Prednisone: Side Effects, Uses, and More

What is prednisone used for? Is prednisone a steroid? 

Prednisone is part of a class of drugs known as corticosteroids, which work to prevent certain immune reactions in the body, including itching and inflammation. These are different from anabolic steroids which are commonly abused for bodybuilding purposes. Prednisone is a synthetic version of 2 steroids our bodies produce naturally: cortisone and hydrocortisone. Prednisone comes in tablets, delayed-release tablets, syrup, nasal, rectal, injection, and intravenous formulations.

Prednisone is a “prodrug.” This means that after it is taken, it is converted to an active form (prednisolone) in the liver. Patients with active liver disease or known decreased liver function should not take prednisone because of the potential to cause toxicity.

Like many steroids, prednisone has several different applications. Prednisone is used to treat allergic and inflammatory reactions (such as from asthma, poison ivy, or anaphylaxis), as well as certain metabolic conditions. It decreases inflammation and reduces the immune system’s reaction to foreign material. It also replaces cortisol, a natural hormone that helps our bodies respond to stress, illness, and injury. It is used to treat a wide variety of autoimmune diseases and hormonal imbalances.

How long do the effects of prednisone last?

The effects of prednisone last for 8-36 hours (although the drug remains in your body for 16 to 22 hours depending on your metabolism) and may be prescribed to be taken multiple times per day. A delayed-release formulation of prednisone (known as Rayos) is taken 1 time per day. 

For patients with diabetes, managing glucose levels while taking prednisone is especially important.  Blood sugar levels will rise after taking prednisone. This effect is dose-related, meaning the higher the dose (and the longer it is taken), the greater the increase in blood sugar. Steroids interfere with the body’s natural insulin (or injected insulin), reducing its effectiveness and therefore increasing blood sugar levels. 

On average, the increase in blood sugar levels is predictable and will rise 4-8 hours after taking prednisone. Elevated glucose levels can persist for up to 3 days, even after completing a tapering regimen. Patients who use insulin may require a temporary dose increase from 10-30%, while patients with type 1 diabetes might need to increase their dose by as much as 50% while taking prednisone. Close blood sugar monitoring is necessary to prevent additional complications.

Prednisone moon face: What are the side effects of prednisone? 

“Moon face” and “buffalo hump” are terms used to describe the swelling in the face associated with long-term use of steroid medications such as prednisone. The swelling can be attributed to an increase in appetite, increased fluid retention, and redistribution of fat deposits around the face and upper back. These effects begin to fade upon stopping the medication but can take weeks to months to completely disappear.

Other common adverse effects include weight gain, elevated blood glucose, osteoporosis (weakening of the bones), increased likelihood of peptic ulcer disease, increased wound healing time, and mood changes. Prednisone may cause increased wakefulness or insomnia. Therefore, to simulate one’s natural body rhythms, healthcare experts generally recommend taking prescription steroids in the morning. Vision changes, cataracts, and psychiatric effects are also possible known side effects. Adverse effects due to the medication are temporary and resolve when the treatment is completed.

Prednisone vs. Prednisolone vs. Methylprednisolone: What are the differences?

Prednisone, prednisolone, and methylprednisolone are all synthetic versions of naturally occurring steroids designed to mimic the hormone cortisol. Each has a slightly different chemical structure and are strong medications. Doctors prescribe the lowest effective doses for each circumstance and will provide a tapering schedule for patients who are taking high doses daily for more than 2 to 3 weeks. 

Prednisone and its active metabolite prednisolone are roughly 4 times more potent than cortisol, while methylprednisolone is about 5 times more potent than naturally made cortisol. Prednisone is available in many forms including tablet, liquid, or concentrated solution. Prednisolone can come as a tablet or as a liquid suspension or solution. Methylprednisolone is also available in oral formulation or as an injection. All 3 medications have similar medical uses and side effects. 

Prednisone and alcohol: Can you drink on prednisone? 

Although there isn’t a direct interaction between prednisone and alcohol, it is not recommended to mix alcohol and prednisone. Several of the effects of prednisone could be worsened by drinking alcohol. Moodiness, behavioral changes, vision changes, changes in bone strength (osteoporosis), weakened immune system, increased blood pressure, slower healing, and changes in blood sugar levels are all side effects of both using alcohol and taking steroid medications. Using the two together can enhance these side effects.

For example, alcohol contains sugar, while prednisone increases blood sugar levels. Taking the 2 together might lead to an additive and unwanted increase in blood sugar levels. Drinking alcohol while taking prednisone may also increase the risk for stomach irritation. The risk of negative effects increases with higher doses and longer courses of treatment. 

Prednisone interactions: Can you take ibuprofen with prednisone?

It is generally not recommended to take ibuprofen with prednisone. Both medications act to decrease inflammation and can irritate the stomach. Taking them together enhances the effects of the other, which can damage the stomach lining. Clinicians recommend “monitoring closely” patients who are using these medications simultaneously. 

Is prednisone safe during pregnancy?

Prednisone may be used while a patient is pregnant for its autoimmune and highly effective anti-inflammatory properties. The FDA has assigned prednisone pregnancy category C, meaning the use of prednisone during pregnancy is generally accepted, provided the benefit from steroid treatment provided to the mother outweighs any potential risks or harm if therapy were not given. 

Generally, doses of 20 mg of prednisone per day or less are considered acceptable during pregnancy, with a very low level of risk. Very small amounts of prednisone and its active metabolite prednisolone cross into a woman’s breast milk. In breastfeeding mothers taking prednisone, infants were not found to have any significant effects.

Prednisone withdrawal symptoms: Is prednisone addictive?

Although unlikely, it is possible to develop a chemical dependence on prednisone. Patients can experience a feeling of euphoria after taking prednisone and other steroid medications. Most incidences of documented prednisone addiction occur in patients who are prone to substance abuse or have pre-existing addictions. Addiction to prednisone is unusual, as clinicians tend to prescribe the lowest effective dose for short periods. Patients who are prescribed longer durations of therapy use tapering schedules to help avoid triggering withdrawal symptoms.   

What should I do if I experience an allergic reaction to prednisone?

Skin rash, itching, hives, and swelling of the face, lips, tongue, or throat are all symptoms of an allergic reaction. It is important to seek medical attention promptly if you experience any of these symptoms after beginning to take prednisone, especially wheezing, difficulty breathing, or throat swelling.  

Can you overdose on prednisone?

When taken as prescribed, prednisone is safe and well-tolerated. If high doses of prednisone are taken at once, toxic effects might include elevated heart rate, blood pressure, and temperature; insomnia, hallucinations, delusions, feelings of suicidality, and symptoms of psychosis; vision changes; and stomach issues such as nausea, vomiting, or diarrhea. 

Although uncommon, reports of overdose have resulted in a range of outcomes from not noticeable to death, despite hospital care. As with all medications, adverse reactions can occur and the level of toxicity is dependent on the size of the dose ingested.

Why do I need to taper prednisone? 

If you have been taking prednisone for more than 2 to 3 weeks, your doctor will taper you off the medication. This is because while taking prednisone, your body makes less of its own natural steroid hormones. The tapering schedule allows your body to “remember” to make cortisol and slowly resume its usual production without the medication. Taking prednisone reduces the body’s usual reaction to foreign substances and allows the body time to heal. After the healing has concluded, a taper is necessary to avoid an overcompensation by your body to “new” foreign material.

What should I do if I take too much prednisone?

If someone swallows prednisone accidentally or if you have a question about using prednisone safely, help from experts is available through the webPOISONCONTROL online tool and by phone at 1-800-222-1222. Poison Control’s expert guidance is always free, confidential, and available 24 hours a day.

If you are concerned about experiencing an adverse reaction to prednisone, be sure to monitor your heart rate, blood pressure, and mental status. If you have diabetes, monitor your blood sugar closely. Patients who have consumed too much prednisone frequently experience hallucinations, mild psychosis, gastrointestinal issues including nausea and vomiting, and irrational and/or uncharacteristic behavior that could be aggressive or depressive in nature, as well as difficulty speaking, thinking, or walking. These symptoms usually resolve quickly when the steroid is stopped. 

 

Kit DeMarco, PharmD
Community Pharmacist

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