By A. G. Moore 10/21/2012While prednisone is used to treat a variety of illnesses besides lupus, many of these illnesses require only a short-term regimen of the medication. Prednisone is often prescribed, for example, to stabilize a patient during the onset of a sudden, critical illness. Or, it may be used as a response to an acute allergic reaction. These are just two of the possible situations in which prednisone might be prescribed. In these instances, although drug interactions are possible, the window in which they may occur is foreshortened so the risk of them is limited. However, when prednisone therapy becomes a long-term regimen, essentially for life, as in lupus, the opportunity for an untoward reaction increases.
Most people with a chronic inflammatory disease will take prednisone on and off for as long as they live. In this circumstance, the drug becomes almost background to everything else. Taking the drug is so routine that its pharmacological significance can be overlooked. But prednisone is a powerful medicine, even in low doses, and has the potential to interact with every other drug. And while all of us must depend on the expertise of physicians and pharmacists to protect us from adverse drug reactions, it is always in our best interest to back up their knowledge with our own vigilance–anyone, even the best, most experienced doctor, can make a mistake.
The place to begin due diligence, as a patient, is in the doctor’s office. The patient has to ask–and this is not always an easy thing to do–that the doctor check for drug interactions. After this, the patient must ask the pharmacist to do the same thing.
Finally, the patient should investigate independently the possibility of a drug interaction. There’s a website put out by the FDA which might indicate a known drug interaction; and drug manufacturers often have websites of their own which list advisories about taking their products.
I came across an article published by the University of Athens Medical School (I referred to this valuable article in another essay, one I wrote on weight and prednisone) which lists the way prednisone interacts with some other commonly prescribed medications. Several of those interactions are cited below, at the conclusion of this article.
The diligence every patient should exercise when prescribed a new medication is doubly important for the elderly (over 60). While lupus is a disease that favors the young, it also is very much present in older people. According to the National Institutes of Health, “despite the fact that elderly individuals represent a group with higher vulnerability to drug interactions, few authors have specifically analyzed the occurrence of this phenomenon among the elderly. ” The difficulty with prescribing for the elderly is multifold: they may have many co-existing conditions and as they age this is more likely to be the case; also, metabolic function in the elderly is not as efficient as it is in younger people and thus drugs are not broken down as quickly nor are they cleared from the body as easily.
Prednisone is described in the NIH article as a medicine of concern; that is, prednisone has a direct effect on the way a patient metabolizes and clears a variety of commonly prescribed drugs (including statins, anti-hypertensives and benzodiazepines).
Before I conclude, let me emphasize that the best authorities for determining drug interactions are the doctor and the pharmacist. But patients also have a role–patients always have a role. Patients are the final firewall between an adverse event and medical treatment. Patient are always a vital part of the team in any treatment plan.
Some drug interactions listed by the University of Athens Medical School are provided below. I have only selected a few drugs for inclusion here, just to give the reader an idea of what they may find if they check out this article. It’s a real eye-opener.
Effect of glucocorticoid (in any form, prednisone, hydrocortisone, prednisolone, etc.) on:
Drug Possible interaction
Digitalis glycosides low potassium
Vaccines from live attenuated viruses severe generalized infections
Aspirin decreased effectiveness
Coumarin anti-coagualants decreased effectiveness
Erythromycin increased effectiveness
Insulin decreased effectiveness