Evaluate infection status and chronic conditions before initiating prednisone.
Absolute: untreated systemic fungal infections, hypersensitivity. Relative: active infections, uncontrolled diabetes or hypertension, peptic ulcer disease, severe osteoporosis, glaucoma.
Prednisone-induced immunosuppression worsens invasive mycoses, so treat the infection first unless steroid rescue is life-saving.
Although rare, excipient-driven anaphylaxis has been reported; switch to an alternative glucocorticoid with distinct excipients.
Prednisone raises glucose through gluconeogenesis and insulin resistance; intensify monitoring and adjust antidiabetic therapy if steroids are unavoidable.
Immunomodulation blunts inflammatory responses and delays recognition of infection; screen for latent disease and provide prophylaxis when appropriate.
Chronic courses accelerate bone loss and osteonecrosis; co-manage with bone-protective therapy and limit cumulative dose when feasible.
High-dose systemic steroids reduce vaccine take and raise dissemination risk; defer live vaccines until prednisone tapers below immunosuppressive thresholds.