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The Power and Pitfalls of Corticosteroids: What You Need to Know

Corticosteroids are a class of drugs that includes synthetic versions of the human cortisol hormone. Prednisone is one commonly prescribed corticosteroid medication that effectively reduces inflammation and suppresses the immune system. 

Corticosteroids like prednisone can treat conditions ranging from asthma to arthritis to inflammatory bowel disease.  

However, prednisone and other corticosteroids also come with an extensive list of side effects, especially when used long-term. Understanding both the benefits and risks can help you use them effectively. 

Short-Term Uses and Benefits 

Corticosteroids are very effective medications when used for short-term periods. Doctors typically define short-term use as treatment lasting less than three weeks. 

Prednisone starts working very quickly to rapidly reduce inflammation, which can help treat acute health crises where inflammation is causing damage to the body’s tissues and organs. 

Exactly how long prednisone can be used before side effects set in depends on factors like the prescribed dosage and the patient’s underlying health. During short-term use, prednisone seems almost miraculous, rapidly relieving pain and discomfort. 

Some potential short-term prednisone side effects include insomnia, increased appetite, and mood changes, though many patients tolerate the therapy quite well for short durations of only a few weeks. 

Risks of Long-Term Use 

Unfortunately, even though they are highly effective medications, corticosteroids come with extensive side effects that make them poorly suited for long-term use.

Potential long-term issues can include osteoporosis, cataracts, skin fragility, impaired wound healing, adrenal insufficiency, and an increased susceptibility to infections. 

The risks tend to increase the longer someone takes corticosteroids like prednisone. 

Some of the immune-suppressing abilities of corticosteroids that provide short-term benefits also set up patients for harm over time. For example, increased immunosuppression over months to years can reactivate otherwise latent infections like tuberculosis. 

Research also links high cumulative lifetime corticosteroid exposure to severe outcomes for viral respiratory infections — relevant given the recent COVID-19 pandemic. 

Implementing a Corticosteroid Exit Strategy

Given the clear risks of prolonged use, prescribing providers should strategize an “exit plan” when starting patients on corticosteroids to encourage stopping as soon as effective.

Planning to continually reduce the dose over time, called tapering, is extremely important to avoid problems associated with abruptly stopping therapy. 

Providers also need to closely monitor patients for side effects at regular intervals and conduct testing to catch issues like osteoporosis development early. Patients and doctors should reconsider the appropriateness of continuing corticosteroid therapy at least every three months. 

For chronic inflammatory conditions poorly responsive to other therapies, clinicians may prescribe corticosteroids like prednisone long-term at the lowest effective dose. Still, continual assessment of whether the benefits outweigh mounting side effect risks remains vital in these complex situations.

The Bottom Line 

Corticosteroids serve a valuable role and can help treat conditions that fail to respond to other medications when used carefully and judiciously. However, long durations increase harm risks substantially. 

Prescribers need thoughtful management plans addressing if, when, and how corticosteroid therapy should end to ensure appropriate short-term rather than problematic prolonged use.

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