropriate while you are unconscious, that treatment can be adjusted to give you the maximum protection.
Doctors always prefer to prescribe the lowest possible dose for your condition. There are difficulties when approaching the end of a course of treatment. Although the withdrawal symptoms are not of the same type as those affecting antidepressants, the same approach is required, slowly reducing the dose over time to allow the body to grow used to working without steroids in the system. In the main, this is a response to the probable insufficiency of the adrenal glands. It takes time for them to begin working again. Indeed, months may pass before your body naturally produces a sufficient level. If you find yourself in a situation of stress, it may be necessary to increase the dose or restart the steroid treatment. The higher the dose and the longer the course of treatment, the longer the likely adrenal insufficiency.
