Prednisone

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Prednisone

Prednisone is a synthetic corticosteroid

Corticosteroid

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiology systems such as stress , immune system and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior....
drug that is usually taken orally but can be delivered by intramuscular injection

Intramuscular injection

Intramuscular injection is the medical injection of a substance directly into a muscle. In medicine, it is one of several alternative methods for the administration of medications ....
and can be used for a number of different conditions. It has a mainly glucocorticoid

Glucocorticoid

Glucocorticoids are a class of steroid hormones which bind to the glucocorticoid receptor , which is present in almost every animal cell.GCs are part of the feedback mechanism in the immune system which turns immune activity down....
effect. Prednisone is a prodrug

Prodrug

A prodrug is a Pharmacology substance that is administered in an inactive form. Once administered, the prodrug is drug metabolism in vivo into an active metabolite....
that is converted by the liver

Liver

The liver is a vital organ present in vertebrates and some other animals; it has a wide range of functions, a few of which are detoxification, protein synthesis, and production of biochemicals necessary for digestion....
into prednisolone

Prednisolone

Prednisolone is the active metabolite of prednisone....
, which is the active drug and also a steroid

Steroid

A steroid is a terpenoid lipid characterized by a carbon skeleton with four fused rings, generally arranged in a 6-6-6-5 fashion.Steroids vary by the functional groups attached to these rings and the oxidation state of the rings....
.

Uses
Prednisone is particularly effective as an immunosuppressant

Immunosuppressive drug

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Uses

Prednisone is particularly effective as an immunosuppressant

Immunosuppressive drug

Immunosuppressive drugs or immunosuppressive agents are medication that inhibit or prevent activity of the immune system. They are used in immunosuppression to:...
, and affects virtually all of the immune system. It can, therefore, be used in autoimmune diseases, inflammatory diseases (such as severe asthma

Asthma

Asthma is a common chronic obstructive pulmonary disease, in which the Lung constrict, become inflammation, and are lined with excessive amounts of thickened mucus, often in response to one or more triggers....
, severe allergies, Angioedema episodes, severe poison ivy

Poison ivy

Toxicodendron radicans is a plant in the family Anacardiaceae. The name is sometimes spelled "Poison-ivy" in an attempt to indicate that the plant is not a true Ivy ....
dermatitis, systemic lupus erythematosus

Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic Autoimmunity connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body?s cells and tissue, resulting in inflammation and tissue damage....
, ulcerative colitis

Ulcerative colitis

Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon , that includes characteristic Peptic ulcer, or open sores, in the colon....
, rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis is a chronic, systemic disease inflammation that may affect many tissues and organs, but principally attacks the joints producing a inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints....
, Bell's Palsy

Bell's palsy

Bell's palsy is a paralysis of cranial nerve VII resulting in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease....
, Crohn's disease

Crohn's disease

Crohn's disease is an inflammatory disease which may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms....
, pemphigus

Pemphigus

Pemphigus is a rare group of autoimmune blistering diseases that affect the skin and mucous membranes.In pemphigus, autoantibody form against desmoglein....
and sarcoidosis

Sarcoidosis

Sarcoidosis, also called sarcoid or Besnier-Boeck disease, is a multisystem disorder characterized by non-caseating granulomas . It most commonly arises in young adults....
), uveitis

Uveitis

Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye, with inflammation specifically of the uvea termed iridocyclitis....
, various kidney diseases including nephrotic syndrome

Nephrotic syndrome

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine....
, mononucleosis

Mononucleosis

Mononucleosis is a condition where there is an unusual proliferation of monocytes. Its meaning is similar to the condition of monocytosis.Sometimes, the use of the term implies Epstein-Barr virus , but it is also possible for cytomegalovirus to cause mononucleosis....
[Epstein Barr virus], and to prevent and treat rejection

Transplant rejection

Transplant rejection occurs when a Organ transplant organ or tissue is not accepted by the body of the transplant recipient. This is explained by the concept that the immune system of the recipient attacks the transplanted organ or tissue....
in organ transplant

Organ transplant

Organ transplant is the moving of an organ from one body to another , for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site....
ation. This medicine may also reduce the sex drive. Prednisone has also been used in the treatment of migraine headaches and cluster headaches and for severe Aphthous ulcer

Aphthous ulcer

An aphthous ulcer, also known as canker sore, is a type of oral ulcer, which presents as a painful open sore inside the mouth or upper throat, caused by a break in the mucous membrane....
("Cankersore") outbreaks.

Prednisone is used as an antitumor drug. Prednisone is very important in the treatment of acute lymphoblastic leukemia

Acute lymphoblastic leukemia

Acute lymphoblastic leukemia , is a form of leukemia, or hematological malignancy characterized by excess lymphoblasts.Malignant, immature lymphoblasts continuously multiply and are overproduced in the bone marrow....
, Non-Hodgkin's lymphomas, Hodgkin's Lymphoma, multiple myeloma

Multiple myeloma

Multiple myeloma is a cancer of plasma cells. These immune system cells are formed in bone marrow, are numerous in lymphatics and produce antibody....
, and other tumors in combination with other anticancer drugs.

Furthermore, the pharmaceutical industry uses prednisone tablets for the calibration of dissolution testing equipment according to the United States Pharmacopeia

United States Pharmacopeia

The is an official public standards?setting authority for all Prescription drug and Over-the-counter drug medicines and other health care products manufactured or sold in the United States....
(USP).

Intravenous application may be employed for cerebral inflammation, as in the periodic attacks caused by multiple sclerosis

Multiple sclerosis

Multiple sclerosis is an autoimmune disease in which the immune system attacks the central nervous system, leading to demyelinating disease. Disease onset usually occurs in young adults, and it is more common in females....
.

Prednisone is also used for the treatment of the Jarisch-Herxheimer Reaction which is common during the treatment of syphilis, and to delay the onset of symptoms of Duchenne muscular dystrophy

Duchenne muscular dystrophy

Duchenne muscular dystrophy is a severe recessive Sex linkage form of muscular dystrophy characterized by rapid progression of muscle degeneration, eventually leading to loss in ambulation and death....
. The mechanism for the delay of symptoms is unknown.

History

The first commercially feasible synthesis of prednisone was carried out in 1955 in the laboratories of Schering Corporation, which later became Schering-Plough Corporation, by Arthur Nobile and coworkers. They discovered that cortisone

Cortisone

Cortisone is a steroid hormone. Chemically, it is a corticosteroid closely related to corticosterone....
could be microbiologically oxidized to prednisone by the bacterium Corynebacterium simplex. The same process was used to prepare prednisolone

Prednisolone

Prednisolone is the active metabolite of prednisone....
from hydrocortisone. Their discovery was protected by US Patents 2,837,464 (1958); 2,897,216 (1959); and 3,134,718 (1964). The enhanced adrenocorticoid activity of these compounds over cortisone and hydrocortisone was demonstrated in mice. Prednisone and prednisolone were introduced by Schering in the mid-1960s under the brand names Meticorten and Meticortelone respectively. These prescription medicines are now available from a number of manufacturers of generic drugs.

Dependency

Adrenal

Adrenal gland

In mammals, the adrenal glands are the star-shaped endocrine glands that sit on top of the kidneys; their name indicates that position . They are chiefly responsible for regulating the stress response through the biosynthesis of corticosteroids and catecholamines, including cortisol and adrenaline, respectively....
suppression will occur if prednisone is taken for longer than 7 days. This will cause the body to lose the ability to synthesize natural corticosteroids, resulting in dependence on prednisone. For this reason, prednisone should not be abruptly stopped if taken for more than seven days, and instead, the dosage should be gradually reduced. This weaning process may be over a few days if the course of prednisone was short, but may take weeks or months if the patient had been on long-term treatment. Abrupt withdrawal may lead to an Addisonian crisis. For those on chronic therapy, alternate-day dosing may preserve adrenal function, thereby reducing side-effects.

Glucocorticoids act to feedback inhibit both the hypothalamus

Hypothalamus

The hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland ....
(decreasing Corticotropin-releasing hormone

Corticotropin-releasing hormone

Corticotropin-releasing hormone , originally named corticotropin-releasing factor , and also called corticoliberin, is a polypeptide hormone and neurotransmitter involved in the stress ....
[CRH]) and corticotrophs in the anterior pituitary

Anterior pituitary

The anterior pituitary comprises the Anterior#Usage in human anatomy lobe of the pituitary gland and is part of the endocrine system. Unlike the posterior pituitary, the anterior lobe is genuinely glandular, hence the root adeno in its name....
gland (decreasing the amount of Adrenocorticotropic hormone

Adrenocorticotropic hormone

Adrenocorticotropic hormone is a polypeptide tropic hormone produced and secreted by the anterior pituitary gland. It is an important component of the hypothalamic-pituitary-adrenal axis and is often produced in response to biological stress ....
[ACTH]). For this reason exogenous glucocorticoid analogues down-regulate the body's ability to naturally produce glucocorticoids. This mechanism leads to dependence in a short time and can be very dangerous if medications are withdrawn too quickly. The body must have time to begin synthesis of CRH and ACTH and for the adrenal glands to begin functioning normally again.

Side-effects

Short-term side-effects, as with all glucocorticoids, include high blood glucose

Glucose

Glucose , a monosaccharide also known as grape sugar, blood sugar, or corn sugar, is a very important carbohydrate in biology....
levels, especially in patients that already have diabetes mellitus

Diabetes mellitus

Diabetes mellitus , often referred to simply as diabetes , is a syndrome of disordered metabolism, usually due to a combination of genetic disorder and environmental causes, resulting in abnormally high blood sugar levels ....
or are on other medications that increase blood glucose (such as tacrolimus

Tacrolimus

Tacrolimus is an immunosuppression medication whose main use is after allogenic organ transplant to reduce the activity of the patient's immune system and so the risk of organ Transplant rejection....
), and mineralocorticoid

Mineralocorticoid

Mineralocorticoids are a class of steroid hormones characterised by their similarity to aldosterone and their influence on salt balance and water balance ....
effects such as fluid retention (it is worth noting, however, that the mineralocorticoid effects of prednisone are very minor; this is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly). Additional short-term side-effects include insomnia

Insomnia

Insomnia is a symptom of a sleep disorder characterized by persistent difficulty falling sleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease....
, euphoria

Euphoria (emotion)

Euphoria is medically recognized as an emotional and mental state defined as a sense of great happiness and quality_of_life. Technically, euphoria is an affect , but the term is often colloquially used to define emotion as an intense, Wiktionary:transcendent happiness combined with an overwhelming sense of well-being....
, and, rarely, mania

Mania

Mania is a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. There are several possible causes for mania including drug abuse and brain tumours, but it is most often associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of ma...
. Long-term side-effects include Cushing's syndrome

Cushing's syndrome

Cushing's syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone ....
, truncal weight gain, osteoporosis

Osteoporosis

Osteoporosis is a disease of bone that leads to an increased risk of bone fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is disrupted, and the amount and variety of collagen proteins in bone is altered....
, glaucoma

Glaucoma

Glaucoma is a group of diseases of the optic nerve involving loss of ganglion cell in a characteristic pattern of optic atrophy. Raised intraocular pressure is a significant risk factor for developing glaucoma ....
, type II diabetes mellitus

Diabetes mellitus

Depression (mood)

In the fields of psychology and psychiatry, the terms depression or depressed refer to sadness and other related emotions and behaviours. It can be thought of as either a disease or a syndrome....
upon withdrawal.

Major

increased blood sugar for diabetics
weight gain
Weight gain

Weight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water....
facial swelling
Moon face

Moon face, or moon facies, is a medical sign where the face swells up into a rounded shape.It is often associated with Cushing's syndrome, which has led to it being known as Cushingoid facies , or steroid treatment, which has led to the name steroid facies....
depression
Depression (mood)

In the fields of psychology and psychiatry, the terms depression or depressed refer to sadness and other related emotions and behaviours. It can be thought of as either a disease or a syndrome....
, mania
Mania

Mania is a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. There are several possible causes for mania including drug abuse and brain tumours, but it is most often associated with bipolar disorder, where episodes of mania may cyclically alternate with episodes of ma...
, or other psychiatric symptoms
unusual fatigue
Fatigue (physical)

Fatigue is a weariness caused by exertion. It can describe a range of afflictions, varying from a general state of wikt:lethargy to a specific work-induced burning sensation within one's muscles....
or weakness
Weakness

Weakness may refer to:* Muscle weakness, the inability to exert force with one's muscles* The Weakness, the thirty-seventh book in the Animorphs series...
mental confusion
Mental confusion

Confusion, of a pathological degree, usually refers to loss of orientation and often memory . Confusion as such is not synonymous with inability to focus attention, although severe inability to focus attention can cause, or greatly contribute to, confusion....
/ indecisiveness
blurred vision
Blurred vision

Blurred vision is an ocular symptom....
abdominal pain
Abdominal pain

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
peptic ulcer
Peptic ulcer

A peptic ulcer, also known as ulcus pepticum, PUD or peptic ulcer disease, is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful....
infections
painful hips
Hip (anatomy)

In anatomy, the hip or coxa in medical termonology is the bone projection of the femur which is known as the greater trochanter, and the overlying muscle and fat....
or shoulders
Shoulders

Shoulders is drinking game that involves players competing in a fast paced game attempting to "count" to 21....
osteoporosis
Osteoporosis

Osteoporosis is a disease of bone that leads to an increased risk of bone fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is disrupted, and the amount and variety of collagen proteins in bone is altered....
insomnia
Insomnia

Insomnia is a symptom of a sleep disorder characterized by persistent difficulty falling sleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease....
severe joint pain
cataracts
anxiety
Anxiety

Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry....
black stool
stomach pain or bloating
Bloating

Bloating is any abnormal general swelling, or increase in diameter of the abdomen area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by borborygmus....
severe swelling
Swelling

Swelling can mean:* In medicine:** Swelling is the enlargement of organs caused by accumulation of excess fluid in tissues, called edema.* In engineering:...
mouth sores or dry mouth
Avascular Necrosis
Avascular necrosis

Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to an area of bone. Without blood, the bone tissue dies and the bone collapses....

Minor

stretch marks
Stretch marks

Stretch marks or striae , as they are called in dermatology, are a form of scarring on the skin with an off-color hue. They are caused by tearing of the dermis, and over time can diminish but not disappear completely....
nervousness
acne
Acne vulgaris

Acne vulgaris is a skin condition caused by changes in the pilosebaceous units . Severe acne is inflammation, but acne can also manifest in noninflammatory forms....
rash
Rash

A rash is a change of the skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin....
increased appetite

hyperactivity
Hyperactivity

Hyperactivity can be described as a physical state in which a person is abnormally and easily excitable or exuberant. Strong emotional reactions, Impulse behavior, and sometimes a short span of attention are also typical for a hyperactive person....
frequent urination
diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
removes intestinal flora

Prednisone

Uses

History

Dependency

Side-effects

Major

Minor

External links