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Prednisone

Sounds like 'PRED-ni-sone'

Key points about prednisone

Prednisone is a steroid used to treat and prevent conditions that cause inflammation.
Prednisone works by calming or suppressing your body's immune system and is especially effective for treating flare-ups of these conditions.
Find out how to take it safely and possible side effects.

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Prednisone is used to treat many illnesses associated with inflammation, eg, asthma, COPD, rheumatoid arthritis, gout, ulcerative colitis, Crohn's disease and other autoimmune conditions.

Prednisone works by calming or suppressing your body's immune system and is especially effective for treating flare-ups of these conditions. Prednisone helps to reduce the symptoms of these conditions – it doesn't cure them.

Prednisone is in a class of medicines known as corticosteroids, which is similar to the steroid hormones your body naturally makes.

In the video below, Dr Thompson talks about prednisone for rheumatic diseases.

Video: Prednisone

(RheumInfo, Canada, 2011)

Note: this video is from Canada so may have information that differs from Aotearoa New Zealand recommendations.

In Aotearoa New Zealand prednisone is available as tablets in 4 different strengths: 1 mg, 2.5 mg, 5 mg and 20 mg.

The dose of prednisone is different for different people, depending on what it's used for.
Doses usually range from 5 mg to 60 mg daily.
Some people may need only a short course of prednisone for a few days, while others may need to take it for longer (weeks to months).
Prednisone tablets come in different strengths. Check the strength of your tablets and the dose you are prescribed. You may need to take more than 1 tablet and your dose may change over time. If you're not sure about your dose ask your pharmacist.
Always take your prednisone exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

Timing: Take your prednisone tablets with food and with a full glass of water. It's usually taken once a day, straight after breakfast. It's best not to take your dose too close to bedtime because it may keep you awake.
Missed dose: If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.
Stopping prednisone: If you've been taking prednisone for more than 3 weeks, or taking high doses of prednisone (40 mg daily or more) for longer than 1 week, stopping suddenly can cause withdrawal symptoms, which can be serious or even life-threatening. Your doctor will reduce your dose gradually. Read more about a steroid withdrawal plan.

Here are some things to know when you're taking prednisone. Other things may be important as well, so ask your healthcare provider what you need to know.

Other medicines: Prednisone interacts with some other medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting prednisone and before starting any new products.
Tell all your healthcare providers: It's important to tell all your healthcare providers that you're taking prednisone.
Increased risk of infections: Taking prednisone for a long time can increase your risk of infections. Tell your doctor if you come into contact with someone who has a contagious illness (eg, chickenpox or measles) or if you feel unwell.
Vaccines: It's safe to have most vaccines, including the flu vaccine, while you're taking prednisone. Protecting yourself against infection is important because prednisone suppresses your immune system. However, ‘live vaccines’, including MMR (measles, mumps, rubella) or chickenpox vaccine, should be avoided. Ask your doctor for advice before you have any vaccines while you're taking prednisone.
Osteoporosis: If you're taking prednisone long term, over several years, it can increase your risk of osteoporosis. Take care to keep up your strength and balance to reduce your risk of falls. Your doctor may suggest medicines or lifestyle changes to protect your bones. Read more about osteoporosis and taking steroids long term.

Like all medicines, prednisone can cause side effects, although not everyone gets them. Most side effects depend on the dose you are taking and how long you're taking prednisone for. Read more about taking steroids long term.

Changes in behaviour and mood

Prednisone, especially in high doses, can cause changes in personality, behaviour and mood, including:

irritability, agitation and restlessness
sleep problems (insomnia) and nightmares
mood swings and aggression
low mood, depression and even suicidal thoughts.

These symptoms usually start within a few days of starting prednisone, but they can happen at any time, even after stopping treatment.

While these symptoms often go away when your dose is reduced or prednisone is stopped, stopping prednisone must be done slowly as directed. Stopping too quickly can make these symptoms worse. You're at higher risk of mood and behaviour changes if you've had similar reactions to other steroids, or if you have a personal or family history of psychiatric illness.

If you have changes in mood and behaviour, especially depression and suicidal thoughts, tell your doctor immediately or phone Healthline 0800 611 116.

Tendon problems

Prednisone can cause tendon problems, eg, tendinitis or tendon rupture. The Achilles tendon in your ankle or calf is most likely to be affected but other tendons can also be involved.

You're at higher risk if you:

are over 60 years of age
are taking statins, eg, atorvastatin
have chronic kidney disease or have had a kidney, heart or lung transplant.

Let your healthcare provider know straight away if you get pain and swelling in your joints. This can happen from a few hours after the first dose to several months after you've stopped the treatment.

Other side effects

Side effects	What should I do?
Difficulty sleeping	Take prednisone in the morning.
Headache Muscle weakness, feeling tired	These are quite common when you first start taking prednisone and usually go away with time. Tell your doctor if they bother you.
Increased appetite	Prednisone increases your appetite. Follow a healthy, balanced diet. Have an eating plan.
Fluid retention causing swollen ankles and feet Increased blood pressure	If you notice swollen ankles and feet, try sitting with your feet raised. Avoid salty foods. Your doctor will check your blood pressure regularly if you're taking prednisone long term. Tell your doctor if this happens.
Raised blood glucose	Prednisone can cause an increase in blood glucose. If you have diabetes, you may need to increase the dose of your diabetes medicine to control your blood glucose. Talk to your doctor about this. Prednisone can also cause diabetes in people who are at risk. Your doctor will check your blood glucose levels regularly.
Eye pain and changes to your vision	Tell your doctor immediately or phone Healthline 0800 611 116.
Problems with your stomach such as pain, blood in your stool (poo) or dark coloured stool (poo)	Tell your doctor immediately or phone Healthline 0800 611 116.