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Treatment Name: Prednisone

Prednisone is a Prescription Therapy to treat Immune Thrombocytopenic Purpura (ITP)

How does prednisone work?
Prednisone is designed to increase the blood platelet count by slowing the destruction of platelets. Prednisone temporarily suppresses the body’s immune system so it stops destroying platelets.

Prednisone may also make your blood vessels less “leaky” so that more platelets stay within the blood stream and increase the platelet count.

Alternative name: “Pred”

Goals of therapy:
Prednisone is taken to decrease the risk of bleeding and bruising in patients with ITP who have a very low platelet count. Prednisone is also commonly taken with the goal of achieving a long-term remission from ITP.

Schedule

  • Usual Prednisone starting dose: 1 mg/kg of body weight (approximately 1-6 oral tablets) by mouth once daily with food
    • Prednisone should be taken at or before noon (if possible) to avoid difficulty falling asleep
    • If it is already afternoon on the day you receive your prescription, do not delay taking the first dose of prednisone as it is important to increase the platelet count as soon as possible to minimize the risk of bleeding

Prednisone is a prescription medication dispensed by a pharmacy and is usually taken at home for 4 consecutive weeks at higher doses. If your platelet count is within the goal range after four weeks, the dose of prednisone will typically be decreased slowly (tapered) over four to six weeks with the goal of ultimately stopping it completely.

  • It is very important to decrease the dose of prednisone slowly to minimize the risk of relapse
  • After the first month of prednisone therapy, a common strategy is to decrease the dose by 10 mg each week (Example: If taking 70 mg daily for the first four weeks, beginning week 5 => 60 mg once daily, week 6 => 50 mg once daily, week 7 => 40 mg once daily, and continuing until prednisone is discontinued)

Some patients are not able to fully discontinue prednisone and require a low daily dose of prednisone (example 10 mg once daily) to prevent the platelets from decreasing to an unsafe level and to prevent bleeding.

It is important to take prednisone as early in the day as possible because it can cause difficulty sleeping at night (insomnia). Prednisone should also be taken with food to prevent a stomach ulcer.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

Side Effects

In clinical studies, the most commonly reported side effects of prednisone are shown here:

  • Puffiness or swelling of the face, (13%)
  • Weight gain, (10%)
  • High blood pressure, (8%)
  • High blood sugar, (6%)
  • Trouble sleeping [insomnia], (5%)
  • Stomach ulcer, (5%)
  • Dizziness, (5%)
  • Fluid retention, (4%)
  • Fatigue, (4%)
  • Mood swings, (4%)
  • Nausea, (3%)
  • Infection, (3%)
  • Joint pain, (2%)
  • Heart palpitations, (1%)
  • Diarrhea, (1%)

On average, 2% of patients discontinue prednisone treatment due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingPainPainDiarrheaDiarrhea

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment then as often as daily during the first week, then periodically during treatment until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging is rarely needed. Imaging may include a chest X-ray if signs or symptoms of pneumonia are present. A CT scan (computerized tomography) may be needed if there is concern of a bleed in the head (known as intracranial hemorrhage).

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue prednisone as planned, reduce the dose, or switch to an alternative therapy.

Prednisone can work in as little as two days, but often takes 6 days to increase the platelet count. In some patients, the time it takes for the platelet count to increase may be longer.

As many as 30% of patients with ITP will not respond to prednisone therapy and require other forms of ITP treatment to increase the platelet count.

ChemoExperts Tips

  • Additional medications that may be prescribed include
    • 1) Bactrim® (Sulfamethoxazole/Trimethoprim; unless you have a sulfa allergy) to prevent Pneumocystis Pneumonia and
    • 2) Omeprazole (Prilosec®, or a similar medication) to prevent stomach ulcers from taking prednisone for a long period of time
  • Prednisone may cause an increase in blood sugar and worsening of diabetes. Adjustments in insulin and other diabetes medications may be needed during therapy with prednisone
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for ITP. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Prednisone, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Prednisone. Depending upon your income, they may be able to help cover the cost of:

  • Pred­nisone

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Prednisone and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Prednisone

Individual Drug Label Information

Pred­nisone (Deltasone®)

  • Prednisone is an oral medication, usually supplied as a white tablet
  • Prednisone may increase the risk of infection. Depending upon how much prednisone is taken, antibiotics may be prescribed to help prevent infections during treatment with prednisone
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 P.M. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of prednisone may need to be gradually decreased to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Prednisone Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the Prednisone package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

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References

1) Wei Y, Ji XB, Wang YW, et al. High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial. Blood 2016;127:296-302.

2) Bellucci S, Charpak Y, Chastang C, et al. Low doses conventional doses of corticoids in immune thrombocytopenic purpura (ITP): results of a randomized clinical trial in 160 children, 223 adults. Blood 1988;71:1165-1169.

3) Connell NT and Berliner N. Which ’roid is all the rage? Blood. 2016;127:273.

Created: January 21, 2018 Updated: November 14, 2018

What is Immune Thrombocytopenic Purpura (ITP)?

A disorder where platelets decrease in number due to decreased production in the bone marrow and increased destruction in the blood. This can lead to an increased risk of spontaneous bruising or bleeding (without injury), especially when the platelet count drops below 30,000 cells per microliter of blood.

I  = Immune, ITP is caused by a disturbance in the immune system
T  = Thrombocytopenic, a medical term meaning low platelet count
P  = Purpura, a type of bleeding in the skin

ITP is NOT a cancer, but it is commonly managed by hematologists (blood doctors) who often treat blood cancers as well. ITP is an uncommon condition and may be caused by auto-immune disorders, infections, certain medications, or pregnancy. However, in many cases, a cause cannot be identified which gives rise to its other name-idiopathic (meaning “cause unknown”) thrombocytopenic purpura. Although ITP may spontaneously resolve, for some patients lifelong therapy may be needed.

The effectiveness of medications may depend upon the causes of ITP and the ability to remove these causes, or whether a splenectomy (removal of the spleen) has been performed, or is able to be performed.

Deciding on a treatment for ITP is in a way like buying, owning, and driving a car. Think about the following similarities to help you understand which treatment is right for you:

BUYING: "0 - 50 time" (0 to 50 k/µL platelets, instead of 0 - 60 m.p.h) is an important performance feature
Once the platelet count exceeds 50 k/µL, bleeding episodes are rare. Therefore, the time it takes to go from very few platelets to a platelet count over 50 k/µL matters. In general, steroids such as prednisone and dexamethasone have the fastest "0 - 50" time.

  • Although exceptions, the thrombopoeitin receptor agonists romiplostim and eltrombopag usually have a 0 - 50 k/µL platelet time of 1 - 2 weeks
  • Although exceptions, one-half of rituximab recipients have a 0 - 50 k/µL platelet time below 5.5 weeks, and the other half over 5.5 weeks. The response to rituximab is often unpredictable

OWNING: Warranty offered?
A 5-year bumper-to-bumper warranty helps us worry less about something breaking or going wrong with our vehicle after we buy it. Likewise, not all medications used for ITP have a long-lasting effect in keeping the platelet count above 50 k/µL.

  • When it works, rituximab can work for 1 - 2 years, but lasting responses beyond two years are rarer. The 5 year rituximab response rate is estimated at 20 - 25%. When the rituximab "warranty" runs out and platelets fall, patients with ITP that had a long lasting response to rituximab may respond to another course of therapy. Certain insurances require the platelet count to be less than 30 k/µL before it will be covered.
  • When they work, the thrombopoeitin receptor agonists romiplostim and eltrombopag generally have lasting effect beyond that of rituximab. The "warranty" period where the platelet count remains above 50 k/µL often lasts 2 years or longer

DRIVING: Cruise control optional?
The ability for a treatment to maintain the platelet count within the goal range is similar to setting the cruise control on a car.

  • Steroids are given in a pulse (example: dexamethasone daily for 4 consecutive days) or given daily for several weeks (example: prednisone), then decreased over several weeks and eventually discontinued a few months after it is started. As a result, when steroids are no longer taken there is a chance for ITP to relapse
  • Because eltrombopag and romiplostim are administered continuously, these medications have the highest likelihood of keeping the platelet count in the goal range for the long haul
  • Rituximab is typically given once weekly for 4 doses, and usually takes several weeks to determine if it is working (see above), therefore it is difficult to predict who will have a lasting response to this therapy
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium