Prednisone - 10 Things You Should Know

Safe Use of Prednisone Decreases Unwanted Side Effects

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Prednisone is a potent anti-inflammatory medication used to treat inflammatory types of arthritis and other conditions. Misuse can lead to undesirable side effects. Prednisone must be taken according to directions and safety warnings must be respected. If you take prednisone or may take prednisone in the future, here are 10 things you should know.

1 - Prednisone reduces inflammation and suppresses the immune system.

Corticosteroids such as prednisone are used by some arthritis patients to reduce inflammation and suppress immune system activity.

Synthetic corticosteroids, like prednisone, are designed to mimic cortisol action in the body. Cortisol is a natural corticosteroid produced by the adrenal glands.

Prednisone is available in tablet form, liquid, or concentrated solution to take by mouth.

2 - Prednisone is inactive in the body until it is converted to prednisolone by liver enzymes.

People who have liver conditions may less effectively convert prednisone to prednisolone. In some cases, a higher dose may be required to compensate for the liver problem.

3 - The starting dose of prednisone depends on the specific condition being treated.

A patient should review all other medications and supplements which they take with their doctor. It is possible that your dose of prednisone may need to be adjusted with other medications or supplements you take. Depending on the condition being treated, a starting dose between 5 mg and 60 mg per day is not uncommon.

The dose is further adjusted based on treatment response. The benefit is usually not immediate and may take a few days or longer.

4 - Prolonged use of prednisone can cause adrenal glands to atrophy and stop producing cortisol.

Patients are often told not to stop taking prednisone suddenly. After long-term use, the dose of prednisone must be tapered gradually to allow the adrenal glands, which may have atrophied, time to recover.

Otherwise, the patient could put themselves in jeopardy of entering into adrenal crisis (e.g., nausea, vomiting, shock).

5 - The usual directions for taking prednisone indicate that the medication should be taken with food.

The most common way to take prednisone is as a single daily dose taken with breakfast. Sometimes, however, the dose can be split and taken either 2 or 4 times a day. If you are having a planned surgery or have a medical emergency, let doctors know you take prednisone. Your dose may need to be adjusted temporarily.

6 - Drug interactions are possible with prednisone.

Prednisone may interact with certain drugs or supplements. For example, estrogen may interfere with breaking down of prednisolone (the active form of prednisone). If an increased level of prednisolone results in the body, more side effects are possible. Another drug, Dilantin, increases the activity of liver enzymes that eliminate prednisone and may decrease the effectiveness of prednisone.

7 - There are mild to severe side effects associated with prednisone use. The side effects occur more frequently with high-dose or long-term use of prednisone.

Possible side effects include:

  • Sodium (salt) retention
  • Fluid retention
  • Weight gain/Obesity
  • High blood pressure
  • Elevated blood sugar
  • Elevated blood fats
  • Potassium loss
  • Headache
  • Muscle weakness
  • Puffiness or moon face
  • Growth of facial hair
  • Bruising easily
  • Thinning of skin
  • Poor wound healing
  • Cataracts
  • Glaucoma
  • Stomach ulcers
  • Aseptic necrosis
  • Irregular periods
  • Rounding of upper back
  • Growth retardation in children
  • Increased appetite
  • Insomnia
  • Psychiatric issues (depression, mood swings, personality changes)

8 - Prednisone increases the risk of infections and decreases the effectiveness of vaccines and antibiotics.

It is imperative that you discuss a current or ongoing infection with your doctor. Because prednisone suppresses the immune system, adjustments may need to be made to your treatment plan.

9 - Prednisone may cause osteoporosis, a brittle bones condition.

High-dose and long-term use of prednisone may increase the risk of developing osteoporosis. Patients are usually advised to take calcium and vitamin D, and possibly one of the bisphosphonates (e.g. Fosamax, Actonel, Boniva, Calcitonin).

10 - If you are taking prednisone and become pregnant, wish to become pregnant, or are breastfeeding, you should alert your doctor.

Prednisone is less likely to cross the placenta than some of the other corticosteroids, but it may cause a birth defect, such as cleft palate. Prednisone is less likely than other corticosteroids to be secreted in breast milk, but still may cause problems for the baby.


Drug Information: Prednisone. MedlinePlus.

Drug Guide: Prednisone. Arthritis Foundation.

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