Daily Column

DEAR DR. GOTT:
What are some of the side effects of prednisone or an overdose of it? My elderly dad who is 82 and fairly healthy came down with a cold a few months ago. He saw his doctor who prescribed prednisone, two pills by mouth four times a day for five days. After taking four days he became delirious and nearly lost consciousness. He went back to the doctor who simply said “Oh, yeah”.

My father seems to be tired a lot, has very little energy and is short of breath. He is seeing a heart specialist who diagnosed him with a fibrillating heart. He never had heart problems before the prednisone. Could the medication have caused his heart problem?

DEAR READER:
Prednisone is an oral corticosteroid and is not an appropriate treatment option for trivial colds. [Read more...]

Daily Column

DEAR DR. GOTT:
My son was just recently diagnosed with sarcoidosis and is being treated with prednisone. I understand that this is becoming more common in recent years and wondered if you have any information about it.

DEAR READER:
Sarcoidosis occurs when inflammation causes tiny lumps of cells (granulomas). The granulomas can continue to grow and clump together to form larger lumps or groups of lumps. If many form in an organ, function is affected.

Sarcoidosis can occur in nearly any part of the body but most often affects the lungs and/or lymph nodes. Other commonly affected areas are the skin, eyes and liver. Very rarely, sarcoidosis can be found in the thyroid gland, kidneys, reproductive organs and breasts. More than one organ is involved in nearly all cases. [Read more...]

Daily Column

DEAR DR. GOTT:
I have a lot of health problems. One is polymyalgia that makes me stiff and in a lot of pain. I’ve taken prednisone but the side effects were terrible, so I stopped that drug.

I have sleep apnea. During my sleep test, they discovered my restless legs syndrome. I now take Mirapex and Clonazepam and that is controlled.

Would massage therapy be helpful in reducing my pain and stiffness? Also, I’d like to know if there’s a support group I could attend in my area with people who have these same symptoms.

DEAR READER:
Polymyalgia rheumatica (PMR) is an autoimmune disorder that causes stiffness and pain in the muscles of the hips, neck and shoulders. The disorder occurs most often in women and in the elderly.

If you are willing to try prednisone again, [Read more...]

Daily Column

DEAR DR. GOTT:
I am 72 years young, active, and do all my own housework. I recently read your letter concerning hair loss after taking medication. I am on three medications and three over-the-counters. The first drug is lisinopril 20 mg tabs, one and a half pills every day. The second is prednisone 4 mg daily prescribed by a rheumatologist because of rheumatoid arthritis . The third is blood pressure medicine known as metoprolol 50 mg that I’ve been on for over four years. I was taking one in the morning and a half every evening until my doctor increased the medication to two a day.

My over-the-counter drugs are a one-a-day multi-vitamin, calcium 1000 mg plus D daily, and calcium citrate 315 mg with 200 IU of vitamin D.

Years ago I noticed hair loss and attributed it to the metoprolol. The problem keeps increasing and, in fact, if it continues, I will need a wig in another year. I mentioned the problem to my doctor and her reply was that all medicines make people lose hair. Would I be wrong in asking my doctor to take me off the metoprolol and prescribe another medication for my high blood pressure? I showed her the drug information provided by my pharmacy indicating hair loss as a side effect.

I recently changed primary care physicians since my first doctor wasn’t concerned at all about my hair loss. What can I do?

DEAR READER:
Let me begin with some general information. Medications must go through several clinical studies before being approved. This is done by giving thousands of people a drug, while others are given a placebo. During the studies, no participant knows if he or she is taking the real thing or a placebo. An adverse consequence in more than 1% of the people studied in both categories is referred to as a common side effect, while less than that amount is referred to as rare. Once a drug is approved, it is no longer studied.

Now for the bad news. You are on lisinopril, metoprolol and prednisone. Rare side effects of all three drugs list hair loss as a possibility. Steroids are known to precipitate hair loss in men, yet all women have some male hormones. Therefore, of the prescription medications you take, all three share a similar consequence. The good news, according to my resources, is that the hair loss is generally reversible once a drug is discontinued.

It could be difficult in your situation to determine which drug might be causing your hair loss, unless you kept meticulous records indicating when the pattern began. As we age, we suffer wrinkles, heart problems, hypertension, arthritis and more. It’s difficult enough dealing with the problems over which we have little control. We shouldn’t have to deal with balding when it might be preventable. I recommend you speak with your new primary care physician who might be able to prescribe different medications in each instance without such an emotionally devastating side effect, no matter how rare it might be.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Wean slowly off Prednisone

DEAR DR. GOTT:
I have been taking prednisone 10 mg daily for 14 months for PMR. I cannot take less than 8 mg without a lot of pain in my wrists and hands. I have researched this and discussed my concerns with my rheumatologist who has now put me on methotrexate (4 tablets of 2.5 mg once a week) to try to wean me off the prednisone. Is this the lesser of two evils? I worry about the long-term side effects of both medicines and more importantly, how to cure the PMR. Any suggestions?

DEAR READER:
Polymyalgia rheumatica is an autoimmune disorder that causes muscle pain and stiffness in joint areas. Relief is achieved by reducing inflammation with over-the-counter medications or, in severe cases, with oral steroids as the mainstay of treatment. PMR can be a disabling disorder requiring aggressive therapy in an attempt to reduce the body’s immune response. Unfortunately, the treatment is not without risk.

You apparently have progressed from over-the-counters to prescription medications, and I cannot advise you which drug to take. That decision depends on your response to each medication. Methotrexate is, in my experience, less troublesome than prednisonebut still has its own side effects.

Although some PMR patients suddenly improve after many years, PMR typically is permanent and incurable. Therapy to treat symptoms is extremely effective but must be taken for years.

I believe that you are in good hands; your rheumatologist has made sound decisions thus far. I urge you to stick with the recommendations provided. Periodically review your health issues with him or her and try to get by on the smallest amount of medication that controls your pain.

Daily Column

DEAR DR. GOTT:
I read your column everyday and hope you can help.

My 50-year-old daughter has developed an allergy that causes a very itchy rash over her entire body. Tests have not determined the cause. She has been on prednisone and is now being weaned off. She has extreme pain over her entire body, especially her feet and is having trouble walking. She has been told that this is a side effect of going off the medication but that other tests cannot be carried out until her body is clear of the steroid.

Is there anything that can relieve the symptoms of withdrawal? Her job requires her to be on her feet most of the day and she is having a hard time functioning efficiently at work.

DEAR READER:
Severe itching can be caused by an allergy, but it can also reflect kidney disease or hidden cancer. Therefore, I suggest that your daughter have further testing performed once the effects of the prednisone have disappeared. To the best of my knowledge, prednisone withdrawal symptoms only occur if the drug is stopped abruptly or is tapered off too quickly. If her doctor is removing the medication too quickly, it could explain her pain. I suggest she speak to him or her and voice her concerns.

As an aside, the pain is a result of cortisol withdrawal. The body makes cortisol naturally until medication, such as prednisone or other corticosteroids, are introduced. Because the body makes only minimal amounts, the adrenal glands (which produce cortisol) shut down in the presence of the medication. It takes time for the body to resume its normal functioning . It can one week to several months to wean down properly from corticosteroid therapy.

Rarely, some individuals will not return to normal function, especially if the dosage and frequency are high and long. If this occurs, medication to replace the missing cortisol must be taken to avoid symptoms. If it is not, serious illness and death occur.

I suggest your daughter have blood work to test the function of her kidneys, a potassium level and certain cancer markers (available for breast cancer). A high potassium level (often caused by kidney disease) may be the culprit. If this is the case, I suggest she be examined by a nephrologist (kidney specialist). If her cancer markers come back abnormal she should be examined by her gynecologist or an oncologist. On the other hand, if everything appears normal, she should continue with the allergist.

If your daughter is having severe pain and side effects, she must be weaned down more slowly. If her physician is unwilling to do so, she should find a new one. Good luck and let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.