Long-term use of drug not risk-free

Dear Dr. Roach: I am 76 years oldandhavebeenon10 mgprednisone daily for four years. I have Wegener’s granulomatosis. I am growing more and more fearful of its long-term consequences. I am considering asking my doctor to ease me off this drug. Is it too much to hope thatmy body’s natural cortisone will kick in after four years on prednisone?

My lungs seem to have escaped harm so far, and my creatinine and glomerular filtration rate have been stable at 2.9 and 21, respectively. The past few months I have had a herniated disc, shingles and sciatica, and was just diagnosed with osteoporosis. I also can’t stand being so overweight.— R.B.

Prednisone, an anti-inflammatory steroid called a glucocorticoid, has had a dramatic, lifesaving effect on many diseases, but it comes at a cost. At least two of the concerns you mention, weight gain and osteoporosis, are common side effects of long-term use. The trend has been to find alternatives with less toxicity.

For people who have been taking lowdoses— less than 10 milligrams — the risk is low, unless the dose has been taken at bedtime; that is more likely to suppress the body’s ability to make cortisone. This low dose can be taken long term with low risk. Even higher doses present a low risk if they have been taken for less than three weeks.

People are athigh risk if they have been takingmore than 20 mg (or have been taking 5 mg or more at night) for three weeks or more, or if they have the typical appearance of someone taking steroids for a long time (such as the classic round or “moon” face).

Since you don’t fit into “high risk” or “low risk,” most authorities recommend a slow and cautious tapering off if your doctor feels it appropriate to stop it. If you were to need surgery, you could get tested for your ability to make cortisone (called a stimulation test).

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu.