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- Hi, I'm Vicky Ruffing.
I am the Director of Patient Education
at the Johns Hopkins Arthritis Center.
- And my name is Dr. Rebecca Manno.
I'm an Assistant Professor of Medicine
at the Johns Hopkins division of Rheumatology
in the Johns Hopkins Arthritis Center.
Welcome to part two of frequently
asked questions about corticosteroids.
- [Vicky] Our first question is I'm going on vacation.
What if I run out of my prednisone?
- Whenever preparing for travel, it is important
to talk to your doctor about having
an adequate supply of all of your medications,
but especially your corticosteroid or your prednisone.
You may want to ask your doctor for a vacation supply
just in case something happens
to your medication during your travels.
But sometimes things happen.
Maybe your luggage gets lost or you miscounted
how many steroid or prednisone tablets that you have.
If you do run out of your prednisone,
call your doctor immediately.
They can usually refill your prescription
at a local pharmacy.
As we discussed in part one of frequently asked questions,
it is important that you don't
stop your prednisone suddenly.
If you do miss a dose, take your next dose
at the time it is normally prescribed.
- [Vicky] Our next question is about vaccinations.
If I am going to get a vaccine,
is that safe while I'm on prednisone?
- Vaccinations are incredibly important
for all of our patients who are on immunosuppression.
Vaccines can protect against very vicious viruses
and infections that can cause a lot of problems.
If you're on prednisone and you're receiving a vaccine,
you need to know if the vaccine is a live vaccine
or a killed or an inactivated vaccine.
Some live vaccines may not be appropriate
while on immunosuppression,
and specifically, high doses of prednisone.
Vicky, how so you council patients
on the flu vaccine while on prednisone?
- Well, of course we encourage all patients
to get the flu vaccine as well as the pneumonia vaccine.
Now, the flu vaccine does not cause the flu.
It is not a live vaccine.
It is a synthetic, if you will,
vaccine against the flu.
We do not see patients come down
with the flu if they've gotten a vaccine.
I just can't stress enough how important it is
for our patients to get the flu vaccine
just so that they can help boost their immunity
and their resistance against flu,
which of course can be deadly.
- That's great advice, Vicky.
So a scenario that comes up quite frequently, Vicky,
especially among my patients who have been on prednisone
for a long period of time, maybe for conditions
such as polymyalgia rheumatica or rheumatoid arthritis
or giant cell arteritis, and they've been slowly tapered off
the prednisone, maybe over a course of months or even years,
so they're off prednisone, but then something new happens.
For example, they get poison ivy,
or they have a terrible asthma attack,
and their doctor recommends a short course of prednisone
to treat a different condition.
This can cause some stress, anxiety,
and a lot of questions for patients.
How do you council patients in this situation?
- Well naturally I think that patients are afraid
that they'll be tied to their prednisone again,
where they may have to have
that long period of months to taper off.
So it's a natural concern for patients to have.
However, what I like to tell patients is that
when we want to use prednisone in a short burst,
it's for a specific reason, and there is a time limit to it.
So a patient's gonna start it and complete it
within two weeks to a month.
So it starts high with a higher does
and then tapers down quickly,
so you do not see that prolonged taper
that's needed when patients have been
taking prednisone for a long period of time.
It's important to treat whatever the condition is
that's requiring that short burst of prednisone,
so we need to weigh risk and benefit,
and it's definitely more on the benefit side
to go with that short burst of prednisone.
- I absolutely agree, Vicky, and it gets back
to a point we made in one of the earlier videos
about whenever prednisone or a steroid is being prescribed,
as a patient it's important to discuss with your doctor
what is the dose, what is the indication,
what is the duration, and what can I expect
to see as far as benefit before you start the medicine.
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