Prednisolone: A danger to sportsmen, women

PREDNISOLONE is one of the common drugs that is prescribed in many health facilities.
I have also prescribed this drug countless times to patients. The drug is however not routinely permitted in sport especially if found during doping controls.
Prednisolone in sport must always be accompanied by an approved therapeutic use exemption (TUE).
A few days ago, I was in South Africa where I was on a doping control assignment and the driver who picked me from the airport had a lot of questions for me.
One of  the common introductory remarks which I got used to during this particular assignment was” This is Dr Joseph kabungo, the doping control doctor”.
This remark reminded me of the seriousness attached to doping control in sport.
Arsene Wenger, the coach for Arsenal has called for routine blood tests at soccer matches in order to curb doping.
Doping is cheating and it is against the ethics of sport.
I will use Prednisolone as a prototype drug to discuss this important subject.
Medical personnel each time they make a diagnosis or establish what is wrong with us always give prescriptions.
If a person is diagnosed with malaria then coartem is given or if it is gastritis specific medicines are always prescribed.
This shows that prescription for drugs are specific depending on what an individual is suffering from.
However, some of the medicines, which can be prescribed to an athlete, have got potential of causing an athlete to test positive to banned substances.
This is why athletes have to take care of some of the drugs prescribed to them.
The World anti-doping agency (WADA) is strict on this issue.
It has emphasised its quest to fight doping control by stiffening the penalty for any athlete found positive for any of the prohibited substances.
The Confederation of African football (CAF) and FIFA have also renewed their commitment to continue the fight against doping.
It is always the desire of CAF and FIFA that all the rules governing sport are strictly adhered to.
FIFA has stated that the fundamental aims of doping controls and anti-doping policies are:
-To uphold and preserve the ethics of sport
-To safe guard the physical health and mental integrity of the player
-To ensure that all competitors have an equal chance of winning.
These fundamental aims have to be respected in competitive sport at all times.
Doping control is not a foreign concept to sport in our country and all athletes have to know that if they are in competition they will have to undergo a doping control at some point.
This is the reason why prescriptions given to athletes have to be scrutinised.
Sometimes prescriptions, which are innocently given to athletes, are potential sources of a positive dope test.
Doping is defined as any attempt either by the player, or at an instigation of another person such as a manager, coach, doctor, physiotherapist to enhance mental and physical performance unphysiologically or to treat ailments or injury-when this is medically unjustified.
It is clear from the definition of doping that there are so many people who might be involved in doping and the medical reasons for giving such a substance must be justified.
Justification of the use of a prohibited substance in sport involves application for a therapeutic use exemption (TUE) at least 21 days before engaging in competition for those athletes who suffer from chronic conditions.
I will not discuss the therapeutic use exemption (TUE) and will reserve this discussion for another time.
I am more concerned about prednisolone, which athletes come into contact with.
The question, which might be asked, is whether all formulations of prednisolone are permitted in sport or not?
I must mention that prednisolone might come in many formulations, which include oral tablets, intramuscular and intravenous injections, and eye and ear ointments.
The other form of prednisolone might be that of a cream for the skin. In sport prednisolone might actually be used as an intra-articular injection, which is a very frequent use of his type of drug in athletes.
Prednisolone, which is given, as an intra-articular injection is not prohibited in sport, just like the eye, ears and skin formulations of prednisolone. However, predinisolone, which is found in the class of drugs known as glucocorticosteroids, is not permitted in its tablet form.
It is also not permitted to be given as an injection through the muscle or through the vein.
Prednisolone is found in the same class of drugs such as cortisol and hydrocortisone, which are all very common glucocorticosteroids.
Glucocorticosteroids have their main effect on glucose metabolism.
These drugs lead to glucose formation i.e. from protein and their amino acid constituents.
This process is commonly known as gluconeogenesis. This means that continuous use of glucocorticosteroids will lead to more glucose than usual in the blood of an individual.
Prednisolone is prescribed and used in the treatment of asthma in many hospital settings.
It is such a common drug to be found in many drug stores and pharmacies and at times sold even without a prescription.
The other use of prednisolone is that of its anti-inflammatory effect in allergic diseases, cancers and diseases of the nervous system.
The local applications of the glucocorticosteroids include traumatic inflammatory and degenerative joint diseases (Injection into the joint), problems with tendons, skin diseases as earlier mentioned and diseases of the eye, ear and nose.
When prednisolone or glucocorticosteroids are used locally then an athlete does not need a TUE before competition.
Glucocorticosteroids have many side effects, which are not good for a sports man.
This is the reason why the sports men have to be protected against the irrational use of medicines like this to protect their health.
Glucocorticosteroids to which prednisolone belong have got side effects which might be detrimental to someone’s health.
Some of the side effects might include diabetes mellitus, which might be, precipitated or worsened if it already exists.
It will also lead to water retention and loss of potassium from the body.
In some cases glucocorticosteroids will lead to muscle weakness and this effect is not desirable in sports men.
For que s t ions and contributions write to Dr Kabungo Joseph
Email: zengajk@yahoo. com or kateulejk@gmail. com

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