Prednisone

Prednisone is a steroid used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), acute gouty arthritis, lupus and polymyalgia rheumatica. Prednisone is not recommended in the management of osteoarthritis (OA).

Prednisone is taken orally.

The dose of prednisone varies widely and is based on your disease and the goals of treatment established by you and your healthcare provider. Therefore, there is really no standard dose. Lower doses of prednisone (i.e., 1-10 mg daily) may be sufficient for certain types of inflammatory arthritis, while higher doses (20 mg per day and upwards) may be needed in other cases.

Prednisone is a synthetic corticosteroid that has anti-inflammatory properties. It works to suppress the body’s immune system by reducing the activity of inflammatory substances in the body. By doing this, prednisone can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

Prednisone generally works very quickly — usually within one to four days — if the prescribed dose is adequate to reduce your particular level of inflammation. Some people notice the effects of prednisone hours after taking the first dose.

Prednisone mimics the anti-inflammatory action of cortisol in our bodies. Cortisol is a steroid hormone produced naturally by our body’s adrenal glands that has many functions, including anti-inflammatory effects. If you take prednisone for longer periods of time your body starts to adjust and decreases the production of cortisol. Stopping prednisone too quickly can sometimes cause side effects (e.g., loss of appetite, fatigue, nausea, fever, lethargy) as our body needs time to start making cortisol again. In very rare cases stopping prednisone too quickly may cause an adrenal crisis, a serious condition which requires immediate medical attention. If you have taken prednisone for longer than three weeks your healthcare provider will likely recommend a gradual decrease of your dose. This will allow your body to recognize it needs to start producing its own cortisol again. Call your prescriber before making any changes to your prednisone dose.

Prednisone can make it hard for your body to fight infections. Therefore, if you have an infection, your prescriber may avoid giving you prednisone. If you develop symptoms of an infection (i.e., fever or chills) while taking prednisone, please contact your prescriber.

You may need to alter your dose of prednisone before and after surgical procedures. Please discuss this with your healthcare provider.

If you have been taking prednisone for longer than 3 weeks, please contact your healthcare provider if you develop any conditions that may affect the amount of prednisone absorbed from your stomach (e.g., food poisoning, stomach bug, prolonged vomiting or diarrhea).

Call your prescriber right away if you develop new severe groin pain. (This may be associated with a very rare side effect of prednisone).

Avoid taking prednisone if you have had an allergic reaction to this medication. People with systemic fungal infections should also avoid this medication.

Prednisone acts quickly and effectively to decrease inflammation, but adverse effects are a major limitation to long-term use. Not all side effects occur in everyone. Most side effects are more commonly associated with use of higher doses for prolonged periods of time and disappear with the decrease and discontinuation of prednisone.

Prednisone can increase your appetite, which can lead to weight gain. When taken for long periods of time prednisone can cause you to lose calcium from your bones, which can lead to weakened bones and osteoporosis if not appropriately managed.

Prednisone can cause nausea, indigestion, increased blood pressure, fluid retention, increased blood sugars, glaucoma, cataracts, difficulty sleeping, mood swings, increased cholesterol, bone loss and skin changes (acne, or make your skin thinner, more easily damaged and slow to heal).

If you will be taking prednisone for a prolonged period of time, discuss obtaining a MedicAlert® bracelet (www.medicalert.ca/,1.800.668.1507) or similar product with your healthcare provider.

The lowest dose of prednisone that controls symptoms should be used to reduce adverse effects. The duration of steroid use should also be limited. High-dose prednisone bursts often are used to suppress disease flares. High doses are used for several days until symptoms are controlled, followed by a taper to the lowest effective dose.

To avoid weight gain while taking prednisone, follow a healthy diet and, if possible, exercise regularly.

To prevent calcium loss from bones, if you are taking prednisone regularly it is important to take extra calcium and vitamin D. Please speak to your healthcare provider about how much you need. If you are taking prednisone for longer periods of time (7.5 mg prednisone or more per day for longer than three months, or less if other risk factors are present) your prescriber may want you to take a medication to help protect your bones (e.g., denosumab, alendronate, risedronate, zoledronid acid,).

Taking prednisone with food or milk can help reduce nausea and indigestion.

If you experience difficulty sleeping while taking prednisone, make sure you are taking prednisone in the morning and avoid taking the medication in the evening or close to bedtime.

If you have been taking a dose of prednisone higher than 5 mg per day for more than 2 weeks, it is likely that prednisone must be tapered off slowly and cannot be stopped abruptly. Stopping abruptly after long-term use can cause significant withdrawal side effects. Discuss the tapering schedule with your doctor if you are stopping to take prednisone.

Routine blood tests may not be required while you are taking prednisone. However, if you are taking prednisone for longer periods of time (more than three months) your prescriber will likely request regular blood work to monitor for blood sugar changes and increased cholesterol and periodic bone mineral density (BMD) tests of your bones. Your prescriber will also monitor for vision changes if you are taking prednisone long-term.

Your prescriber may also want to meet with you regularly to monitor your blood pressure and to evaluate whether you need to continue taking prednisone.

Store this medication at room temperature (15 to 30 degrees Celsius) and keep it out of reach of children.