Medications

Prednisone

Prednisone is a synthetic hormone commonly referred to as a “steroid”. Prednisone is very similar to cortisone, a natural corticosteroid hormone produced by the body’s adrenal glands.

Prednisone is used for the treatment of Rheumatoid Arthritis, Psoriatic Arthritis, Polymyalgia Rheumatica, Systemic Lupus Erythematosus, diseases that cause inflammation of the blood vessels (vasculitis), other types of arthritis, and for many other types of diseases.

Prednisone suppresses the body’s immune system and also works to reduce inflammation that people experience as heat, redness, swelling, and pain.

Corticosteroids like prednisone are very different from anabolic steroids, the risky steroids related to male hormones that some athletes abuse for performance gains in sports and bodybuilding.

Taking Prednisone

Prednisone is usually available as oral tablets. Other medications that are similar to Prednisone called corticosteroids may be given by injection.

Prednisone – Dose, Administration, and Frequency

Typical doses for Prednisone vary, and can range from 1 mg per day to 100 mg per day.

Sometimes Prednisone is prescribed every other day and sometimes it is prescribed two or even three times a day.

The dose may be increased during stressful events like surgery or another medical illness to mimic the body’s normal hormone response.

Prednisone is often best taken in the morning with breakfast. This schedule mimics the body’s natural production of corticosteroid hormones.

Most patients start to feel the effects of prednisone within a few days. Some patients will start feeling better hours after taking the first pill.

Important Tests and Risks

Prednisone has a number of potential side effects. Not all patients who take prednisone experience these side-effects.

Side-effects are often related to the dose and the length of time that a given patient has been taking this medicine. Higher doses taken for long periods of time are be more likely to cause side-effects than short courses of lower dose prednisone.

Stopping Prednisone

Prednisone needs to be gradually reduced to stop. Stopping prednisone too quickly can sometimes result in serious side-effects.

Patients should call their doctor before making any changes to their dose.

Forgetting a Dose

If you take prednisone and forget to take a dose at your usual time, but remember later the same day, take it immediately.

If you take prednisone daily and forget the previous day’s dose, skip that dose and resume taking the usual dose for today.

If you take prednisone on alternating days and forget the previous day’s dose, take that dose today, and then tomorrow resume the schedule of alternating days.

Calcium & Vitamin D Supplements

Prednisone can weaken the bones.

Doctors often advise patients to take extra Vitamin D, and sometimes they may prescribe a “bone hardener” medication to take along with Prednisone.

Watch Out for Potentially Serious Side-Effects

A very rare but serious possible side effect of Prednisone is avascular necrosis.

Patients should call a doctor immediately if they develop a new severe pain in the groin while taking this medication.

Science

How Prednisone Works

Prednisone is a synthetic corticosteroid that is similar to cortisone, a natural corticosteroid hormone produced in the body’s adrenal glands.

Prednisone suppresses the body’s immune system, and prevents the release of substances in the body that can cause inflammation (heat, redness, swelling, and pain).

Although corticosteroids like Prednisone are often called “steroids”, they are very different from the types of male-hormone-related steroids that some athletes might abuse for strength or performance gains in sports.

Despite Prednisone’s potential for side effects, the combined immunosuppressive and anti-inflammatory effects of the medication, as well as its relatively fast action compared to many other treatments, can make it a very useful tool to treat many forms of arthritis.

Safety

Side Effects

Not all people who take prednisone have side-effects. The side-effects are largely related to the dose and the length of time that the medication is taken. Higher doses taken for longer periods of time (over 3 months) would be more likely to cause side-effects than short courses of lower dose prednisone.

People taking prednisone should talk to their doctor if they are concerned about any side effects.

Short-term side effects

As the dose of prednisone is decreased and stopped the following side-effects will disappear:

  • Mood changes – Some patients feel full of energy (euphoric) which may result in difficulty sleeping, while others patients may feel depressed or irritable, or rarely, have hallucinations.
  • Increase in appetite – the medication can increase appetite and this can result in weight gain
  • Face and back swelling – prednisone can cause swelling of the face or the upper part of the back.
  • Stomach irritation – prednisone can sometimes upset the stomach with nausea or indigestion.
  • Blurry vision – prednisone can sometimes cause blurry vision.
  • Risk of infection – prednisone can decrease a person’s resistance to infection. Any infections or fevers should be taken seriously and reviewed by a doctor.
  • In women, Prednisone may cause alterations in the menstrual cycle.
  • Blood sugars – prednisone may cause a rise in blood sugars, sometimes resulting in diabetes.
  • Rise in blood pressure and fluid retention – prednisone may cause a rise in blood pressure or fluid retention (ankle swelling).

Long-term side-effects

The following side-effects might occur in patients who have taken prednisone for long periods of time.

In many patients, these side-effects can be reduced with appropriate monitoring and prevention.

  • Skin changes – prednisone can affect the skin, such as: an increase in acne, hair growth, easy bruising, or wounds that take longer to heal.
  • Eye problems – with prolonged use of prednisone, cataracts or glaucoma may develop.
  • Bone loss – prednisone can cause loss of calcium from the bones in some people, resulting in fragile bones (osteoporosis).
  • Bone damage – a rare side-effect is damage to the bones called osteonecrosis. This can occur in any bone but the most common site is the hip, resulting in groin pain.
  • Muscle weakness – rarely muscles around the hips and shoulders become weak, causing difficulty climbing stairs or getting up from a chair.

How to minimize the side-effects of prednisone

  • Patients should take prednisone as prescribed and attend regular follow-up visits with their doctor.
  • People taking prednisone for a prolonged period (more than 3 months) can obtain a “MEDIC-ALERT” bracelet.
  • Taking prednisone with food can help to reduce problems with nausea.
  • Following a diet can help maintain body weight.
  • Patients should remember to take any medications that they may be prescribed that reduce the risk of osteoporosis. Patients should ensure that they are taking appropriate amounts of calcium and vitamin D and discuss these supplements with their doctor.
  • If planning a trip or vacation, people taking prednisone should ensure they have an extra backup supply. Any medication should always taken on-board any flights or ships as carry-on and not stored with checked luggage.

Who Should NOT Take Prednisone

People who should NOT take prednisone include:

  • Patients who have had a previous serious allergic reaction to the medication

People who become pregnant or are planning to become pregnant should discuss their medications with their doctor.

Prednisone is believed to be one of the safer medications and has been used safely and successfully to treat arthritis during pregnancy.

When to Call a Doctor

Patients taking prednisone should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.

Other reasons to call a doctor while taking prednisone include:

  • New severe groin pain
  • Fever or possible infection
  • Blurry vision
  • Pregnant or Planning Pregnancy
  • Planning surgery

Video

Watch Canadian rheumatologist Dr. Andy Thompson introduce Prednisone in this short video: