Clare.T
10-27-2004, 06:59 PM
This post is prompted by a report on the BBC about excessive over prescribing of Prednisone by GP's in the UK
http://www.whale.to/drugs/corticosteroids1.html
The best doctors explain to their patients why they are prescribing a medicine , how it might help them, what undesirable side effects to look out for, when and how best take the medicine and arrange tests to check for hidden side effects. . Doses will be adjusted according to the patient's individual needs and response.
Unfortunately we often see lupus sufferers here on the forum who have been treated with Prednisone or similar oral steroids for many years as sole therapy and are now suffering serious irreversible side effects.
We need to be informed about our medicines to make sure that our treatment is in line with the most up to date practices and that we are getting the best treatment available, although of course it is up to our doctors to decide in partnership with us on treatment options and choices.
Many of us have no choice but to be treated by doctors who are not lupus specialists, have little or no experience of treating lupus patients and who are not up to date with the latest therapies.
Dr Wallace writes
Steroids are the most effective and most misunderstood treatment for lupus. They are also the most used and abused therapeutic interventions for the disease.
Simply stated, if organ threatening disease is present and steroids are not prescribed, the patient usually loses function in that organ.
(The Lupus Book p212)
He also describes steroids as a blessing and a curse. " Without them many lupus patients would die, but with them, serious complications can arise.........
Not everybody develops all of these complications and many individuals who are steroid dependant develop none of them "
(pps 216-217)
These days every effort is made to keep steroid use to the lowest dose for the shortest time needed. Monotherapy - the use of a single drug - is unusual these days : most often a cocktail of drugs is prescribed to maximise the benefits of each and minimise the side effects.
The anti malarials, NSAID's and the steroid sparing drugs Imuran and Methotrexate help to reduce the need for steroids in disease control.
Some cases never need steroids. Some will need low maintenance doses for long periods
Measures can be taken to minimise the side effects of steroids : Dr Wallace often prescribes antacids,H2 blockers, eg Zantac or proton pump inhibitors eg Prilosec along with steroids.
A low sodium low fat and low carbohydrate diet with limited calorie intake is advisable.
Sometimes diuretics are used to minimise bloating and fluid retention.
Sedatives may be useful at night and patients are urged to be active to minimise muscle atrophy and osteoporosis
Dr Wallace says that steroid dependent patients should take at least 1 gram of calcium a day to protect their bones. Bone loss is a serious concern of long term steroid use for men as well as women regardless of age . There are a number of osteoporosis and bone building medicines available these days. Bone density should be checked as often as required.
Here is a small selection of useful links and information to help you evaluate the treatment you are getting
Please note: this is not medical advice, just freely available information. Always consult your physician. Physicians differ in their prescribing and treatment practices.
________________________________
Side effects
http://www.rxlist.com/cgi/generic/pred_ad.htm
>>>Musculoskeletal: Muscle weakness, steriod myopathy, loss of muscle mass, osteoporosis, tendon rupture, particularly of the Achilles tendon, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fracture of long bones<<<
_________________
http://dermnetnz.org/treatments/systemic-steroids.html
Steroid withdrawal Dr M Lockshin
http://lupusmidatlantic.linktier.com/subindex.jsp?nav_id=74
------------------------------------------------------------------------------------------------
http://www.hss.edu/Conditions/Lupus/Sle-Overview
>>>4. Corticosteroids. Corticosteroids are synthetic versions of a hormone produced by your adrenal glands. They help suppress inflammation. High dose oral corticosteroid (60 mg/day of prednisone or equivalent) for four to six weeks, followed by taper (gradual reduction of dosage) over several months, is the gold-standard treatment for patients with systemic flare, glomerulonephritis, severe thrombocytopenia, vasculitis, and neurologic disease of any type except antiphospholipid antibody-associated stroke. Lower doses of corticosteroid are used for symptomatic treatment of patients not responding to NSAIDs and/or antimalarials. Bolus intravenous steroid is methylprednisolone (Solu-Medrol), 1000 mg, given over 30 minutes daily for three consecutive days has been used to treat acute SLE since the 1970s. However, there is little research to support this practice - except for inducing remission in patients with glomerulonephritis. Most specialists use bolus steroid for control of other lupus manifestations; some use it monthly in lieu of daily oral steroid. There are no systematic studies proving that one regimen is better than the other. (Long-term use of corticosteroids increases the risk of developing osteoporosis.)
-----------------------------------------------------------------------------------------------------------------------
http://www.lupuscanada.org/en/chapter/trea...edications.html (http://www.lupuscanada.org/en/chapter/treating_with_medications.html)
>>In my view, the single most important factor explaining the remarkable improvement in life expectancy of SLE patients has been the discovery of the steroid drug cortisone in 1948 and, shortly after, the related drug prednisone. Although the term cortisone continues to be used by patients and the public, SLE patients are now treated with the much more effective drug prednisone. This drug is the best inflammation-fighting drug available at the moment. Prednilosone is also used in Canada and, for some SLE patients, is the best drug available. These drugs are sometimes referred to as steroids, but they are not related to testosterone and the other anabolic steroids used by some athletes to build muscle.
The decision to prescribe prednisone is never made lightly by your physician. Prednisone is considered if the symptoms are not being well controlled by other treatment(s), if there is a concern that SLE may quickly get out of control unless prednisone is used or if SLE is severe and perhaps life-threatening.
On the bright side, prednisone is necessary for the successful treatment of many lupus patients. For some, it is a lifesaving drug and the single best drug available. However, this powerful drug has a dark side too. There is no doubt that prednisone can cause a wide variety of side-effects in both the short and the long term. If you are taking prednisone, it is important for you to know what these problems are. This information is included in Appendix Two at the back of the booklet, "Side-effects of prednisone". Patients will be happy to know that research is underway to find steroid drugs which would have the powerful inflammation-fighting action of prednisone with fewer unwanted side-effects.
At times, patients may be tempted to stop taking prednisone or to reduce or increase their dose. Perhaps they are fed up with the side-effects or perhaps they are feeling better or worse. It is important that patients taking cortisone understand how cortisone works and why stopping or changing the medication without the supervision of the physician is dangerous.
Cortisone is a chemical that is normally produced by the body, not a foreign substance. In fact, the body has a vital need for cortisone. When prednisone treatment is started, the body responds by stopping its own production of cortisone and the adrenal glands that produce it get sluggish and lazy. If prednisone is used for a period of time and then suddenly stopped, the body may not be able to start producing enough cortisone for some time. The result could be a life-threatening lack of cortisone (adrenal insufficiency). So prednisone should never be stopped suddenly. If you are tempted to stop taking your prednisone, do not do it. Rather, discuss the situation with your physician.
>>>Other patients decrease or increase their dose on their own. This is unacceptable. If you feel well enough that you think prednisone could be decreased or if you feel worse and think that it should be increased, call your doctor. Never forget that both you and your doctor have worked very hard to improve your health. You should not put your improvement at risk by making any changes to your therapy.<<<<
http://www.lupuscanada.org/en/chapter/side...prednisone.html (http://www.lupuscanada.org/en/chapter/side_effects_of_prednisone.html)
__________________________________________________ ____________
http://www.lupus.org/education/brochures/steroids.html
__________________________________________________ __
Clare.T
http://www.whale.to/drugs/corticosteroids1.html
The best doctors explain to their patients why they are prescribing a medicine , how it might help them, what undesirable side effects to look out for, when and how best take the medicine and arrange tests to check for hidden side effects. . Doses will be adjusted according to the patient's individual needs and response.
Unfortunately we often see lupus sufferers here on the forum who have been treated with Prednisone or similar oral steroids for many years as sole therapy and are now suffering serious irreversible side effects.
We need to be informed about our medicines to make sure that our treatment is in line with the most up to date practices and that we are getting the best treatment available, although of course it is up to our doctors to decide in partnership with us on treatment options and choices.
Many of us have no choice but to be treated by doctors who are not lupus specialists, have little or no experience of treating lupus patients and who are not up to date with the latest therapies.
Dr Wallace writes
Steroids are the most effective and most misunderstood treatment for lupus. They are also the most used and abused therapeutic interventions for the disease.
Simply stated, if organ threatening disease is present and steroids are not prescribed, the patient usually loses function in that organ.
(The Lupus Book p212)
He also describes steroids as a blessing and a curse. " Without them many lupus patients would die, but with them, serious complications can arise.........
Not everybody develops all of these complications and many individuals who are steroid dependant develop none of them "
(pps 216-217)
These days every effort is made to keep steroid use to the lowest dose for the shortest time needed. Monotherapy - the use of a single drug - is unusual these days : most often a cocktail of drugs is prescribed to maximise the benefits of each and minimise the side effects.
The anti malarials, NSAID's and the steroid sparing drugs Imuran and Methotrexate help to reduce the need for steroids in disease control.
Some cases never need steroids. Some will need low maintenance doses for long periods
Measures can be taken to minimise the side effects of steroids : Dr Wallace often prescribes antacids,H2 blockers, eg Zantac or proton pump inhibitors eg Prilosec along with steroids.
A low sodium low fat and low carbohydrate diet with limited calorie intake is advisable.
Sometimes diuretics are used to minimise bloating and fluid retention.
Sedatives may be useful at night and patients are urged to be active to minimise muscle atrophy and osteoporosis
Dr Wallace says that steroid dependent patients should take at least 1 gram of calcium a day to protect their bones. Bone loss is a serious concern of long term steroid use for men as well as women regardless of age . There are a number of osteoporosis and bone building medicines available these days. Bone density should be checked as often as required.
Here is a small selection of useful links and information to help you evaluate the treatment you are getting
Please note: this is not medical advice, just freely available information. Always consult your physician. Physicians differ in their prescribing and treatment practices.
________________________________
Side effects
http://www.rxlist.com/cgi/generic/pred_ad.htm
>>>Musculoskeletal: Muscle weakness, steriod myopathy, loss of muscle mass, osteoporosis, tendon rupture, particularly of the Achilles tendon, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fracture of long bones<<<
_________________
http://dermnetnz.org/treatments/systemic-steroids.html
Steroid withdrawal Dr M Lockshin
http://lupusmidatlantic.linktier.com/subindex.jsp?nav_id=74
------------------------------------------------------------------------------------------------
http://www.hss.edu/Conditions/Lupus/Sle-Overview
>>>4. Corticosteroids. Corticosteroids are synthetic versions of a hormone produced by your adrenal glands. They help suppress inflammation. High dose oral corticosteroid (60 mg/day of prednisone or equivalent) for four to six weeks, followed by taper (gradual reduction of dosage) over several months, is the gold-standard treatment for patients with systemic flare, glomerulonephritis, severe thrombocytopenia, vasculitis, and neurologic disease of any type except antiphospholipid antibody-associated stroke. Lower doses of corticosteroid are used for symptomatic treatment of patients not responding to NSAIDs and/or antimalarials. Bolus intravenous steroid is methylprednisolone (Solu-Medrol), 1000 mg, given over 30 minutes daily for three consecutive days has been used to treat acute SLE since the 1970s. However, there is little research to support this practice - except for inducing remission in patients with glomerulonephritis. Most specialists use bolus steroid for control of other lupus manifestations; some use it monthly in lieu of daily oral steroid. There are no systematic studies proving that one regimen is better than the other. (Long-term use of corticosteroids increases the risk of developing osteoporosis.)
-----------------------------------------------------------------------------------------------------------------------
http://www.lupuscanada.org/en/chapter/trea...edications.html (http://www.lupuscanada.org/en/chapter/treating_with_medications.html)
>>In my view, the single most important factor explaining the remarkable improvement in life expectancy of SLE patients has been the discovery of the steroid drug cortisone in 1948 and, shortly after, the related drug prednisone. Although the term cortisone continues to be used by patients and the public, SLE patients are now treated with the much more effective drug prednisone. This drug is the best inflammation-fighting drug available at the moment. Prednilosone is also used in Canada and, for some SLE patients, is the best drug available. These drugs are sometimes referred to as steroids, but they are not related to testosterone and the other anabolic steroids used by some athletes to build muscle.
The decision to prescribe prednisone is never made lightly by your physician. Prednisone is considered if the symptoms are not being well controlled by other treatment(s), if there is a concern that SLE may quickly get out of control unless prednisone is used or if SLE is severe and perhaps life-threatening.
On the bright side, prednisone is necessary for the successful treatment of many lupus patients. For some, it is a lifesaving drug and the single best drug available. However, this powerful drug has a dark side too. There is no doubt that prednisone can cause a wide variety of side-effects in both the short and the long term. If you are taking prednisone, it is important for you to know what these problems are. This information is included in Appendix Two at the back of the booklet, "Side-effects of prednisone". Patients will be happy to know that research is underway to find steroid drugs which would have the powerful inflammation-fighting action of prednisone with fewer unwanted side-effects.
At times, patients may be tempted to stop taking prednisone or to reduce or increase their dose. Perhaps they are fed up with the side-effects or perhaps they are feeling better or worse. It is important that patients taking cortisone understand how cortisone works and why stopping or changing the medication without the supervision of the physician is dangerous.
Cortisone is a chemical that is normally produced by the body, not a foreign substance. In fact, the body has a vital need for cortisone. When prednisone treatment is started, the body responds by stopping its own production of cortisone and the adrenal glands that produce it get sluggish and lazy. If prednisone is used for a period of time and then suddenly stopped, the body may not be able to start producing enough cortisone for some time. The result could be a life-threatening lack of cortisone (adrenal insufficiency). So prednisone should never be stopped suddenly. If you are tempted to stop taking your prednisone, do not do it. Rather, discuss the situation with your physician.
>>>Other patients decrease or increase their dose on their own. This is unacceptable. If you feel well enough that you think prednisone could be decreased or if you feel worse and think that it should be increased, call your doctor. Never forget that both you and your doctor have worked very hard to improve your health. You should not put your improvement at risk by making any changes to your therapy.<<<<
http://www.lupuscanada.org/en/chapter/side...prednisone.html (http://www.lupuscanada.org/en/chapter/side_effects_of_prednisone.html)
__________________________________________________ ____________
http://www.lupus.org/education/brochures/steroids.html
__________________________________________________ __
Clare.T