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Prednisone (Deltasone®) is a corticosteroid immunosuppressant used to treat a variety of diseases. Liver transplant recipients use it to prevent or treat organ rejection. Prednisone may be used in low doses for long-term immunosuppression or in higher doses for treatment of rejection.
Rejection occurs when the body recognizes the transplanted organ as foreign, and attacks the organ as if it were a harmful intruder. Prednisone prevents or treats rejection by suppressing the body’s immune response.
Prednisone is taken orally and is available as a liquid or in tablet form. Tablets are available in many concentrations, including 20-, 10-, and 5-mg doses. Usually, 5-mg tablets are prescribed, regardless of the total dose, so that – if your doctor changes your child’s dosage – you can simply change the number of tablets your child takes to equal the newly prescribed amount.
How to Take
Prednisone should never be taken on an empty stomach. It is usually best to take it in the morning, after breakfast and before 9 a.m. If your child needs to take prednisone more than once a day, be sure he or she eats before taking the other doses.
If your child misses a dose of prednisone, call your coordinator for advice.
Notify your transplant coordinator if your child is unable to take prednisone because of vomiting, inability to swallow, or other reasons. The coordinator can help arrange for your child to receive prednisone intravenously.
Common side effects include:
- Stomach upset, nausea. These symptoms can often be avoided when prednisone is taken after eating.
- High blood sugar (hyperglycemia). Your child’s blood sugar level will be checked as a part of regular laboratory studies, but you should be aware of common signs of high blood sugar: thirst, excessive urination, and fatigue. Report symptoms of high blood sugar immediately. It may be necessary for your child to avoid concentrated sweets and take medications to lower his or her blood sugar. Your child’s blood sugar level may increase temporarily if his prednisone dose is increased to treat rejection, or if she receives intravenous steroids to treat rejection. If your child’s blood sugar level is too high, he or she may need to be hospitalized.
- Swelling. You may notice swelling of your child’s face, feet, or hands. Report swelling to your transplant coordinator if your child gains more than two pounds in a day.
- High blood pressure (hypertension). Prednisone may affect the way your child’s body retains fluid and removes sodium (salt). Lowering the amount of sodium in your child’s diet can lower his or her blood pressure.
- Mood swings. Prednisone may cause a depressed mood. High doses used to treat rejection may cause euphoria (an extreme feeling of well-being) that wears off in a few days. Be aware that these feelings are usually temporary.
- Insomnia (difficulty sleeping). This effect occurs more often with higher doses.
- Osteoporosis (weakening of bones). This side effect occurs after long-term use of prednisone. It is important for your child to get the necessary calcium every day, either through diet or through a supplement. This is especially important for girls. Blood calcium levels do not indicate whether your bones are receiving sufficient calcium – your body will take calcium from your bones to maintain a normal calcium level in the blood.
- Cataracts or glaucoma. Prednisone may cause blurry vision or a change in eyesight. More serious conditions, such as glaucoma and cataracts, can occur after long-term prednisone use. If your child has a history of vision problems, alert your coordinator to see if your dosage of prednisone can be reduced or eliminated.
- Steroid dependency. The human body makes a hormone that is very similar to prednisone. To maintain a balance, the body may stop making this hormone while on prednisone. This is one reason why prednisone usage should not be stopped suddenly; rather, the dosage should be reduced gradually. Sudden withdrawal can cause extreme fatigue, weakness, stomach upset, or dizziness; it also can be life threatening. Stopping your child’s prednisone dose can be particularly risky if your child has been under physical stress (such as when fighting an infection or recovering from surgery). Notify your primary care doctor that your child is taking, or was taking, steroids.
- Infections. Because prednisone inhibits the immune system, it decreases the ability to fight infection. Any infections your child does pick up may show fewer symptoms. Report any signs of infection to your transplant coordinator so that your child’s prednisone dose can be reduced, if necessary.
- Slowed wound healing.
- Bruising, rashes, and other skin changes. Skin effects will be less noticeable as your child’s dose of prednisone is reduced. Because taking prednisone can make your child more vulnerable to sunburn, and because those who are immunosuppressed have a greater risk of getting skin cancer, avoid excessive sunlight. If your child plays in the sun, make sure to use a sunscreen with a sun protection factor (SPF) of at least 15. Hats provide additional protection. Report any changes in a mole or new growth to your coordinator, and see your child’s doctor or dermatologist to have the growth examined.
Rare side effects include:
- blood in urine, stools, or vomit
- severe nausea or vomiting
- muscle weakness
- prolonged sore throat
- difficult breathing
Tell your transplant doctor or pharmacist about any prescription or over-the-counter medication your child is taking, so that you can be warned of interactions and prevent them. Notify your coordinator if any medications are discontinued or any new medications are prescribed.
Store prednisone at room temperature.
Take prednisone exactly as prescribed. It is best to take prednisone in the morning, to decrease side effects.
Never stop or reduce the dosage of prednisone unless your transplant surgeon or coordinator tells you to do so. Sudden withdrawal of prednisone can be life threatening.
Avoid alcohol. Some parents allow their children a moderate amount of alcohol during religious or other special occasions, but this is not permitted for an immunosuppressed child or teen. Ask your doctor’s advice when choosing a cough syrup for your child, as some syrups contain alcohol.
To prevent an ulcer, your child may be required to take an antacid during the period he or she is on steroids.
We recommend that patients wear a medical alert bracelet or pendant (such jewelry is marketed under the name Medic Alert) that says "Taking steroids."
Prednisone is routinely stocked in most U.S. pharmacies.
Drug information changes periodically. For the most updated information on drugs, visit www.drugs.com.
Learn more about other Liver Transplant Drugs.
November 20, 2010
November 20, 2010