May 6, 2020/Primary Care

8 Prednisone Side Effects + How to Minimize Them

From ‘moon face’ to mood issues

prednisone side effects can include insomnia

Whether you’re attacked by poison ivy or have inflammatory bowel disease symptoms that affect your quality of life, taking prednisone can be a game-changer. But there’s a catch: Prednisone is known for a host of side effects that range from annoying to intolerable.

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“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 Donald Ford, MD.

What is prednisone?

Prednisone is a strong anti-inflammatory steroid and jack-of-all-trades that is prescribed to treat conditions such as:

  • Poison ivy.
  • Sore throat.
  • Inflammation in different parts of the body.
  • Inflammatory arthritic conditions, such as rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica.
  • IBD, including Crohn’s disease and ulcerative colitis.

Prednisone mimics cortisol, your body’s “fight-or-flight” hormone. Cortisol’s many responsibilities include keeping inflammation at bay. “When we use prednisone as a treatment, we’re usually trying to either reduce inflammation directly or moderate the body’s inflammatory response,” says Dr. Ford.

How to counteract prednisone side effects

Compromised immune system

Turns out, prednisone’s greatest asset is also its greatest weakness. The very action that makes prednisone so effective — its ability to mute the immune system and relieve symptoms — can also lead to an increased risk of illness and infection, since your body’s defenses are low.

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What you can do: Practice healthy lifestyle habits, including getting enough sleep and eating healthfully. “Treat yourself well,” Dr. Ford says. “Anything you can do to stay healthy is going to benefit you and reduce some of the problems associated with prednisone.”

Fluid retention

Fluid retention is one of prednisone’s most famous side effects. “‘Moon face’ is common, which is swelling in the face that can occur after you’ve been on steroids for a long time,” Dr. Ford notes. “You can also get swelling in the legs and midsection.”

What you can do: “Prednisone alters how the body processes salt, so staying on a low-salt diet can help to some degree,” he says. “And exercise can help keep excess weight off.”

Hyperactivity

While prednisone is not a stimulant, it can make you feel more alert or jittery. “It doesn’t really interrupt sleep, but some patients find it keeps them awake when they don’t want to be,” Dr. Ford says.

What you can do: “If it’s possible, we recommend you take your whole dose in the morning,” he recommends. “Then hopefully, that sense of extra alertness will dissipate by bedtime.”

Stomach upset

Prednisone may cause gastrointestinal symptoms when you take it on an empty stomach.

What you can do: This one is pretty simple: Take your dose with food.

High blood sugar

If you typically have normal blood sugar levels, file this side effect under no big deal. But if you’re one of the millions of Americans with diabetes, this is something to watch out for.

What you can do: If you have diabetes, double down on controlling 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 (such as meditation) to cope with and reduce stress.
  • Eat more fruits, vegetables, whole grains, and low-fat or skim milk and cheeses.
  • Be active — shoot for exercise most days of the week.
  • Get adequate rest (ideally seven to nine hours each night).

High white blood cell count

Curiously enough, prednisone raises white blood cell counts on lab tests, Dr. Ford says. These are immunity cells that protect you from disease. “What’s happening is that prednisone releases white blood cells from your tissues into your bloodstream. The number goes up on a blood test, because the cells have ‘moved’ there. But the actual white blood cell count is not increasing, so it’s most likely fine.”

What you can do: Take a breath, and stay calm. You don’t need to do anything (for once!)

Bone density loss

Long-term steroid use (longer than a month) can lead to loss of bone density, which also ups your risk for bone fractures. Some patients lose as much as 10% to 20% of their bone mass in the first six months of treatment.

What you can do: Talk with your doctor about your personal risk. “We typically start screening for bone density at age 65. But if somebody is younger and on chronic prednisone, then we would do bone density tests earlier and begin osteoporosis treatment if necessary.”

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Symptoms related to mood

Mood issues may be connected to prednisone’s penchant for making you feel energized. “You may get that initial revved-engine feeling followed by a down,” notes Dr. Ford. “Long-term, we don’t think it causes depression, but it can certainly make your mood more volatile.”

What you can do: Your doctor can change your dose or add another medication to counteract any effects on your mood. And keep loved ones in the loop so they can give you any extra support you need.

How prednisone dosage impacts side effects

Most steroid side effects only occur when people take prednisone long-term. For non-chronic issues, you might take it only for a couple of weeks.

“We also try to start you on a high dose and then rapidly lower it, which also minimizes side effects,” Dr. Ford 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,” says Dr. Ford.

“We’re trying to roughly match how much cortisol the body produces, though many patients will be on a higher or lower dose than that.”

The right prednisone dosage helps your body fire on all cylinders and reduces potential side effects. But if you hit a symptom sweet spot, it doesn’t mean you no longer need to take it.

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

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