Prednisone: uses, side effects and precautions

Prednisone belongs to the corticosteroid family (also called oral steroids). According to MedlinePlus, it works in two ways: it replaces steroid hormones when the body does not make enough, and for other conditions it reduces swelling and redness and changes how the immune system works.

It is not the same as the anabolic steroids some people use to build muscle. Prednisone requires a prescription and comes as tablets, an oral liquid and delayed-release tablets.

According to MedlinePlus and the FDA label published on DailyMed, oral corticosteroids such as prednisone are used, among other things, for:

Common effects listed by MedlinePlus and the FDA label include increased appetite, trouble sleeping, mood changes or irritability, heartburn, fluid retention and higher blood sugar.

With prolonged use, the label warns of risks such as weaker bones (osteoporosis), cataracts and glaucoma, and effects on growth in children. These are other effects MedlinePlus and the label describe, which the doctor watches for:

• Weight gain and changes in where fat collects (rounder face, belly).
• High blood pressure and salt and water retention.
• Diabetes or hard-to-control blood sugar.
• Weak muscles.
• More infections, and thin skin that heals slowly.
• Irregular periods.

Do not stop taking it on your own because of side effects: tell the doctor, who can adjust the plan.

The FDA label says corticosteroids can raise blood glucose and that diabetes medicines sometimes need adjusting. If you have type 2 diabetes, check your sugar more often while you take it and tell the doctor if it climbs. If you have never been told you have diabetes, prednisone can unmask it. The signs of high blood sugar are strong thirst, frequent urination, blurred vision and fatigue.

When you take prednisone for a long time, your adrenal glands make less of your own cortisol. If you stop suddenly, the body runs short: according to MedlinePlus, you can feel extreme tiredness, weakness and an upset stomach. The FDA label explains that lowering the dose gradually reduces that risk, and that the cortisol shortfall can last for months after stopping.

That is why, after a long course, the doctor tells you how to taper it. Follow that plan and do not stop it without talking with her. If you have surgery, an accident or a serious illness in the months after, tell the doctor you took prednisone.

Before starting, tell the doctor and the pharmacist everything you take. According to the FDA label and MedlinePlus, these are the most important interactions and precautions:

Dexamethasone is a corticosteroid from the same family as prednisone, and it is used for similar conditions. According to MedlinePlus and its FDA label on DailyMed, it is used for severe allergies, asthma and other respiratory diseases, certain forms of arthritis and rheumatic diseases, and skin, blood, kidney, eye, thyroid and bowel problems. It is also used in some cancers and to replace hormones when the adrenal glands do not make enough.

They are not interchangeable. Dexamethasone is much more potent per milligram: according to the equivalence table in the FDA label, a small amount of dexamethasone equals a several-times-larger amount of prednisone. Its effect can last longer: according to the FDA label for a dexamethasone tablet, in healthy volunteers, after a single dose, cortisol took about 3 days to return to near normal. That is why you should never swap one for the other on your own.

Its side effects and precautions are similar to prednisone’s: it can raise blood sugar, cause mood changes, anxiety or trouble sleeping, and lower your defenses against infection. MedlinePlus warns not to stop it without talking to your doctor first, and the FDA label explains that after prolonged use it is tapered gradually to avoid a cortisol shortfall. The doctor decides whether a corticosteroid is right for you, and which one.

Pregnancy and breastfeeding. The FDA label says prednisone can harm the baby during pregnancy. It is a decision made with your doctor, weighing benefits and risks. If you are pregnant, planning a pregnancy or breastfeeding, tell the doctor.

Children. Prednisone is also used in children; with prolonged use it can affect growth, and the label calls for monitoring it. In video visits, patients under 21 are seen with a parent or guardian on camera.

If you take prednisone and have any of these signs, call 911 or go to the emergency room. If you are thinking of harming yourself, call 988 or Línea PAS at 1-800-981-0023. See when to go to the ER.