Prednisone: What are 12 Things You Should Know?

Prednisone first came onto the market over sixty years ago and is still going strong. But did you know that this common drug used for a variety of different conditions also has some pretty serious side effects as well?

1. What Is Prednisone?

Prednisone is a corticosteroid - often called a steroid for short. These types of steroids are different from the anabolic steroids misused by bodybuilders or athletes wishing to gain a competitive edge.

Corticosteroids come in two types - glucocorticoids and mineralocorticoids. Prednisone is a glucocorticoid. Glucocorticoids have a powerful anti-inflammatory effect and mimic cortisol (a hormone that is released by our adrenal glands in response to inflammation and stress). Prednisone controls inflammation by suppressing our immune system and is four times more potent than cortisol at decreasing inflammation.

However, prolonged use can cause immunosuppression, muscle wasting, bone changes, fluid shifts, and personality changes. For these reasons, prednisone is usually only prescribed short-term.

2. Prednisone has been around for more than 60 years

The discovery of prednisone in the 1950s by Arthur Nobile revolutionized the treatment of arthritis.
Since then, it has been used in the treatment of dozens of other conditions, such as asthma, allergies, lupus, multiple sclerosis, ulcerative colitis, and numerous skin conditions. While experts may not know the exact cause of some of these conditions, they do know that they are all associated with inflammation. For example:

• asthma is a chronic inflammatory disease of the airways
• symptoms of an allergic reaction are the result of excessive inflammation caused by an overreaction of the immune system.

Prednisone helps in the treatment of these conditions by dampening down this inflammation.

Prednisone has helped save the lives of hundreds of thousands of people. But like every drug, its good points need to be weighed up against its not-so-good points.

3. Prednisone is inexpensive

Prednisone has long gone off-patent so it shouldn’t leave too much of a hole in your wallet, although some formulations (such as delayed-release preparations) may be more expensive than others.

Your drugstore may sometimes stock different generics from time to time, which may mean that sometimes the color or look of your prednisone may change.
Check with your pharmacist if you are unsure why there is a change. Alternatively, you can use our pill identification wizard.

4. Dosing schedules vary: read the label

Prednisone dosing may be complicated and not uncommonly start with a high dose that is gradually reduced over days to weeks. There is a fine line between too much and too little prednisone. Always read the label or talk with your pharmacist about the schedule your doctor has recommended. Never assume it will be the same as you had last time or the same dose that a friend or family member had.

• Never take more prednisone than your doctor has recommended.
• Never stop prednisone suddenly if you have been taking it for a long period.
• Never start another course of prednisone without first discussing this with your doctor.
• Always follow all instructions.

5. Prednisone is not so kind on your stomach

Prednisone can irritate the lining of your stomach and should always be taken with a meal. If your stomach still feels sore after taking prednisone with food, try taking an antacid. If the discomfort persists or gets worse, talk to your doctor.

You are also more likely to get stomach ulcers if you take prednisone in combination with anti-inflammatories (such as ibuprofen or diclofenac) or aspirin. If you are prescribed these medicines, ask your doctor about protective agents that can reduce this risk.

6. Morning dosages are usually best for prednisone

If you take prednisone daily, for a long period, it can cause adrenal gland suppression. This is when your body stops producing cortisol by itself.

If you are on daily prednisone, experts recommend taking the dose in the morning, to reduce this risk. Taking prednisone too late in the evening can cause sleeplessness and insomnia, too. Make sure you also take your dose of prednisone with food, and just FYI, grapefruit juice has no effect on prednisone.

Prednisone has long-lasting effects and is usually prescribed once daily. Occasionally, people on higher dosages are instructed to take it twice a day for short periods before dropping it down to just a single dose.

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7. Some people may experience withdrawal symptoms on stopping prednisone

This doesn’t mean that prednisone is addictive. Rather it means that it can just take a while to kick-start your body back into producing cortisol again if you have been on prednisone for longer than two weeks.

Withdrawal symptoms can range from severe fatigue to weakness, body aches, joint pain, and difficulty sleeping. Talk to your doctor about slowly tapering prednisone over several weeks if you need to discontinue it.

8. Prednisone increases your risk of infection

Infections are more common in people taking prednisone because it suppresses their immune system. This makes it harder for your body to fight off infection. In some circumstances, prednisone can help pre-existing infections, particularly those caused by yeasts or fungi, to spread.

Symptoms of an infection may also not be as obvious or typical while you are on prednisone. While you are taking prednisone, you should take common-sense precautions to reduce your risk of infection - such as washing your hands often and avoiding people who are sick, especially those with viral illnesses such as COVID-19, chickenpox, or measles.

ell your doctor straight away if you develop any sort of infection, including eye infections or candida infections, while you are taking prednisone.

9. Long term side effects of Prednisone can be severe

Long-term use of prednisone may lead to bone loss and osteoporosis. It can cause changes in the distribution of body fat which together with fluid retention and weight gain may give your face a moon-like appearance.

Stretch marks, skin thinning, and excessive facial hair growth are also not uncommon. Women who are pregnant or planning a pregnancy should let their doctor know before they take prednisone. Prednisone may be given in low doses to women who are breastfeeding a baby for the treatment of certain conditions such as asthma, rheumatoid arthritis, inflammatory bowel disease, or an allergic reaction.

Children are particularly susceptible to prednisone's side effects. Prednisone may suppress growth and development, an unfortunate effect that may be helped by alternate-day treatment or growth hormone therapy. Prednisone may also cause sleeplessness and affect your moods. People with diabetes may find their blood glucose control is not as good as it usually is while they are taking prednisone.

It is a good idea to wear a medical alert tag or carry a Steroid Card if you need to take prednisone long-term.

10. Weight gain is common

Prednisone makes you hungry and weight gain is a common side effect. Fat deposits may occur around your abdomen, face, or back of your neck. Fluid retention can also occur and may manifest as leg swelling and a sudden weight increase.

The higher the dose and the longer the duration of treatment, the more likely you are to put on weight. You can control fluid retention by eating a diet low in sodium and eating more foods that contain potassium such as bananas, apricots, and dates. A diet high in protein and low in carbohydrates may make you feel fuller for longer, making you less likely to overeat.

11. What is the difference between Prednisone and Prednisolone?

Both prednisone and prednisolone are man-made glucocorticoids. They are used to treat similar conditions and are generally considered equally effective. However, in people with liver disease, prednisolone is usually preferred. This is because prednisone needs to be converted by liver enzymes into prednisolone before it can work.

Price-wise, prednisone is usually much cheaper than prednisolone.

12. Prednisone may interact with some medicines

Prednisone can interact with several different drugs, including OTC medicines and some herbal preparations. Let your doctor know about all the medications you take.

The most common interactions are with NSAIDs, anti-infectives (such as ciprofloxacin, and some HIV medicines), immune suppressants, diuretics ("water” pills), and anticoagulants (blood thinners), but there are many more. If you are worried that some of your medicines may be interacting with prednisone, talk with your doctor or pharmacist. Alternatively, you can use our drug interaction checker.