Medically reviewed by Dr. Kate Rowland, MD, MS, FAAFP For many of those who have taken prednisone due to chronic illness, cancer or other health issues, the experience could perhaps be described as a “love-hate relationship.” As Mighty contributor Rosie Koina wrote in her essay about the side effects she’s experienced, “I have very mixed feelings about prednisone. It is a wonder drug. But I hate having to take it.” Prednisone, a corticosteroid used as an anti-inflammatory or immunosuppressant, can do wonders for certain symptoms and conditions, sometimes bringing people relief when no other treatment will do the trick. But some have found this relief does come at the cost of several less-than-pleasant side effects, including weight gain, insomnia, mood changes and others. Fortunately, there are a number of measures you can take to cope with and combat many of the side effects prednisone can cause. We spoke with several medical experts as well as patients who know firsthand what the medication is like to find out how it works and how to navigate its effects. Of course, you should always speak with your doctor and discuss any underlying health concerns before starting or stopping prednisone because it can be dangerous to stop abruptly even if you’ve been taking it for two to three weeks or longer. While many people experience similar side effects, prednisone may affect everyone differently. It’s important to make your own decision (in conjunction with your doctor) and do what’s best for you and your health. Below, you’ll find a breakdown of all the topics we will cover in this piece. To navigate the article easily, we’ve included bookmarks to each section, so feel free to click on the topic you find most interesting, and the link will take you to that portion of the article. What Is Prednisone? Why Is Prednisone Prescribed? How Long Do You Take Prednisone? Is There Anyone Who Should Not Take Prednisone? What Are the Side Effects of Prednisone? How Can You Manage the Side Effects of Prednisone? General Coping Tips Coping With: Weight Gain Coping With: Bone Thinning and Osteoporosis Coping With: Difficulty Sleeping Coping With: Increased Risk of Infection How to Safely Stop Prednisone Benefits vs. Side Effects of Prednisone What Is Prednisone? Prednisone is a type of corticosteroid – a group of hormones produced either naturally in the adrenal cortex in your adrenal gland or in a medication form. Prednisone, a synthetic corticosteroid, works the same way as the stress hormone cortisol, the body’s natural corticosteroid, Amy Calabrese Donihi, PharmD, BCPS, FCCP, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy, explained to The Mighty. “Cortisol is definitely essential for normal body functioning,” said Dr. Donihi. It is produced in response to stress and helps the body regulate blood sugar, fight infection, respond to stressful situations (both physically and mentally) and control the metabolism of fat, protein and carbohydrates. When you take prednisone, the level of corticosteroids in your system rises above normal body amount levels. In these higher amounts, the corticosteroids begin reducing inflammation and lowering immune responses in the body, which may help some of your symptoms depending on your condition. Why Is Prednisone Prescribed? According to Donihi, prednisone is prescribed for a number of reasons. Many people with inflammatory or immune-related conditions may be familiar with the drug, as it is often used to help reduce inflammation and suppress immune system activity. This may be particularly helpful for people with autoimmune diseases such as asthma, lupus, rheumatoid arthritis and inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Prednisone is sometimes prescribed to treat certain types of cancer as well. People with Addison’s disease may also need to take prednisone, since their adrenal glands don’t produce enough cortisol. The prednisone serves as a synthetic replacement of that hormone to replace what the body isn’t making, preventing the body from going into an adrenal crisis. Prednisone is also commonly used in anti-rejection regimens for patients who have undergone an organ transplant. By suppressing the immune response, it helps prevent the body from rejecting the transplanted organ. How Long Do You Take Prednisone? The short answer? “It definitely varies patient to patient, and it depends exactly what it’s being used for,” explained Donihi. Some patients may require a short burst of prednisone for an exacerbation of their condition – for instance, an acute flare-up of asthma or chronic obstructive pulmonary disease (COPD). For someone with a longer-term health concern – perhaps an inflammatory disease like lupus or colitis – they might be prescribed a longer course of prednisone that lasts weeks or months rather than days. Is There Anyone Who Should Not Take Prednisone? Medication interactions with prednisone are not common. If your doctor believes you would benefit from prednisone, there’s typically no reason why it wouldn’t be prescribed. Though your doctor will likely monitor you closely while on prednisone, certain health conditions or risk factors may require you and your doctor to exercise additional caution, said Sanjay Sethi, M.D., professor of medicine and division chief of pulmonary/critical care/sleep medicine at the University at Buffalo in New York. Dr. Sethi explained to The Mighty that people who have conditions aggravated by the side effects of prednisone may be at risk. This includes people with diabetes, since prednisone can increase blood sugar levels, and mood disorders, since the drug can cause difficulty sleeping, irritability and, rarely, psychosis. If you’re worried about any potential side effects or changes in your symptoms, reach out to your doctor right away. Individuals with compromised immune systems may also be at a higher risk of contracting a disease or infection, as long-term prednisone use can further weaken the immune system. (Read more about protecting against infection below.) Most people should be clear to take prednisone if their doctor believes it will help them recover or reduce symptoms, but always bring up any concerns you may have with your physician. What Are the Side Effects of Prednisone? Donihi explained that some of the more common side effects of prednisone tend to be less serious. “You might experience them more in the short-term, and if you’re only taking the short course of the prednisone they’ll go away very quickly after you stop taking it,” she said. According to Donihi and Sethi, short-term side effects may include: Increased appetite Fluid retention or edema Upset stomach Acne Difficulty sleeping Tremors Sweating Rapid heartbeat Change in mood (either hyper or sad) Those taking prolonged courses of prednisone (longer than three weeks) may experience more serious side effects, such as: Eye problems, such as glaucoma or cataracts Mood changes, which can cause people to be more irritable, anxious or depressed Thinning of the skin, which can cause the skin to bruise more easily Elevated blood pressure Elevated glucose levels Weight gain (due to fluid retention and/or increased appetite) Redistribution of body fat to the face, abdomen or back of the neck (sometimes called a “buffalo hump”) Slower healing of cuts and bruises, which increases the risk of infection Osteoporosis, bone fractures, bone thinning and loss of bone Lowered immunity, which results in increased risk of infection To read more about how prednisone has affected people with chronic illness in our Mighty community, check out the stories below : 9 Side Effects of Prednisone I’ve Experienced How Prednisone Has Affected My Teeth Prednisone: The Marvelous Monster in My Life 6 Wacky Side Effects of Prednisone They Don’t Tell You About Dear Prednisone, I Would Not Be Where I Am Today Without You How Can You Manage the Side Effects of Prednisone? Whether it’s a set of general coping tips for living with prednisone or ways to combat specific symptoms like weight gain or having trouble sleeping, we have you covered. General Coping Tips Donihi shared several basic tips for ensuring your health and safety while taking prednisone – though this advice could apply to just about any medication. From carrying your medication info with you everywhere you go to making sure you check with a doctor before changing or stopping prednisone, here’s where you can start. 1. Carry a card with your medication name and dosage. Donihi recommended carrying a “medical information” card with the specific name and dosage of your prescription, especially if you’re taking prednisone (or any other drug) longer than two or three weeks. If you’re in an emergency situation or need to inform your healthcare providers about any current medications (see No. 2!), having the information handy could be a lifesaver – literally. 2. Tell all your healthcare providers you’re taking prednisone. If you followed step No. 1 and created a medical info card, show it to your doctor! Donihi said it’s critical for all your healthcare providers to know you’re taking prednisone – even the ones you might not think to tell, such as your dentist. Whether you’re considering a new medication, undergoing surgery or in an emergency situation, the medical professionals caring for you need to know you’re taking prednisone so they can adjust any treatment plans accordingly. (P.S. Make sure your healthcare providers know about any other medications or supplements you’re on, too!) 3. Don’t stop prednisone suddenly or without a doctor’s supervision. Stopping prednisone cold turkey can be dangerous for your health (read more about the importance of tapering below!). Even if you’re experiencing side effects, always consult a doctor before starting or stopping a medication. Patients who stop a course of prednisone suddenly can go into adrenal crisis, which life-threatening. You may also experience withdrawal, Donihi said, and experience difficult side effects as a result, like nausea, fever and muscle aches. Coping With: Weight Gain Weight fluctuations can be one of the most frustrating side effects of prednisone, both physically and emotionally. Prednisone causes the body to retain sodium and lose potassium, which can result in fluid retention, weight gain and bloating. It may also cause an increased appetite, causing you to eat more than you typically would. To help combat some of the fluid retention, Donihi suggested reducing your salt intake. “Avoid salty foods, avoid chips, avoid adding salt when [you] cook,” she said. Though it may seem counterintuitive, drinking more water can help decrease fluid retention as well. In case prednisone leaves you with the munchies, it can be helpful to stock up on foods with nutritional value, so you don’t find yourself reaching for unhealthy snacks in the middle of the night. It’s certainly easier said than done but watching your caloric intake and eating nutritious foods can help prevent prednisone weight gain, said Donihi. While there are some steps you can take to manage weight gain, it’s not always possible to fend it off completely – especially if you’re on a high dose of prednisone for a longer period of time. Mighty contributor Polly Stewart shared the following reminder for those struggling with how prednisone has affected their weight: To others dealing with the effects of steroids, just remember you can only control your body so much… Sometimes it doesn’t matter what your calorie intake is or if your body will allow you to exercise, the side effects will still win. Above all, know that you are not alone, and look at the big picture — these medications are most likely keeping you alive. Surely that is more important than anything else. Coping With: Bone Thinning and Osteoporosis When taken over long periods of time, prednisone can cause issues with your bone health, which, though rarely, can include osteonecrosis (bone death) that causes pain around your joints in particular or osteoporosis that leads to thinner and more brittle bones that fracture easily. It’s important for anyone taking long-term courses of prednisone to consider preventive measures that can help keep bones strong and healthy. Donihi had several recommendations. First, she advised people taking prednisone to avoid smoking and limit their alcohol intake. Several studies have found that cigarette smoking is a risk factor for bone fractures and osteoporosis, and heavy drinking has been associated with osteoporosis as well. Partaking in smoking or heavy drinking on top of prednisone would increase the risk of bone loss and fractures. Weight-bearing exercises (such as walking or yoga) can help prevent bone loss as well as muscle atrophy, both of which can be caused by prednisone over time. When your muscle tissues start to atrophy or break down, your muscles aren’t able to support your bones as well and help them stay strong too. Talk to your doctor about which types of exercise would be most suitable for you and your health. You should also ensure that you’re getting enough nutrients in your diet to promote proper bone health. “The American College of Rheumatology actually recommends that all patients who take prednisone should be getting a calcium intake between 1,000 and 1,200 mg per day and a vitamin D of 600 to 800 international units per day in their diet,” Donihi said. “And that will hopefully help prevent some of those fractures.” Though it may sound like common sense, Donihi stressed the importance of exercising caution in your everyday life to avoid falling or getting injured. For instance, if it’s winter, you probably shouldn’t walk on an icy sidewalk so you don’t fall and break your hip. “Because of that osteoporosis,” she said, “[you] really want to make sure [you’re] doing things to prevent the fractures from happening.” Finally, if you are taking a long-term course of prednisone, check in with your health care provider about how the medication could be affecting your bones. If you have a higher risk level for bone issues, your doctor may prescribe bisphosphonate medications right away for osteoporosis. Alternatively, you may need to get a bone mineral density test to assess for osteoporosis. If the test reveals that you are at risk for fractures, Donihi said, your doctor may prescribe a medication that can help prevent this. To read more about how prednisone can affect the bones, check out these stories from our Mighty contributors : How I Became Empowered After an Osteoporosis Diagnosis How Prednisone Has Affected My Teeth Coping With: Difficulty Sleeping Prednisone has been known to make people feel “wired” or “hyped up,” which can lead to insomnia and difficulty sleeping. Despite feeling exhausted from lack of sleep, it can still be a challenge to drift off at night. One strategy Donihi recommended is to talk to your doctor about the time of day you’re taking the prednisone. “If [you’re] taking it later in the day, talk to [your] health care provider and ask them if it’s OK to just take it once a day in the morning,” she said. “In many disease states that’s perfectly acceptable.” Donihi explained that some people may have less trouble sleeping at night if they only take prednisone once a day in the morning. Before changing your medication schedule, it’s imperative you talk to your doctor, as this approach might not be appropriate for everyone. For more recommendations on coping with insomnia, check out the following stories from our Mighty community : 12 Things I Do to Manage My Insomnia 27 Tips for the Nights When Your Chronic Illness Makes It Hard to Sleep How You Can Prevent Chronic Insomnia Coping With: Increased Risk of Infection One of the effects of prednisone is a decreased immune response. While this may sometimes be the goal in prescribing the medication, as with autoimmune disease patients or organ transplant recipients, it can also have the additional consequence of making someone more vulnerable to infection. It’s important for anyone taking prednisone to be extra careful to avoid germs and practice proper hygiene. Washing your hands is a must, and Donihi said to try and avoid other people who are sick. Donihi also recommended getting an influenza vaccine if you’re taking prednisone. In general, age-appropriate vaccines are recommended even when taking prednisone. However, double-check with your doctor. In some cases, if you’ve been taking more than 20mg of prednisone a day for longer than two weeks, your doctor may suggest you do not get vaccines that contain live virus. “Patients who are on prednisone are more prone to getting infections and the infections don’t clear as quickly,” she explained. “If we can prevent the infection from coming, that’s always important.” For those on high, long-term doses of prednisone, Sethi added that your doctor might prescribe certain antibiotics in addition to the prednisone as a preventative measure to help reduce the risk of infections. If you have a fever or believe you’ve contracted an infection, he advised that you should report your symptoms to your doctor right away so the issue can be treated early. For more tricks and tips that help our chronic illness community avoiding getting sick, check out the following stories : 18 ‘Hacks’ That Help People With Chronic Illness Avoid Catching the Flu 10 Fashionable Face Masks People With Chronic Illness Recommend 15 Flu Season Essentials People With Chronic Illness Swear By How to Safely Stop Prednisone If you’re currently taking prednisone and struggling with any of its side effects, know you are not alone. However, it’s critical to talk with your doctor before discontinuing the medication. Those who have been taking prednisone for a prolonged period of time may experience serious consequences if they stop taking the medication suddenly and all at once. Although the literature suggests two or more weeks is a prolonged period of time to be taking prednisone, Donihi explained that for some patients, stopping suddenly can be cause for concern after a 10-day course. She said there are a few reasons not to stop taking prednisone abruptly. First, taking prednisone long-term causes the adrenal glands to atrophy, or shrink, and become unable to generate adequate amounts of cortisol — the body’s “natural” corticosteroid. If someone were to stop prednisone suddenly, Donihi cautioned, they could experience an adrenal crisis. An adrenal crisis requires immediate medical attention and can be potentially life-threatening. It is critical for anyone taking prednisone to work with their health care provider to gradually decrease their dosage over time — also known as tapering — to let their adrenal glands recover. Another reason tapering is important is to prevent a rebound of symptoms. For those who may be taking prednisone due to an inflammatory condition such as arthritis or colitis, stopping the medication suddenly could cause symptoms to flare up again suddenly, Donihi explained. In addition, if you’ve been off steroids for even six months and require surgery, your body may not be able to adequately activate your stress response, which puts your health in danger. Benefits vs. Side Effects of Prednisone Though some of the side effects of prednisone can be difficult to cope with – physically or emotionally – that doesn’t necessarily mean it should be avoided. “These side effects should not scare people away from taking it, if indeed they need to take it for their chronic disease,” Donihi said. For many people, prednisone can help reduce symptoms and control disease flare-ups. As with any medication you take, it’s important to consult your doctor and weigh the benefits with the risks. If prednisone helps you, but you struggle with the side effects, Mighty contributor Donna Adams offered the following reminder: Sometimes you have to choose to take the bad with the good, in hopes the good makes it all worth it.Some of us don’t have a choice. Or at least it doesn’t feel like it when the choice is life or death. However, even without knowing it, when we thought we didn’t have a choice, we did — we made the choice to live, and to fight for the best life we could by trying to get as well as we can… and with that comes great struggle. But please, anyone struggling with the effects of prednisone, chronic illness, or any other medication: You made the right choice.And even when you can’t see it, or feel it, this is worth the struggle you are enduring right now.