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Appendix A prednisone
Most of us have a love/hate relationship with prednisone. I think this is prefectly normal. We need it to stay alive. It reduces inflammation in our lungs, helps clear plugs and thus minimizing damage to our lungs, and it helps lower our IgE and lessen allergic reaction. Unfortunately it also has numerous side effects. It can affect any part of the body. In my case it has caused weight gain, cataracts and easy bruising. It can cause osteoporosis and other skeletal problems, high blood pressure, ulcers, thin skin, delicate blood vessels, diabetes, cataracts, glaucoma, mental disturbances and many other problems. You should be in close contact with your doctor when using this drug. It also wouldn't hurt to look up all of the side effects in a drug reference book because you may develop something unusual that it would help to be aware of. For the most part prednisone should be used as sparingly as possible. The most sparing way to use it is a quick taper, when you are on it for about a week or so and the first few days are high doses which are rapidly dropped until you go off it. If that can't manage you properly then the next thing to consider would be alternate day doses. This is thought to minimize adrenal suppression. After that, more aggressive schedules would be daily doses and divided doses, which would be more than one dose during a day. The closer the doses are together the more you have an enhanced therapeutic response but the side effects are more pronounced too. As a teenager I was always put on quick tapers because I was still growing up, but by the time I was in college we switched me to a steady alternate day dose because the quick tapers weren't doing it for me and I had grown up a little more. Now I take daily doses.
If and when you taper you should work closely with your doctor. You should be given a tapering schedule to follow. This should be done slowly. To discontinue prednisone abruptly could result in going into shock and or dying. I am not joking. If you experience severe weakness while tapering you should contact your doctor, but first bump up your prednisone dose to compensate for what might be adrenal suppression. Anytime you are on prednisone you should wear medical identification for a period of approximately 2 years after you have gone off it. For most of us that means continuously wearing medical ID. This is very important in case you are in an accident or develop a sudden illness. Medical personnel need to know if they should assume that you are adrenal suppressed. They can compensate for this by giving you IV steroids. To not have this information available could result in your death. This is all information given to me over a number of years by various doctors.