Re: Oral Methylprenisolone and Fatigue

Posted By Lee on December 23, 1998 at 18:16:21:

In Reply to: Re: Oral Methylprenisolone and Fatigue posted by CCF Neuro[P] MD, RPS on December 23, 1998 at 17:10:10:






: : Recently my doctor prescribed oral predisone to help combat an infection that a course of antibiotics
: : did not overcome.  In the course of taking the meds, my fatigue level went higher than what it had been
: : prior to the infection.  At the time, they suspected I may have MS.
I have heard that Medrol can cause and increase in fatigue in some diseases, but not necessarily in
: : MS.  What other diseases with characteristic fatigue could show an increase in fatigue with the introduction
: : of a Medrol Pak?
Dear Lee:
What was the infection?  For most patients with MS, actually, steroids seems to give them a boost, not only in energy but also in affect.  But yes, it can cause fatigue and drowsiness.  Prednisone can cause the lymphocyte population to decrease by down-regulating the IL-2 gene.  In the test tube it can actually induce lymphocyte death.  Anyway, it can cause the release of certain types of cytokines that have the same effect as having the flu (sort of what your natural immune system does in a generalized viral illness). These cytokines can cause fatigue.  Another way that steroids can induce a fatigue like state is when they suppress the adrenal axis and down-regulate ACTH release.  However, as I said before, usually steroids give one energy due to the release of glucose.  So, in reality there are not specific diseases that will give an individual fatigue from added steroids.  It would depend on how acute and pronounce a disease happened to be when the medication was given, and how that individual would react to the added steroid.  Sorry, that there isn't a particular set of diseases.  This is my experience and maybe there are others who have seen particular diseases react to steroids with fatigue as a general symptom of the steroid, but I haven't nor have I read anything concerning this fact.
Sincerely,
CCF Neuro[P] MD, RPS
Thank you for your response.  The med-pak was given after a course of erythromycin
for the fourth episode of pharyngitis this year. (It did not work.
I have subsequently had two more episodes of pharyngitis, the most recent also causing
severe bronchitis.)  
I am allergic to most antibiotics and had an extreme reaction to augmentin which was given after the erythromycin (I only took one pill)
and which caused vomiting so violent that I had tiny red bruises from my cheekbones to my hairline and dark purple bruises under my eyes,
red "whites" of the eyes and a small amount of bleeding from them as well.  The medpak was given INSTEAD of an antibiotic at that point.
I found your answer very interesting.  Thank you.
        
Dear Lee:
Just for your information, the only throat infection that needs to be treated with antibiotics is strep throat.  If you have reoccurring strep then you might be a carrier of strep and in that case a coarse of clindamycin would be of benefit.  I hope your throat infections go away.  
Let us know if we can be of help.
Sincerely,
CCF Neuro[P] MD
Thank you again.  I have had these since I was a child along with recurring ear infections and kidney infections.  I always figured I just had lower immunity than everyone else.