Prednisone

Prednisone is a prescription corticosteroid (steroid) used to reduce inflammation, suppress an overactive immune system, and treat endocrine and metabolic disorders. Prednisone is used for a wide range of conditions, including severe allergies, asthma and COPD flare-ups, rheumatoid arthritis and other forms of arthritis, lupus, psoriasis and other skin conditions, ulcerative colitis, Crohn's disease, eye inflammation, some blood disorders, and low adrenal hormone levels.

Prednisone works by mimicking the effects of glucocorticoid hormones secreted naturally by our adrenal glands. Prednisone is a man-made (synthetic) version of these hormones. Prednisone is different from steroids taken to build muscle (anabolic steroids).

Prednisone belongs to the drug class called glucocorticoids, which are a type of corticosteroid.

Prednisone tablets come in 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, and 50 mg strengths. Prednisone 20 mg and prednisone 10 mg tablets are the strengths most often used for short courses in adults. Prednisone also comes as a delayed-release tablet (Rayos), as an oral liquid, and as a concentrated oral solution (Prednisone Intensol) that is measured with a special dropper.

Many of the original brands are discontinued; however, generic prednisone is available.

Take prednisone exactly as prescribed, with food or milk to protect your stomach. Your doctor will often start you on a higher dose and then lower it. Do not change your dose or stop the medicine without advice.

• Take your dose in the morning if your doctor tells you to. Your adrenal glands are most active between 2 am and 8 am, and taking a steroid at that time interferes with them the least. A morning dose may also help you sleep better, though that is a separate benefit.
• Swallow delayed-release tablets whole. Do not crush, break, or chew them.
• Measure liquid prednisone with a marked oral syringe, dosing spoon or medicine cup, not a kitchen spoon. Use the dropper that comes with the concentrated solution.
• You may mix the concentrated solution with juice or a soft food such as applesauce.
• Tell your doctor if you have a serious illness, a fever, an infection, surgery, or a medical emergency. You may need a higher dose for a short time.
• You may need regular blood tests, blood pressure checks and eye checks during long-term treatment.
• Wear a medical alert tag or carry a card saying you take a steroid.
• Store prednisone at room temperature, away from moisture and heat. Throw away any unused concentrated solution 90 days after you first open the bottle.

Do not take prednisone if you have a systemic fungal infection, which is a fungal infection that has spread through your body.

Prednisone weakens your immune system. This makes it easier to get an infection; an existing infection may become worse and can reactivate an old infection, such as tuberculosis or hepatitis B. It can also hide the usual signs of infection, so an infection may be advanced before you notice it. Tell your doctor about any illness or infection you have had in the past few weeks.

Stay away from people who are sick. Chickenpox and measles can be serious or even fatal in someone taking a steroid. Call your doctor straight away if you are exposed to either one.

Do not have a live vaccine while you are taking prednisone unless your doctor says it is safe.

Do not stop taking prednisone suddenly after more than a few days of treatment. Your body needs time to start making its own steroid hormones again. Your doctor will lower your dose in steps.

Call your doctor at once if you have shortness of breath, severe pain in your upper stomach, bloody or black stools, severe depression, changes in personality or behavior, vision problems, or eye pain.

You should not use prednisone if you are allergic to it, or if you have a systemic fungal infection.

To make sure prednisone is safe for you, tell your doctor if you have or have ever had:

• an infection of any kind, including tuberculosis, hepatitis B, herpes infection of the eye, or a fungal infection;
• diarrhea that has no clear cause, or time spent in the tropics, since prednisone can wake up a parasite infection such as amebiasis or threadworm;
• malaria, especially cerebral malaria (malaria affecting the brain);
• liver disease, such as cirrhosis;
• kidney disease;
• heart disease, heart failure, high blood pressure or low potassium levels;
• an underactive thyroid;
• diabetes;
• osteoporosis;
• glaucoma or cataracts;
• stomach ulcers, ulcerative colitis, diverticulitis, or a history of bleeding in the stomach or bowel;
• myasthenia gravis (a condition that causes muscle weakness); or
• depression, mood swings or another mental health condition.

Long-term steroid use can cause bone loss. Your risk is higher if you smoke, if you do not exercise, if you do not get enough calcium or vitamin D, or if osteoporosis runs in your family. Talk with your doctor about protecting your bones.

Pregnancy

Prednisone crosses the placenta. Taking it in the first trimester may raise the risk of birth defects, and taking higher doses later in pregnancy may affect the baby's growth and their adrenal glands. Tell your doctor if you are pregnant or plan to become pregnant. Some conditions still need steroid treatment during pregnancy, so this is a decision to make with your doctor rather than stopping on your own.

Breastfeeding

Prednisone passes into breast milk in small amounts. Tell your doctor if you are breastfeeding so you can talk through the dose and the timing of feeds.

Children

Prednisone is used in children, but long courses can slow growth and affect bone development. The dose should not be higher than prescribed, and your child should be monitored during treatment.

Older adults

Older adults are more likely to have liver, kidney, or heart problems that affect how prednisone is handled, and are more likely to already have osteoporosis, diabetes, or high blood pressure. A lower dose may be needed.

Common prednisone side effects

The most common prednisone side effects are trouble sleeping, mood changes, increased appetite and weight gain, fluid retention and swelling, increased sweating, acne, thinning skin that bruises easily, slow wound healing, higher blood sugar, indigestion and stomach upset.

Many of these effects are dose related. They are more likely on higher doses and on longer courses, and most settle after the medicine is stopped.

Serious prednisone side effects

Get emergency medical help if you have signs of an allergic reaction to prednisone: hives, difficult breathing, or swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• signs of infection, such as fever, chills, sore throat, cough or a wound that is not healing, since prednisone can hide the usual warning signs;
• blurred vision, eye pain or seeing halos around lights, which can be signs of glaucoma (raised pressure in the eye) or cataracts;
• severe pain in your upper stomach that spreads to your back, with nausea and vomiting, which can be a sign of pancreatitis (inflamed pancreas);
• bloody or black, tarry stools, or vomit that looks like coffee grounds, which can be signs of a bleeding stomach ulcer;
• severe depression, unusual excitement, confusion, changes in personality or behavior, or a seizure;
• swelling, rapid weight gain or shortness of breath, which can be signs of fluid retention or heart failure;
• signs of low potassium, such as confusion, an uneven heartbeat, extreme thirst, passing more urine than usual, leg discomfort, or muscle weakness;
• a very high blood pressure reading with severe headache, blurred vision, ringing in your ears, chest pain or shortness of breath;
• sudden pain, swelling or bruising in a tendon, especially at the back of the ankle, since prednisone can weaken tendons and cause the Achilles tendon to rupture;
• new bone pain, especially in a hip, shoulder or knee, which can be a sign of aseptic necrosis (bone tissue that has lost its blood supply); or
• flat, painless spots that are red or purple on light skin, or bluish, brown or black on dark skin, which can be a sign of Kaposi's sarcoma.

Prednisone side effects in women

Women taking prednisone may notice irregular or missed periods, unwanted facial hair growth, acne and changes in body fat, such as a rounder face and more fat around the neck and waist. Long courses of prednisone also raise the risk of osteoporosis (thinning of the bones), and postmenopausal women are already at higher risk. Ask your doctor whether you need a bone density scan or a calcium and vitamin D supplement.

Long-term prednisone side effects

Taking prednisone for months or years raises the risk of osteoporosis and broken bones, muscle weakness and muscle loss, cataracts and glaucoma, diabetes, high blood pressure, Cushing's syndrome (a set of changes caused by too much steroid, including a rounded face and fat around the trunk), and adrenal suppression, where your body stops making enough of its own steroid hormones.

Children who take prednisone for a long time may grow more slowly. Your child's doctor should check their growth at regular visits.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The usual starting dose of prednisone for adults is 5 mg to 60 mg per day, depending on the condition being treated and how severe it is.

• There is no single standard dose. Your doctor will decide on a starting dose, then lower it in small steps to the smallest dose that still controls your condition.
• Doses for children are based on the condition rather than strictly on age or weight, and must be set by a doctor.

Short courses of prednisone for problems such as an asthma flare, gout, or a bad allergic reaction are often given as a short fixed-dose course for a few days. A dose pack steps the dose down day by day over about six days. Follow the instructions on your pack exactly, since the number of tablets changes each day.

Prednisone treatment takes one of two shapes. Some people take it for a few days or weeks for a problem that will settle, such as an asthma flare or a severe allergic reaction. Others take it every day for months or years for an ongoing condition such as rheumatoid arthritis or ulcerative colitis.

If you take prednisone long term, your doctor will settle you on a maintenance dose. This is the lowest daily dose that still keeps your condition under control, and it is reached by lowering the dose in small steps rather than all at once. Your maintenance dose is not fixed. It may need to go up for a time if your condition flares, or if you have surgery, a fever, an infection, or another serious illness, and it may come down again afterwards. Do not adjust it yourself.

How do you stop taking prednisone safely?

If you have taken prednisone for more than a few days, your doctor will taper the dose rather than stopping it all at once. While you are taking a steroid, your adrenal glands slow down their own hormone production, and they need time to start up again. Stopping suddenly can cause extreme tiredness, weakness, body aches, upset stomach, weight loss, a craving for salt, and changes in skin color. Call your doctor if you feel unwell while your dose is being lowered or after you finish.

Prednisone formulations

• Prednisone 1 mg tablets
• Prednisone 2.5 mg tablets
• Prednisone 5 mg tablets
• Prednisone 10 mg tablets
• Prednisone 20 mg tablets
• Prednisone 50 mg tablets
• Prednisone Oral Solution 5 mg per 5 mL
• Prednisone Intensol™ Oral Solution (Concentrate) 5 mg per mL
• Prednisone delayed-release tablets (Rayos) 1 mg, 2 mg, and 5 mg

Take the missed dose as soon as you remember. Skip it if it is almost time for your next dose. Do not take extra medicine to make up a missed dose. If you take prednisone once every other day, or you are following a taper, call your doctor or pharmacist for advice rather than guessing.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

A single large dose of prednisone is not likely to cause life-threatening symptoms. The bigger risk comes from taking high doses over a long time, which can cause thinning skin, easy bruising, changes in the shape or location of body fat, acne, extra facial hair, irregular periods, and loss of interest in sex.

• Avoid being near people who are sick or have an infection. Call your doctor if you are exposed to chickenpox or measles.
• Do not have a live vaccine, such as MMR, chickenpox, rotavirus, yellow fever, oral typhoid, or the nasal flu vaccine, without your doctor's approval. Avoid close contact with someone who has just had an oral or nasal live vaccine.
• Limit alcohol. Both alcohol and prednisone irritate the stomach lining, so together they raise the risk of stomach bleeding.
• Be careful with NSAIDs such as ibuprofen, naproxen, and aspirin, since taking them with prednisone raises the risk of stomach bleeding.
• Your doctor may ask you to cut back on salt, since prednisone makes your body hold onto fluid.

Many medicines interact with prednisone. Some change how much prednisone is in your body, and others add to its side effects. Tell your doctor about every medicine you take, including anything you start or stop during treatment. Be especially careful with:

• medicines that raise prednisone levels, such as ketoconazole, itraconazole, posaconazole, voriconazole, clarithromycin, and some HIV and hepatitis C medicines;
• medicines that lower prednisone levels and can make it work less well, such as rifampin, rifabutin, rifapentine, carbamazepine, phenytoin, phenobarbital, primidone and St. John's wort;
• NSAIDs and aspirin, which raise the risk of stomach ulcers and bleeding;
• blood thinners such as warfarin, since prednisone can change how your blood clots and you may need extra monitoring;
• insulin and diabetes tablets, since prednisone raises blood sugar and your doses may need to go up;
• diuretics (water pills) and amphotericin B, which can lower potassium further;
• digoxin, which is more likely to cause problems if your potassium is low;
• live vaccines, which should usually be avoided;
• cyclosporine, which interacts in both directions and raises the risk of seizures; and
• birth control pills and hormone therapy.

This list is not complete. Many other prescription medicines, over-the-counter products, vitamins and herbal products can interact with prednisone. Give a list of all your medicines to any healthcare provider who treats you.