Prednisone: 7 things you should know
Medically reviewed by C. Fookes, BPharm. Last updated on Feb 26, 2019.
1. How it works
- Prednisone is a corticosteroid that is used to reduce inflammation and calm down an overactive immune system. Its glucocorticoid activity is greater than its mineralocorticoid activity, which means that it has more effects on the immune response and inflammation than it does on electrolytes and fluid. Prednisone may also be called a glucocorticoid.
- Prednisone mimics the effect of glucocorticoid hormones that are secreted naturally by our adrenal glands in response to stress and which are essential for life. Prednisone is a man-made (synthetic) version of these hormones.
- Prednisone helps dampen down an over-reactive immune system and reduces inflammation.
- Can help control severe or incapacitating allergic conditions unresponsive to conventional treatment including asthma, allergic rhinitis, and atopic dermatitis.
- Controls excessive inflammation associated with certain eye diseases, skin diseases, hematological disorders, and respiratory diseases.
- May be used short-term in the management of acute flare-ups or exacerbations of arthritis (includes Rheumatoid arthritis, osteoarthritis, and psoriatic arthritis), ankylosing spondylitis, bursitis, and other inflammatory disorders.
- May be used short-term for the management of collagen disorders including systemic lupus erythematosus, polymyositis, and acute rheumatic carditis.
- Used for the palliative care of certain leukemias and lymphomas.
- In people with endocrine disorders, mineralocorticoids such as hydrocortisone or cortisone are mostly preferred over prednisone; however, in certain circumstances, prednisone may be given.
- Can help regain control over the inflammatory process associated with diseases such as ulcerative colitis and regional enteritis. May be used in the treatment of some kidney disorders.
- May be used short-term for a number of other conditions.
- Generic prednisone is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Agitation or irritability, dizziness, indigestion, headache, an irregular heart beat, swelling, and mood changes are common side effects reported with short-term use. Facial hair growth (especially in women); high blood pressure and other cardiovascular effects; an increased appetite which may result in weight gain; slow skin healing and skin thinning; osteoporosis (brittle bones); the onset of diabetes; and stomach ulcers are associated with moderate-to-long term use.
- Prednisone increases a person's susceptibility to infection. The risk is greater with higher dosages. Some signs of an infection may be masked by prednisone. Some infections associated with prednisone use have been fatal, especially those associated with viral illnesses such as chickenpox or measles.
- Prednisone exacerbates systemic fungal infections and should not be used in people with systemic fungal disease (such as candidiasis or aspergillosis). Latent diseases (caused by pathogens such as amoeba, tuberculosis, or Toxoplasma) may also be activated.
- Side effects are more likely to be experienced at dosages greater than 7.5 mg/day and with long-term therapy. Long-term prednisone administration has been associated with the suppression of the hypothalamic-pituitary adrenal (HPA) axis (a complex interactive signaling and feedback system involving the hypothalamus, the pituitary gland, and the adrenal glands). Suppression of this axis can result in corticosteroid insufficiency - where natural corticosteroid levels are no longer adequate to maintain vital bodily processes - after withdrawal of treatment. For this reason, moderate-to-long-term prednisone therapy should be withdrawn gradually.
- The dosage of prednisone requires adjusting during times of stress.
- All corticosteroids, including prednisone, can cause salt and fluid retention, which may lead to blood pressure elevation and increased potassium excretion. Calcium excretion is also increased.
- Prolonged prednisone use may affect growth and development in children.
- Cataracts, glaucoma, eye infections, an increase in new episodes of optic neuritis and corneal perforation associated with herpes simplex of the eye, have all been reported with prednisone use.
- Alcohol should be limited or avoided to help reduce the risk of gastrointestinal side effects.
- With high doses of corticosteroids, live or live-attenuated vaccines should be delayed until several months after corticosteroid treatment has stopped.
- May not be suitable for some people including those with cardiovascular disease, low thyroid levels, gastrointestinal disease, pre-exisiting bone disease, or psychiatric disorders.
- May interact with a number of other drugs including some anti-infectives, antidiabetic agents, bupropion, NSAIDs, and drugs metabolized by CYP 3A4 liver enzymes.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Take with food and a full glass of water to reduce the risk of prednisone adversely affecting your stomach.
- Single doses are preferred over split doses; however, larger dosages may be split. Some people may be instructed to only take prednisone every other day (alternate day therapy).
- Take prednisone in the morning, before 9 AM (unless instructed otherwise) to more closely mimic your body's natural secretion of cortisol. Take your prednisone exactly as directed by your doctor. Never increase the dosage unless under your doctor's advice.
- Stopping prednisone suddenly can be dangerous. Your doctor will advise you on how to taper down your prednisone dose if you have been taking it for more than a few weeks.
- If you are taking higher dosages of prednisone, you should not receive any live or live-attenuated vaccines. Your response to killed or inactivated vaccines may also be diminished.
- Avoid contact with anybody known to have, or recently exposed to, viral illnesses such as chickenpox or measles. If you inadvertently come into contact with somebody, contact your doctor immediately as immune globulin or antiviral treatment may be required.
- Limit or avoid alcohol use while taking prednisone to help reduce the risk of indigestion and the development of stomach ulcers.
- Talk with your doctor as soon as possible if you are taking prednisone and you become unwell, for any reason.
6. Response and Effectiveness
- Prednisone takes approximately 60 minutes to be metabolized in the liver to its active form, prednisolone. Liver disease does not appear to affect metabolism. Effects can last from 18-36 hours, meaning that alternate day dosing is possible.
- Temporary dosage increases may be necessary during disease flare-ups or during times of stress or infection.
- Prednisone is five times more potent at relieving inflammation than naturally occurring cortisol.
Medicines that interact with prednisone may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with prednisone. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed. Common medications that may interact with prednisone include:
- Antibiotics, such as clarithromycin, erythromycin, rifabutin, rifampin, or troleandomycin
- Anticholinesterases, such as neostigmine, or pyridostigmine
- Anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
- Antidepressants, such as desipramine, fluoxetine, sertraline, or St. John's Wort
- Antifungal medications, such as itraconazole, ketoconazole, or voriconazole
- Antinausea medications, such as aprepitant
- Epilepsy medications, such as carbamazepine, oxcarbazepine, phenobarbital, phenytoin, or primidone
- Estrogen-containing hormonal contraceptives (includes birth control pills, patches, rings, implants, and injections)
- Heart medications, such as amiodarone, diltiazem, or verapamil
- HIV medications (eg, atazanavir, delavirdine, efavirenz, indinavir, etravirine, ritonavir, nevirapine, saquinavir, or tipranavir)
- Immunosuppressants, such a cyclosporine
- Nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ibuprofen, ketorolac, meloxicam, nabumetone, or naproxen
- Other corticosteroids, such as dexamethasone
- Potassium-depleting agents, such as amphotericin B Injection and diuretics (eg, furosemide, hydrochlorothiazide)
- Some asthma medications, such as zafirlukast
- Vaccines (may inhibit the immune response)
- Others, such as aminoglutethimide, bupropion, cholestyramine, cyclosporine, digoxin, isoniazid, quetiapine, or thalidomide.
Prednisone may increase blood glucose concentrations in people with diabetes and dosage adjustments of antidiabetic agents (eg, insulin, glyburide) may be required. Use with fluoroquinolone antibiotics (such as ciprofloxacin, levofloxacin) may increase the risk of tendon rupture with fluoroquinolones.
In addition, alcohol can increase the likelihood of gastrointestinal side effects with prednisone, and possibly liver and kidney damage. Prednisone may suppress the inflammatory response to skin tests.
Note that this list is not all-inclusive and includes only common medications that may interact with prednisone. You should refer to the prescribing information for prednisone for a complete list of interactions.
Prednisone [Package Insert]. Revised 11/2017. West-Ward Pharmaceuticals Corp https://www.drugs.com/pro/prednisone.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Prednisone only for the indication prescribed.
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