How to Lessen Your Prednisone Side Effects (2024)

Prednisone is a type of corticosteroid (steroid) drug that reduces inflammation by suppressing the immune system. While it treats many inflammatory and autoimmune conditions, prednisone also causes side effects, especially if used at a high dose or for a long time. These include insomnia, changes in mood, weight gain, and irregular menstrual periods.

Prednisone is typically prescribed at the lowest effective dose for the shortest amount of time. This reduces the risk of side effects and severe complications like osteoporosis, glaucoma, and diabetes. Before you stop the medication, your healthcare provider will recommend slowly tapering the dose to safely flush it from your system and avoid withdrawal symptoms.

This article explores common side effects of prednisone and strategies to help prevent them. It also looks at how to safely discontinue prednisone when it is no longer needed.

Prednisone Side Effects

Prednisone is known to cause many side effects. The risk is largely dose-dependent, meaning that they are more likely to occur at higher doses and/or when you take the drug for a long time.

Some of the more common side effects of prednisone include:

• Stomach upset
• Hyperactivity
• Insomnia
• Facial mooning
• Mood swings
• Acne
• Thin, fragile skin
  
• Red or purple blotches or lines under the skin
• Slowed healing of wounds
• Increased appetite
• Weight gain
• Abnormal body or facial hair growth
• Extreme tiredness and weakness
• Irregular or absent periods
  
• Low libido
• Depression

Potentially irreversible, long-term complications can also develop if prednisone is used excessively, including:

• Lipodystrophy (the abnormal redistribution of body fat)
• Osteoporosis (porous and brittle bones)
• Cataracts (clouding of the lens of your eye)
• Glaucoma (eye disease characterized by optic nerve damage)
• Type 2 diabetes
  

Preventing Prednisone Side Effects

The first and best way to avoid prednisone side effects is to take the drug as prescribed. Don't miss or alter the dose without first speaking with your healthcare provider.

Other strategies may be used to reduce the risk or severity of some prednisone side effects.

Osteoporosis

Anyone taking prednisone for a long time can experience some level of bone density loss. However, there are certain people who are at greater risk of osteoporosis, including older adults, post-menopausal females, people with hyperthyroidism, and heavy smokers or drinkers.

If you are at risk of osteoporosis, there are things you can do to prevent or slow bone mineral loss when taking prednisone:

• Eat a healthy, calcium-rich diet (including dairy, nuts, beans, soy, leafy greens like kale, and oily fish like salmon or tuna).
• Take a vitamin D or calcium supplement.
• Exercise routinely, incorporating strength training to strengthen bones.
• Get 15 minutes of sunlight which can increase vitamin D levels (but wear sunblock).
• Cut back on alcohol and quit cigarettes, both of which promote bone mineral loss.

Weight Gain

Typically, most weight gain from prednisone is related to fluid retention. Even when used for a short time, prednisone can cause swelling of the face ("facial mooning") related to fluid retention.

Your appetite can also increase while taking prednisone, causing you to pack on body fat along with water weight.

To manage your weight while on prednisone:

• Cut back on sodium (salt) which promotes fluid retention.
• Eat potassium-rich foods like bananas, avocado, squash, and beans that decrease water retention.
• Plan your meals beforehand, counting calories and avoiding high-fat or sugary foods.
• Have low-calorie snacks on hand to avoid binging on junk food between meals.
• Exercise regularly, including aerobic activities and strength training.
• Discuss the benefits of diuretics (water pills) with your healthcare provider.

These interventions may not only help prevent weight gain but possibly reduce the risk of lipodystrophy.

If you are having trouble with your weight or putting together a healthy diet plan, ask your healthcare provider for a referral to a nutritionist. A personal trainer can also help you build an effective but appropriate workout plan.

Mood Symptoms

As with the other prednisone side effects, the risk of mood symptoms increases with the dose and duration of treatment. In one observational study of 53 people with inflammatory bowel disease (IBD), almost half developed mood swings after taking prednisone for two weeks.

There are several ways to better cope with prednisone mood swings:

• Let family and friends know what to expect and how they can support you. Doing so can take some of the stress off you.
• Exercises like brisk walking, dancing, jogging, or cycling may help improve mood by triggering the release of feel-good hormones called endorphins.
• Try stress-reduction strategies like yoga, meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (PMR).
  
• Eat a balanced diet rich incomplex carbohydratessuch as whole grains and legumes. These may help increase levels of another feel-good hormone called serotonin.
• Get plenty of rest as sleep deprivation adds to irritability and anxiety.
• Avoid alcohol which can trigger depression and caffeine which can increase edginess.

Insomnia

Prednisone mimics a stress hormone called cortisol that your body releases in tandem with your circadian rhythm (sleep-wake cycle). It is highest in the morning when you awaken and gradually tapers down during the day until you fall asleep at night.

While you are on prednisone, the body reacts to it in the same way as it would to cortisol, causing you to be wide awake if levels in the body are high.

To reduce the risk of insomnia:

• Take your prednisone dose in the morning with breakfast. Taking prednisone late in the afternoon or evening may affect your sleep.
• Improve your sleep hygiene by creating a comfortable sleep environment and maintaining a regular sleep schedule. Avoid electronics, caffeine, and other things that can overstimulate you before bedtime.
• Try working out lightly before bedtime. This may help burn off stress and help you sleep better.

Why the Prednisone Dose Matters

The risk and severity of prednisone side effects increase with the drug's dosage and how long you take it. The higher the dose, the higher the risk of side effects. The longer you are treated, the greater the risk of complications.

Prednisone is generally intended for short-term use to rein in inflammation and bring a disease under control. When that is achieved, the dose is gradually reduced until the treatment is finally stopped.

With some conditions, like autoimmune diseases, other drugs like biologics can then be prescribed to maintain control of the condition.

Choosing the Right Dose

Prednisone is also prescribed at the lowest possible dose to bring the disease under control. However, for some conditions, this is not possible, and higher doses are needed. If this is the case, your healthcare provider will weigh the benefits and risks of treatment.

If, for example, you are at risk of osteoporosis, your healthcare provider will need to monitor your condition and may prescribe supplements to protect the bones.

If you have certain conditions like open-angle glaucoma and must take prednisone, your healthcare provider may want you to see an eye healthcare provider. They can closely monitor for any increases in eye pressure or any worsening of glaucoma symptoms.

Stopping Prednisone Safely

Stopping prednisone abruptly is rarely a good idea, especially if you are taking more than 10 milligrams (mg) a day or have been on it for more than three weeks. This is because your body will have become accustomed to having the cortisol substitute in your system and no longer produce cortisol on its own.

Although prednisone is eliminated from the body rather quickly—usually within several days—it can take time before the body is able to produce enough cortisol to meet the body's needs. If you stop too quickly, the gap in available cortisol can lead to withdrawal symptoms such as:

• Fatigue
• Fever
• Headaches
• Joint pain
• Muscle pain
• Nausea or vomiting

To avoid this, healthcare providers will usually taper gradually the dose so that the body has the chance to resume making cortisol on its own. Depending on your condition, how long you've been on treatment, and how large your dose was, the tapering can take days, weeks, or even months.

Your healthcare provider will provide you with an exact tapering schedule that will allow you to eventually get off prednisone completely.

Summary

Prednisone is a corticosteroid drug used to treat many inflammatory conditions. However, it can cause side effects, especially at high doses or with long use. To reduce the risk, your healthcare provider will prescribe prednisone at the lowest dose and for the shortest period of time.

Prednisone should never be stopped suddenly as this could lead to withdrawal symptoms. If prednisone is no longer needed, your healthcare provider will give you a tapering schedule during which the dose is gradually reduced until you can stop completely.