Prednisone (Corticosteroid): Standard Uses + Safety & Side Effects

Prednisone is a corticosteroid used for its anti-inflammatory effects. Its ability to target many pathways in the inflammation process makes it the standard treatment for a wide variety of diseases. Read on to learn more.

Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. Please discuss your medications with your doctor.

What is Prednisone?

Immunosuppressant

Prednisone is a corticosteroid drug that suppresses the immune system and decreases inflammation. It can be taken alone or as part of a treatment plan with other drugs. The available forms include [1]:

• Rayos, extended-release tablet (lasts for a longer time)
• Delayed-release tablet (starts to act only after 4-6 hours)
• Deltasone
• Intensol (prednisone solution)
• Generic tablets
• Generic solution

Prednisone should not be confused with methylprednisolone or prednisolone. Although all 3 are similar, the dosing and bioavailability differ [2, 3].

Snapshot

Proponents:

• Suppresses inflammation
• Treats rheumatoid arthritis and IBD
• May relieve lupus and other autoimmune conditions
• Helps with severe asthma, purpura, and leukemia
• Multiple available forms
• Well-studied and -established treatment

Skeptics:

• Not suitable for long-term use
• Increases the risk of fractures, diabetes, and infections
• May cause mood swings, muscle cramps, and menstrual disorders
• May cause or worsen adrenal insufficiency in the long run
• Interacts with antibiotics and anti-seizure drugs

How It Works

Prednisone mimics the action of cortisol, a naturally occurring steroid hormone produced by the adrenal cortex. Before activating glucocorticoid receptors, prednisone travels from the gut to the liver, where it becomes prednisolone – the active form [2, 4].

As a corticosteroid, prednisone weakens the immune system’s inflammatory response by:

• Blocking leukocyte response at the site of inflammation [5, 6]
• Blocking inflammatory compounds (such as cytokines, prostaglandins, leukotrienes, NF-κB, and AP-1) [7, 8]
• Reducing the activity of genes that code for inflammatory compounds [7]
• Activating anti-inflammatory genes (such as SLPI, MKP-1, IkB-a, GILZ) [7]

Uses of Prednisone

Prednisone is a steroid drug which should only be used with a doctor’s prescription. We strongly advise against using prednisone for any reason other than what a doctor recommends.

1) Rheumatoid Arthritis

In 81 patients with rheumatoid arthritis (RA), 10 mg per day prednisone improved arthritic symptoms, reduced the need for other drugs, and reduced joint damage after 6 months. However, most effects weaned off at 12 and 24 months [9].

In a study of 350 patients with RA, modified-release prednisone (5 mg/day) in addition to standard treatment improved arthritic symptoms, reduced severity of the disease, and increased physical function compared to placebo [10].

2) Inflammatory Bowel Disease

In an uncontrolled study of 89 patients with acute ulcerative colitis, treatment with 40-80 mg prednisone completely resolved symptoms in 47% of severe, 80% of moderate, and 84% of mild cases [11].

In 205 patients with ulcerative colitis, 40 mg/day prednisolone improved symptoms faster than 20 mg/day fluticasone propionate (another corticosteroid) within 2 weeks [12].

3) Respiratory Problems

In two studies of 175 children with acute asthma attacks, prednisone (2 mg/kg) reduced hospitalization rates and improved breathing [13, 14].

The use of alternate-day prednisone therapy (1 mg/kg for 24 months) helped 285 children with mild to moderate symptoms of cystic fibrosis, a genetic disorder that affects the lungs [15].

In a study of 785 pneumonia patients, prednisone therapy (50 mg/day for 1 week) resulted in quicker improvement [16].

4) Purpura

People with purpura experience bleeding under the skin, skin spotting or discoloration. The immune system attacks platelets, causing a low platelet count and reduced blood clotting [17].

In a pilot study of 4 mg/kg/day prednisone, 22 out of 25 children with purpura improved, with an increase in platelet count. The same treatment was as effective as an initial therapy in another 53 children with purpura [18, 19].

In 171 patients with purpura, prednisone (1 mg/kg/day) was given for 2 weeks, followed by a weaning period of 2 weeks. It reduced stomach and joint pain, and improved kidney symptoms [20].

5) Leukemia

Prednisone is currently part of the standard treatment for lymphocytic leukemia, usually combined with other drugs. Lymphocytic leukemia is a type of cancer that affects white blood cells (lymphocytes) in the bone marrow.

In a study of 96 patients with chronic lymphocytic leukemia, the combination of prednisone + monthly chemotherapy (chlorambucil) showed the greatest reduction in disease severity [21].

Recently, studies compared prednisone with another steroid, dexamethasone, for lymphocytic leukemia and got mixed results. In some, dexamethasone was more effective, while in others there was no difference [22, 23, 24].

6) Lupus

Lupus is an autoimmune disease, and the goal of treatment is to reduce an overactive immune response. Since prednisone suppresses the immune system, it is one of the main treatment options for lupus, in combination with other drugs [25].

In a study of 111 patients with lupus and active kidney inflammation, a combination of prednisone and another immunosuppressant, cyclophosphamide, protected the kidneys better than prednisone alone [26].

7) Autoimmune Hepatitis

Prednisone is one of the main treatment options for autoimmune hepatitis (AIH). In AIH, the immune system attacks liver cells and causes inflammation [27].

In a review of 11 clinical trials, prednisone (alone and in combination with azathioprine) was effective in reducing symptoms, liver inflammation, and liver enzymes. The combination achieved better results [27].

8) Inflammatory Diseases

Polymyalgia Rheumatica (PMR) is an inflammatory condition that causes muscle pain and stiffness in the neck, shoulders, and hips. In 62 patients with PMR, modified-release prednisone reduced overall pain, shoulder pain, fatigue, and stiffness [28].

In a review of various glucocorticoid treatments for patients with PMR, an initial dose of 15 mg/day prednisone was effective in reducing the symptoms [29].

Prednisone Side Effects and Precautions

Side Effects

1) Increases the Risk of Bone Fractures

In 74 postmenopausal women with rheumatoid arthritis, long-term prednisone treatment (10 mg/day) increased the frequency of spine deformities.

In a large study of 244,235 patients (with 244,235 matched controls), oral corticosteroids like prednisone increased fracture frequency, especially in higher doses. When patients stopped taking these drugs, the risk of fractures rapidly returned to normal [30].

Prednisone (10 mg) decreased bone mineral density in 40 rheumatoid arthritis patients [31].

In a study of 539 lupus patients, prednisone (10 mg/day for 10 years) was associated with a 2.5-fold increase in the risk of osteoporotic fractures [32].

2) Can Cause Mood Disorders

Out of 80 patients on at least 20 mg/day prednisone, 42 experienced mood disorders – anxiety, irritability, euphoria, hyperactivity, depression, or manic episodes – with 5 cases requiring hospitalization [33].

In a case study of 20 patients taking 7.5 mg/day prednisone, there was a 60% higher risk of mood or anxiety disorder [34].

Out of 12 patients in one study, 9 reported behavioral changes that resembled hypomania – feelings of irritability, feeling high, talkativeness – when taking 80 mg prednisone [35].

3) Increases the Risk of Infections

Prednisone use was associated with serious infections in 6,290 patients with Crohn’s disease [36].

In a study of 697 patients with acute lymphoblastic leukemia, prednisone treatment (max 60 mg/day) during the incubation period of the chickenpox virus (varicella) increased the severity of infection [37].

Prednisone use of ≥ 40 mg/day had a 5-fold increase in infection frequency in 233 patients with lupus [38].

4) May Cause Cataracts

Out of 58 children receiving prednisone for IBD, 12 developed cataracts (no cataracts in 58 controls) [39].

In a study of 539 lupus patients, prednisone (10 mg/day for 10 years) was associated with almost a 2-fold increase in cataracts [32].

5) Increases the Risk of Cardiovascular Disease

In the above study of lupus patients, prednisone use was associated with a 1.7-fold increase in chest pain, heart attack, and artery bypass procedures. High-dose prednisone was associated with a 1.2-fold increase in stroke due to low blood supply [32].

Out of 80 patients on at least 20 mg/day prednisone, seven developed high blood pressure [33].

6) Increases Blood Glucose Levels

In a 785 patient study of prednisone for pneumonia, 19% of patients got increased glucose levels that required insulin treatment (compared to 11% of placebo-patients) [16]

7) May Cause Skin Changes

Out of 80 patients on at least 20 mg/day prednisone, 37 experienced skin disorders such as unwanted hair growth, thinning skin, bruising, and delayed wound healing [33].

8) May Increase Muscle Cramping And Weakness

In the above study, 32.5% of patients reported muscle cramps and 15% of patients reported muscle weakness [33].

9) May Cause Menstrual Disorders

39% of women (premenopausal) experienced menstrual disorders such as irregular or shorter periods and less menstrual bleeding in the study mentioned above [33].

10) May Cause Stomach Problems

In a study of 101 patients taking 5 – 60 mg prednisone, 22 patients reported stomach and gut problems such as heartburn and changes in bowel movements [40].

11) May Increase Fluid Retention

In a study of 101 patients taking 5 – 60 mg prednisone, 33 patients experienced fluid retention [40].

12) May Cause Insomnia

Insomnia occurred in 13 patients in the above study [40].

Contraindications

Prednisone should not be taken by anyone who has experienced a hypersensitivity to the drug or any of its other components.

Pregnancy and Breastfeeding

Prednisone should not be used if you are pregnant. The exception are certain circumstances where the benefits outweigh the potential risk to the fetus [41].

Prednisone can cross into breast milk and it is not recommended to take the drug if you are breastfeeding. Again, there might be some exceptions to this rule [41].

Drug Interactions

Drugs that alter the activity of liver enzymes that metabolize prednisone (CYP3A4 inhibitors and inducers) may affect prednisone metabolism [2, 41]:

• Estrogen increases the effect of prednisone
• Anti-seizure and sedating drugs (barbiturates, phenytoin, carbamazepine) decrease the effect of prednisone
• Antibiotics (ketoconazole, macrolides) increase the effect of prednisone

Prednisone may also increase blood glucose levels, which may reduce the effectiveness of diabetes drugs [16].

Other drugs that may interact with prednisone include [41]:

• Aminoglutehimide
• Amphotericin B
• Anticholinesterase Agents
• Anticoagulants (warfarin)
• Cholestyramine
• Cyclosporine
• Digoxin
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Prednisone and Vaccines

Some studies show that prednisone treatment can be unsafe or reduce the effectiveness of vaccines, but others show no difference.

In a study of 30 nephrotic patients, high-dose prednisone therapy showed no difference in pneumonia vaccine response compared to controls [42].

Prednisone treatment (2 mg/kg/day for 5 days) showed no significant difference in influenza vaccine response in 50 asthmatic patients [43].

However, in 24 patients with lupus (with 24 age-matched controls), prednisone treatment decreased immune response to the influenza vaccine [44].

The Center for Disease Control (CDC) recommends that individuals with suppressed immune systems should not get live vaccines. The CDC defines an immunosuppressive steroid dose at ≥ 20mg /day prednisone for over 2 weeks [45].

Forms and Dosage of Prednisone

Prednisone is available as immediate- and delayed-release tablets and as a solution.

Prednisone dosing varies widely from 1-80 mg depending on the disease being treated, whether the condition is acute or chronic, and the response to treatment.

One of the main challenges is finding the right dose and duration of treatment while minimizing the risk of side effects.

Slowly decreasing the dose rather than immediately stopping prednisone – tapering – is often used and is linked to better treatment outcomes and fewer side effects [29].

Genetics

Prednisone must be converted to prednisolone by the liver to become active. Therefore, liver disease may decrease prednisone metabolism and its anti-inflammatory effects [2].

Mutations in the NR3C1 gene, which encodes the glucocorticoid receptor, may also affect response to prednisone treatment. Depending on the nature of the mutation, it may increase or decrease the sensitivity of glucocorticoids like prednisone [46].