Prednisone for multiple sclerosis
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What is prednisone used for?
Prednisone is an oral glucocorticoid, a type of corticosteroid, that is often used to manage acute relapses — times when symptoms suddenly get worse, or new symptoms suddenly appear — in people with multiple sclerosis (MS). Glucocorticoids, such as prednisone, ease symptoms but do not affect the ultimate outcome or natural history of the disease.
Brand names for prednisone approved for use in MS include Rayos and Prednisone Intensol.
The active form of prednisone, called prednisolone, also is available for treating acute exacerbations in MS. Brand names of this treatment include Millipred and Orapred.
Therapy Snapshot
| Brand Name: | Rayos, Prednisone Intensol |
| Chemical Name: | Prednisone |
| Usage: | Relapse management therapy for acute MS exacerbations |
| Administration: | Oral tablets |
How does prednisone work for MS?
Prednisone is a biologically inactive molecule, or prodrug. Once inside the body, prednisone gets converted into active prednisolone in the liver. One tablet of prednisone is generally equivalent to the same dose of prednisolone.
The man-made medication exerts its effects in MS mainly by binding to protein receptors, called glucocorticoid receptors, on the surface of immune cells. By binding to these receptors, which normally respond to a naturally occurring hormone called cortisol, the therapy dampens the inflammatory activity of these cells, thereby reducing the number of inflammatory cells and lowering the levels of inflammatory molecules.
Prednisone also reduces the permeability of blood vessels — including those that form the selective blood-brain barrier that keeps toxins or pathogens from reaching the brain — which also limits the number of immune cells that reach the brain and cause damage. Together, this is thought to reduce the inflammation that spurs MS relapses.
Who with MS can take prednisone?
Prednisone is indicated to alleviate symptoms during acute exacerbations or relapses of MS. The exact regimen is typically tailored based on the needs of the individual; some relapses may be so mild that they do not require treatment with corticosteroids.
The medication can be used in children, though it can interfere with a child’s normal development, particularly by slowing growth. As such, children treated with prednisone require careful monitoring and treatment planning.
There is no overall difference in safety and efficacy for corticosteroids in geriatric (elderly) patients compared with younger individuals. However, certain side effects — particularly osteoporosis, a condition that weakens bones and makes them susceptible to fracture — may be more common in elderly patients.
Who should not take prednisone?
Anyone with a known allergy to prednisone or any of the components in its formulation should not take the medication. Prednisone Intensol, in particular, as well as Millipred and Orapred, are also contraindicated, or not recommended, to be prescribed for people with systemic fungal infections.
How is prednisone administered in MS?
There is no standard regimen for how glucocorticoids are used in the management of MS relapses. Dosing of these medications is tailored based on the situation of the patient — for example, heavier individuals generally need a higher dose — and may require some trial and error to find a dose that is high enough to manage symptoms but as low as possible to avoid safety risks.
Generally, relapse treatment first involves administering high doses of corticosteroids over three to five days. This most commonly is done with corticosteroids that are given intravenously, or directly into the bloodstream (e.g., methylprednisone), though high doses of oral corticosteroids like prednisone also may be used in some circumstances.
After the high-dose treatment, patients are then usually given oral corticosteroids at gradually lower doses. This “tapering off” is recommended to prevent withdrawal symptoms associated with suddenly stopping corticosteroids, which can include anxiety, sweating, nausea, and insomnia.
Prednisone is commonly used for this final phase of treatment, which may last from 10 days to six weeks. According to the U.S. Food and Drug Administration, a regimen of daily oral doses of 200 mg Prednisone Intensol for one week, followed by 80 mg doses every other day for one month, is generally effective for managing acute relapses of MS.
| Administration | Oral tablets |
| Dosage | 200 mg (decreased to 80 mg after initial high-dose treatment) |
| Timing | Higher dosage for one week, followed by lower dosage every other day for one month |
Common side effects of prednisone
The most common side effects of prednisone include:
- swelling and fluid retention
- increased blood pressure
- changes in mood and behavior
- increased appetite and weight gain
- changes in glucose tolerance (how the body processes sugar)
Blood pressure and fluid retention
Prednisone may cause the body to retain water and salt. It also can cause high blood pressure and low levels of potassium (hypokalemia). Blood pressure, as well as sodium and potassium levels, should be monitored during treatment.
Behavioral and mood disturbances
Corticosteroids can cause mood changes, and they may worsen existing psychological problems. These therapy-induced mood changes can range from euphoria to severe depression; insomnia, mood swings, and personality changes may occur.
Psychosis, which is characterized by hallucinations (sensing something that isn’t there) and/or delusions (fixed beliefs with no basis in reality), also can develop or worsen due to corticosteroid treatment.
Hormonal changes
Prednisone mimics the activity of a naturally occurring hormone called cortisol, and it can cause several hormone-related alterations that should be monitored for with long-term treatment. These may include hypothalamic-pituitary-adrenal (HPA) axis suppression, in which the body makes too little cortisol, or Cushing’s syndrome, which is caused by excessive cortisol levels. Hyperglycemia (high blood sugar) also may occur.
Infections
Because they lower the activity of the immune system, corticosteroids can raise the risk of new infections, or worsen pre-existing or latent infections. Many symptoms commonly associated with infections (e.g., fever) are caused by the immune system’s response and not the infection itself; for this reason, symptoms of infections may not be obvious in patients on corticosteroids.
Gastrointestinal perforation
In individuals with certain digestive problems, such as ulcers or some kinds of intestinal infections, corticosteroids can increase the risk of gastrointestinal perforation, or a tear in the digestive tract. Signs of gastrointestinal perforation, such as irritation and inflammation of the gut, may be masked in patients on corticosteroids.
Decreased bone density and slowed growth
Prednisone can alter how calcium is regulated in the body, which can lead to a decrease in bone density and an increase in the risk of osteoporosis, in which bones become weak and brittle.
In children and adolescents, in particular, prednisone may interfere with normal bone growth. It also may interfere with normal growth in young people whose bodies are still developing; these patients should be closely monitored if treated with corticosteroids.
Eye problems
Prolonged prednisone treatment can cause an increase in the pressure within the eyeballs, which should be monitored if patients are treated for more than six weeks. Corticosteroids also may cause cataracts (a clouding of the eye’s lens) or glaucoma, which can damage the nerves that connect the eye to brain (optic nerves).
Prednisone also may increase the risk of eye infections. The therapy should not be used in people with an active herpes infection of the eyes.
Vaccination
People who are being treated with immunosuppressive doses of prednisone should not receive any vaccines that contain a live or attenuated (weakened) virus. Killed or inactivated vaccines may be given to people on corticosteroids — though since vaccines work by activating the immune system against a future threat, and corticosteroids suppress immune activity, vaccines may be less effective in corticosteroid-treated patients.
Use in pregnancy and breastfeeding
Prednisone can cause damage to a developing fetus, especially early on in pregnancy. Prednisolone, the active form of prednisone, is secreted in small amounts in human breast milk and may interfere with the growth of a newborn, especially at high or prolonged doses.
During pregnancy or breastfeeding, prednisone should be used only if the benefit of the treatment outweighs the potential risks. The potential risks and benefits should be discussed between patients and their healthcare team.
Babies who were exposed to substantial amounts of prednisone during pregnancy should be monitored after birth for signs of hypoadrenalism, a hormonal problem characterized by the low function of the adrenal glands.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about prednisone
For most people with MS, the disease is characterized by relapses, or times when existing symptoms rapidly get worse or new symptoms suddenly appear. These relapses are driven by inflammation in the central nervous system that causes damage. Corticosteroids such as prednisone can be used to decrease this inflammation, thus helping to alleviate the symptoms of acute relapses. Prednisone, however, does not alter the long-term course of the disease.
Prednisone may cause damage to a developing fetus. It should only be taken during pregnancy if the potential benefits of treatment outweigh the risks; these should be discussed in detail between patients and their healthcare providers.
The prescribing information label for prednisone-based therapies does not refer to a direct interaction with alcohol. However, both prednisone and alcohol can cause similar effects on the body, including mood changes, weakening of the immune system, increased blood pressure, and potential liver damage. Consequently, if a person drinks alcohol while taking prednisone, there is a greater likelihood of experiencing these effects. Patients treated with prednisone are therefore advised to ask their healthcare providers about safe alcohol consumption during treatment.
It is difficult to predict when and if MS patients will respond to treatment with prednisone, especially since glucocorticoid therapy is tailored based on the needs of the individual. For most people, symptoms usually ease within a few days of treatment, though there can be a great deal of variability.
An increase in appetite and weight gain are common side effects of prednisone treatment. Though less common, thinning of hair on the scalp is also a potential side effect of treatment with prednisone.
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