You Should NOT use Prednisolone if...
My friend contacted me this week and said: “Oh no! I've been prescribed Prednisolone!” She's not normally a person, who takes Prednisolone. So, when she told me this, she was saying it with trepidation, because she's been following me on social media and seeing all of the many warnings that I put out about Prednisolone, because I feel that there's not enough information to warn people about how truly harmful Prednisolone and other corticosteroids are.
So, when she said: “I don't even know how many fire ants on my foot. And it is still red and swollen. And I can't even walk on it. So, I went to the doctor and they said: here's some Prednisolone.” Then I said: “What else did they give you?” She said: “Well, I've been trying to put some creams on there, to make it go down.” I said: “But did they give you any Epinephrine?” She answered: “No. Why would they give me that?” So in this article I'll answer that question.
I am Dr. Megan, your Prednisolone pharmacist, and I'm committed to helping people, who have to take Prednisolone and find ways to make it more tolerable, so that they could feel well, even though they're taking this medication.
Prednisolone Side Effects
We're going to talk about new research that shows when we should not use Prednisolone. One of them was published on October 1, 2019. The other one was at the end of September 2019.
First we'll talk about allergic reactions, and then we'll talk about pneumonia. Before we jump into the actual studies, I wanted to lay the foundation of a principle called benefits versus risks.
You need to make your decisions in life. And, especially, when you're talking about medicine, it’s important to weigh the benefits and the risks. You should answer the question: Should I take a prescription drug?
Now if the benefit side is lower than the risk side, then that's worth it to you. The benefits should outweigh the risks. It's heavier on the benefit side. There are more benefits: you're feeling better, you can get out of bed, you can play with your children, you can actually walk, you can swallow, and you cannot bleed to death. Whatever those benefits are for you, if they are greater than the risks, then it's worth it.
There are many risks, when it comes to Prednisolone. There are over a hundred and fifty side-effects. But if the possibility of those side effects is not as bad as whatever you're taking Prednisolone to treat your disease, then it's worth it.
Let's look at a different situation, which is the opposite. On this situation there are ways too many risks and not enough benefits. So, the drug is only helping a little bit or, maybe, it's not even helping at all. But the risks, the side-effects and all of those miserable things are much worse, than any benefit you might be getting.
As for my situation, then I was taking Prednisolone for a bleeding disorder called ITP. I didn't ever feel like I was sick, but I knew that. I could instantly bleed to death, if I got in a car accident with low blood levels. It was kind of this hypothetical: “Well, maybe it's worth it, and maybe it's not.” But, when I was still on high-dose Prednisolone, and my numbers were slow anyway, then it wasn't worth it anymore, because it wasn't working for me.
The Prednisolone was no longer giving me any benefit, but it was still giving me lots of risks. I wasn't sleeping, I felt terrible, I craved tons of food, and my face was super around with the moon. In that situation, nine months after I started taking Prednisolone, it wasn't worth it anymore. The benefits did not outweigh the risks. So, that's the foundation we need to understand, when we dive into the data.
The study came out in September. It's about anaphylaxis. And anaphylaxis is a really big word that means a very severe allergic reaction. So, this is the type of reaction, where somebody is allergic to shellfish or peanuts, or something really terrible. And it will close off their throat and make their lips fat, make their eyes squinty, and they can die, because they don't breathe. They can't breathe anymore, because their throat is closed off.
In my friend’s situation, she was severely allergic to these fire ants. My question for her was: “Did they give you Epinephrine?” Because in this brand-new study it said that only 31% of people, before they got to the hospital, are given epinephrine, and then, when they got into the hospital, only a half of them were given Epinephrine. That's like the EpiPen or somebody injects it in the thigh of the person, who's allergic. So, less than a half, even when they got to the hospital, had been given the Epinephrine. And that's not good, because it should be the first-line treatment.
About a half of the people were given antihistamine like Benadryl, which helps to that turn off allergic reactions. And 2% of the patients were given critical steroids like Prednisolone.
The research showed the following: those, who received cortical steroids, had a three times greater admission to the intensive care unit or ICU. And that's a problem, because you're probably really sick, if you're ending up in the ICU. Now, it’s not clear, whether this is “the chicken or the egg”, when the people are being given steroids, because they're so bad off. They're doing so terribly.
One person said on rotation: “Nobody should die without a steroid.” So, is that why or were they admitted, because they were given a steroid? It's hard to know that. But their conclusion is that we should always use Epinephrine. First, prompt epinephrine is critical. Second is to use antihistamines to support that. And then, finally, their findings do not support the use of corticosteroids like Prednisolone. So, we should avoid it, when it's anaphylaxis. That is one situation we should not use Prednisolone.