Prednisone Side Effects and How To Feel Better When Taking Steroids

Prednisone is one of the most common corticosteroid medications around. Whether you’ve had a run in with poison ivy or you live with inflammatory bowel disease, asthma, rheumatoid arthritis or a number of other conditions, your healthcare provider is likely to at least consider prescribing prednisone.

Prednisone can be a game-changer in managing a wide range of conditions. But like just about any medication, prednisone and other steroids can come with side effects — ranging from annoying to nearly intolerable.

Thankfully, there are ways to manage them. So, you can reap the benefits with fewer drawbacks.

“By teaming up with your doctor and practicing good old-fashioned self-care, you can minimize or even eliminate prednisone side effects,” says family medicine doctor Kevin Hu, MD.

How to feel better when taking steroids

If your healthcare provider recommends taking prednisone or another steroid, it’s for good reason. Corticosteroids are a boon for your health if you’re living with an overactive immune system, pain and other concerns.

But while they go about their business, steroids can cause trouble for some people. Some side effects come on quickly. Others may take a while to develop. And some may be alleviated by lowering your dosage.

In most cases, the benefits are worth the side effects. And even better, there are steps you can take to help minimize effects.

Let’s take a look at common prednisone side effects and what to do about them.

Boost a weakened immune system

Prednisone’s greatest asset is also its greatest weakness. Prednisone effectively mutes your immune system to relieve symptoms. That’s what makes it so effective for things like autoimmune conditions, inflammation and more.

But a lowered immune response can also put you at risk for illness and infection. Your body’s defenses are lowered when you take prednisone. And that can mean more coughs, colds, ear infections and susceptibility to bacterial infections.

What you can do

Practice healthy lifestyle habits to help strengthen a weak immune system:

• Get enough sleep (between seven and nine hours for most people).
• Eat a balanced diet.
• Drink plenty of water.
• Don’t smoke.
• Practice good hand hygiene.

“Treat yourself well,” Dr. Hu advises. “Anything you can do to stay healthy is going to benefit you and reduce some of the problems associated with prednisone.”

Know about ‘moon face’

The so-called moon face — when your face appears round and puffy — is perhaps one of prednisone’s most famous side effects. It can happen because steroids can cause your body to redistribute fat — around your face and also around your midsection.

What you can do

If swelling and moon face are affecting your well-being and/or your mental health, talk with your healthcare provider. There may be opportunities to reduce your dosage or try another medication. Connecting with a support group can help, too.

Manage fluid retention

Swelling in your legs and midsection is also a common side effect of prednisone. That’s because taking steroids can cause your body to retain fluid, rather than flush it out of your system.

Fluid retention can lead to a cascade of negative effects on your health.

“Managing fluid retention can help keep your blood pressure at a healthy level,” Dr. Hu states. “That’s important because prednisone may raise blood pressure as well.”

What you can do

“Prednisone alters how the body processes salt, which can lead to fluid retention. Staying on a low-salt diet can help to some degree,” he explains. “Exercise can also help keep excess weight off.”

Visit your healthcare provider regularly to keep tabs on your blood pressure. If it’s going too high, they can provide recommendations to keep it managed.

Address trouble sleeping

Prednisone isn’t classified, medically, as a stimulant. But it can make you feel more alert or jittery. That amped-up feeling can be uncomfortable. And it can keep you from getting the rest you need.

“Prednisone doesn’t necessarily interrupt sleep, but some patients find it keeps them awake when they don’t want to be,” Dr. Hu acknowledges.

What you can do

Many people find that taking prednisone in the morning can help. If possible, take your full dose at breakfast. Taking your medication early in the day can help ensure that sense of extra alertness will dissipate by bedtime. That can help you unwind and get the sleep you need.

Settle your upset stomach

Prednisone may cause gastrointestinal symptoms like:

• Nausea
• Vomiting
• Diarrhea
• Stomachache

That’s most likely to happen when you take it on an empty stomach.

What you can do

This one is pretty simple: Take your dose with food.

Lower high blood sugar

Taking prednisone can raise your blood sugar. If you typically have normal blood sugar levels, file this side effect under no big deal. But if you’re living with diabetes, this is something to watch out for.

What you can do

If you have diabetes, double down on managing and monitoring your blood sugar. And if you get your prednisone and diabetes medications from different doctors, make sure they’re aware of each other.

These healthy habits can affect your sugar levels, too:

• Use strategies to cope with and reduce stress.
• Eat more fruits, vegetables, whole grains, and low-fat or skim milk and cheeses.
• Be active — aim for exercise most days of the week.
• Get adequate rest.

Understand high white blood cell count

Curiously enough, prednisone raises white blood cell counts on lab tests, Dr. Hu reports. These are immunity cells that protect you from disease. If you have a blood test while taking prednisone, the results may look abnormal.

“What’s happening is that prednisone releases white blood cells from your tissues into your bloodstream,” he explains. “The number goes up on a blood test because the cells move there. But the actual white blood cell count is not increasing, so it’s most likely fine.”

What you can do

Be sure the provider interpreting your results is aware that you’re taking prednisone so they can take that into account. If the other numbers in the report are on track, breathe a sigh of relief and know all is well.

Counteract bone density loss

Long-term steroid use (longer than a month) can lead to loss of bone density, which also raises your risk for bone fractures. Some people lose as much as 10% to 20% of their bone mass in the first six months of treatment. That can be significant. Especially if you were already living with low bone density.

What you can do

Talk with your healthcare provider about your personal risk.

“We typically start screening for bone density at age 65. But if somebody is younger and on long-term prednisone, then we would do bone density tests earlier and begin osteoporosis treatment if necessary,” Dr. Hu shares.

Address mood changes

Mood issues may be connected to prednisone’s penchant for making you feel energized.

“You may get an initial revved-engine feeling followed by a down,” Dr. Hu says. “Long term, we don’t think steroids cause depression, but it can certainly make your mood more volatile.”

What you can do

Talk with your healthcare provider about how you’re feeling emotionally. They may be able to change your dose or add another medication to counteract the effects.

And keep loved ones in the loop about how prednisone affects your emotional state. A heads-up may be all they need to understand what you’re going through and be ready to give any extra support you may need.

When do prednisone side effects start?

More intrusive steroid side effects only occur when people take prednisone long term — about a month or more. That includes issues like moon face and lowered bone density.

Other side effects can come on quickly. That includes restlessness, upset stomach, mood changes and spikes in your blood sugar.

Dosing affects side effects

Healthcare providers dose prednisone with the risk of side effects in mind. The right prednisone dosage helps your body fire on all cylinders and reduces potential side effects.

“We try to start you on a high dose and then rapidly lower it, which minimizes side effects,” Dr. Hu explains. “That way, you get the benefit of a strong anti-inflammatory burst to settle down the reaction. Then, the prednisone stays in your system long enough at lower levels so the whole reaction can turn itself off.”

For longer-term prescriptions, doctors may taper down dosages gradually to get them as low as possible without the return of symptoms.

“We typically aim for a dose that’s about 5 to 7 milligrams a day,” he points out. “We’re trying to roughly match how much cortisol the body produces — though many people will be on a higher or lower dose than that as needed.”

Your provider will work with you to find a sweet spot between managing your condition and minimizing side effects. Changing your dose on your own or stopping taking prednisone without a healthcare provider’s recommendation can be problematic.

“Don’t stop taking prednisone without checking with your doctor first,” Dr. Hu cautions. “Stopping it suddenly will likely bring back the symptoms we’re trying to manage.”