How to Reduce Prednisone Side Effects

Prednisone is a type of corticosteroid (steroid) drug used to treat many diseases and conditions associated with inflammation but is well known to cause short-term and long-term side effects, sometimes severe.

Prednisone reduces inflammation by suppressing the immune system to treat conditions like asthma, Crohn's disease, and leukemia. However, the loss of immune function can lead to serious and sometimes irreversible side effects.

This article explores some of the more common prednisone side effects in men and women, including strategies to help reduce the risk. It also looks at how to safely discontinue prednisone to avoid drug withdrawal and gradually flush the drug out of your system.

Prednisone Side Effects

Some of the more common side effects of prednisone include:

• Stomach upset
• Hyperactivity
• Insomnia
• Fluid retention (including facial mooning or "moon face").

More serious side effects include:

• Osteoporosis (porous bones)
• Cataracts (eyes clouding)
• Glaucoma (eye nerve damage)
• Type 2 diabetes
  

Preventing Side Effects

There are ways to reduce the risk or severity of some prednisone side effects. By identifying your risk of these side effects, you can take steps to reduce them.

Osteoporosis

Anyone taking prednisone for a long time can experience some level of bone density loss. However, there are certain conditions that increase a person's risk of osteoporosis, including:

• A family history of osteoporosis
• Older age
• Menopause
• Hyperthyroidism
• Having a thin frame
• Smoking
• Heavy alcohol use
• Getting little or no exercise

If any of these apply to you, speak with your healthcare provider about ways to prevent or slow bone mineral loss. This includes eating a healthy diet with plenty of calcium, taking a vitamin D or calcium supplement. and exercising routinely including strength training.

Weight Gain

Exercise also helps reduce the risk of weight gain from prednisone. Even when used for a short time, prednisone can increase appetite and cause swelling of the face (called "facial mooning").

With long-term use, prednisone can also cause changes in body fat, leading to fat deposits at the back of the neck or around the belly.

Reducing salt intake can prevent water retention that contributes to facial mooning. Watching fat and calorie intake can help to prevent weight gain. To deal with an increased appetite, have plenty of low-calorie snacks on hand, including vegetables and fruits. Working with a nutritionist can help.

Exercise and diet may also help reduce the risk of body fat redistribution, known as lipodystrophy. Even so, it may be difficult to avoid if you are on prednisone for a long time. Speak with your healthcare provider if you begin to notice symptoms of lipodystrophy.

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, almost half developed symptoms of mood changes after taking prednisone for two weeks. These symptoms went away after they stopped the prednisone.

It helps to prepare for these side effects by letting family and friends know what to expect and how they can support you. Doing so takes off some of the stress. It may help you recognize when mood swings occur.

Exercise may help "burn off" some of the stress. It also can help improve mood by triggering the release of feel-good hormones called endorphins. You can also try stress reduction strategies like yoga, meditation, guided imagery, and progressive muscle relaxation.

Getting plenty of rest is also essential. This can be difficult because prednisone can interfere with sleep. One way to cope is to improve your sleep hygiene. This includes avoiding food and electronics before bedtime and sleeping in a cool, dark room. Some people also benefit from melatonin supplements available over the counter at drugstores.

Insomnia

Prednisone mimics a hormone called cortisol. This is a hormone that the body releases at times of stress.Cortisol levels are highest in the morning and gradually taper down as the day goes on.

To reduce some side effects, like insomnia, once-daily doses should be taken in the morning with breakfast. Taking the dose of prednisone too late in the evening may affect your sleep.

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 to 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 mg a day or have been on it for more than three weeks.

When you're on prednisone, the body has no need to produce its own natural cortisol. Stopping suddenly leaves the body with no cortisol to function normally. This can lead to withdrawal symptoms, such as:

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

To avoid this, healthcare providers will usually slowly taper the dose, or lower it gradually, so that the body has the opportunity to resume making its own cortisol. Depending on your underlying disease (reason for taking prednisone), as well as the dose and duration of treatment, the tapering can take many weeks or many 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 an important 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 the shortest period of time possible.

You can reduce the risk of certain side effects like insomnia by taking the drug earlier in the day. Other side effects like weight gain, mood swings, and osteoporosis may be reduced with lifestyle changes like diet, exercise, and improved sleep habits.

Prednisone should never be stopped suddenly; this can 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.

A Word From Verywell

Some people feel that the side effects of prednisone outweigh the benefits of treatment. If side effects are interfering with your ability to function normally or decreasing your quality of life, let your healthcare provider know.

There may be other treatments that can help. In some cases, all that may be needed is a dose reduction. However, it's important to never adjust the dose or dosing schedule on your own without first speaking with your healthcare provider.