Why am I prescribed steroid tablets?
Steroids is used in the treatment of inflammatory rheumatoid arthritis and other autoimmune diseases such as systemic lupus erythematosus (SLE), vasculitis and inflammatory muscle disease. In rheumatoid arthritis, steroids are effective against swelling and inflammation. However, they only suppress the disease and do not cure it.
Steroids can be given in different ways. They can be given as tablets, or by injection into a muscle or into a vein, or injected directly into a joint.
Prednisolone is the most commonly prescribed steroid tablet. Some steroids, such as the hormone cortisol, occur naturally in the human body.
When do I take prednisolone?
Prednisolone comes as 5mg tablets. It is usually taken once a day in the morning, with or after food. Sometimes it is prescribed on an ‘alternate-day’ basis, which means that you take prednisolone on every second day.
What dose do I take?
Your doctor will advise you about the dose. This will depend on why prednisolone is being used, and on your body weight. Often your doctor will start you on a high dose and then reduce this as your symptoms improve. If you have been on steroids for a long time, then your doctor will make any reductions very slowly.
You should not stop taking your steroid tablets or alter the dose unless advised by your doctor. It can be dangerous to stop steroids suddenly.
Your doctor may decide that you should continue on a small dose (a maintenance dose) of prednisolone indefinitely.
When taking steroid tablets you must carry a Steroid Card, which records how much prednisolone you are on and how long you have been taking it. If you become unwell or are involved in an accident you will probably require extra steroids. Your doctor can give you a steroid card.
How long will prednisolone take to work?
Prednisolone works very quickly. Usually you will notice a benefit within a few days.
What are the possible side effects?
In the case of prednisolone, the longer you are taking it, and the higher the dose, the more likely you are to have problems. Your doctor will take this into account and will keep you on the lowest possible dose that keeps your disease under control. However, very often steroids are necessary to control disease, so it is a question of carefully weighing up the risks and benefits of continuing on them. If you are on very low doses of steroids you may never experience any problems.
The most common side effects are weight gain, a round face, thinning of the bones (osteoporosis), easy bruising, indigestion, stomach pains, stretch marks and thinning of the skin. Muscle weakness, changes in mood (for example, feeling depressed) and cataracts can occur. The blood sugar may rise and if you have diabetes you may require a change in the treatment of your diabetes. If you suffer from epilepsy, then it is possible that prednisolone could make the epilepsy worse. Prednisolone can also make glaucoma worse.
Taking prednisolone can make you more likely to develop infections. If this happens or if you have a fever you should report to your doctor. Signs of infection can be disguised by prednisolone. So if you feel unwell or develop any new symptoms after starting prednisolone, it is important to tell your doctor. High doses of prednisolone can cause a rise in blood pressure.
If you have not had chicken-pox but come into contact with someone who has chicken-pox or shingles, you should report to your doctor immediately as you may need special treatment. If you develop chicken-pox or shingles you should report to your doctor immediately.
In children, taking steroids can suppress growth. However, some of the conditions for which steroids are prescribed can also affect growth.
What should I know about osteoporosis and how can I reduce the risks?
Osteoporosis means thinning of the bones, making fractures more likely. As mentioned above, lont-term treatment with steroid tablets can cause osteoporosis. To reduce the risk it is a good idea to follow the general recommendations below. However, you should also ask your doctor for advice on your particular case:
- Make sure your calcium intake is at least 1.5g (1500mg) per day. Vitamin D supplements may also help.
- Do at least 30 minutes of weight-bearing exercise each day (that is, exercise which involves walking or running).
- Avoid smoking and reduce the amount of alcohol you drink.
- Hormone Replacement Therapy (HRT) can be useful for women around the time of the menopause.
- In men, testosterone replacement can be useful if the levels of this hormone are low.
- Your doctor may advise the use of bisphosphonate drugs (Fosamax) or calcitonin.
Do I need any other special checks while on steroid tablets?
Your doctor may check your general condition from time to time, for example your weight, blood pressure and blood sugar level.
Can I take other medications along with steroid tablets?
Some other drugs interact with prednisolone and you should always tell any doctor treating you that you are taking prednisolone. You should not take ‘over-the-counter’ preparations without discussing this first with your doctor. However, many drugs can be safely taken with prednisolone.
Can I have immunisation injections while on steroid tablets?
You should avoid immunisation injections which involve any of the live vaccines such as polio and rubella (German measles).
Do steroid tablets affect pregnancy?
Although it is best not to take prednisolone during pregnancy, it is safer than some other drugs. If you are plannning a family you should discuss this with your doctor beforehand. If you find you are pregnat and are on steroids, do not stop them, but discuss with your doctor. Never stop steroids abruptly. If you wish to breast feed you should seek advice about this from your doctor first.
- ALWAYS CARRY YOUR STEROID CARD.
- NEVER STOP STEROIDS ABRUPTLY OR ALTER YOUR DOSE WITHOUT DISCUSSING WITH YOUR DOCTOR FIRST.