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Ask the Expert: What are the side effects of taking a low dose prednisone every day? It's the only thing that helps with my pain, but I hear it's not a long-term solution?

Prednisone belongs to the class of medications known as corticosteroids (or anti-inflammatory agents). These medications provide relief of inflammation and are used to treat a variety of medical conditions including pain, asthma, Sjögren’s and rheumatoid arthritis. As with all medications, corticosteroids have some adverse side effects related to the dose and the duration in which the medication is taken. Side effects associated with low dose (7.5 mg/day or less) daily prednisone are less severe than those seen with higher doses (greater than 30mg/day) and can usually be managed with precautions. Common side effects of daily low dose prednisone include elevated blood pressure, swelling, changes in blood sugar, increased appetite, weight gain, insomnia, osteoporosis (thinning of bones), irregular menstrual periods, and mood changes. Serious side effects associated with higher doses and long-term use (greater than 1 month) are impaired wound healing, decreased growth (in children), decreased muscle production, fat deposits, stomach ulcers or bleeding, vision problems, higher risk for infection, and in rare cases life-threatening allergic reactions.

Although the list of side effects may make you wonder whether you should take this medication or not, please be reassured that many people take daily low dose prednisone with minor or no side effects. The following self-care tips may help minimize some of the side effects associated with prednisone. For those experiencing swelling and/or elevated blood pressure, a healthy low sodium diet, regular exercise, and stress management can help to keep your blood pressure under control while taking daily low dose prednisone. If you have diabetes, it is important to monitor your blood sugar and report any severe fluctuations in blood sugar to your provider. It is recommended that prednisone be taken with food or milk to minimize stomach upset and reduce the chance of stomach ulceration. Schedule yearly eye exams and report any new changes in vision to your eye doctor. Long term corticosteroid therapy may cause thinning of bones (osteoporosis) which increases the risk of bone fracture. Talk to your doctor or pharmacist about vitamin D and calcium supplementation to help protect your bones. Since long term prednisone use can increase your risk for infection, ask your doctor or pharmacist to review your vaccination history and be sure to stay up to date on all of your recommended vaccines. Alert your family members and friends about the possibility of mood changes associated with this medication, so they can help detect any unusual changes in your behavior. Report any changes in mood or behavior to your doctor.

Although experiencing side effects is unpleasant, it is crucial to avoid sudden discontinuation of this medication. Never stop or decrease your dose unless instructed by your doctor. Your doctor can instruct you on how to slowly decrease your dose if you need to stop taking this medication for any reason.

By Ajay John, Pharmacy Intern and Kayli Smith, Pharm.D

This article was first printed in  the Foundation's patient newsletter for members. Click here to learn more about becoming a member. 

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Comments

— Nov 27, 2021

I have been experiencing anosmia for over ten years now.
64-Year-old male Caucasian of European descent.
5'/10" 185 lbs. retired.
My anosmia symptoms are complete loss of taste and smell.
So far nobody has determined a cause nor has anyone showed any interest in anything other than treating symptoms.
It hasn't been easy for anyone who experiences this condition.
I have burned many pizzas and other food over the years.
I had a ruptured gas tank in my car and can't smell a gas leak or anything but someone smelled it and told me, and the gas tank was replaced.
Anyone who knows anything about anosmia knows of the dangers that accompany the complete loss of taste and smell.
The reason you are reading this message right now is because as a patient/person, I have found a way to restore my sense of taste and smell 100%.
The treatment I tested worked perfectly to restore the senses.
I am getting pushback from my PCP.
My allergist disagrees with my PCP.
Just want I don't want on my health care team.
I lose confidence.
10 years, no taste or smell of anything here on Earth, retired in 2020 only to be in lockdown to stop the spread of covid, and during that time while being treated for Gout, by accident I discovered that prednisone in low doses 2.5mg - 5mg per day, totally restores the function of the olfactory glands with no evidence of known side effects in my body.
(I know, just because you don't see it doesn't mean it's not there.)
That means I can taste and smell again 100%.
You would think my PCP would be happy for me.
He wouldn't even prescribe 3 ea 20mg tablets to restore my sense of taste and smell for Thanksgiving.
I have literally begged my PCP to show a little compassion and allow me to continue my experiment with medical supervision but I just get a big NO!
Has there been any new studies in this regard?
One of the symptoms of covid 19 is of course the loss of taste and smell.
I see that when I do an online search about prednisone and anosmia, the results are predominately related to covid 19.
That is not my case.
It is True that I have been pursuing an answer to how to restore the taste and smell sensors in this body for many years now.
The medical records show these attempts.
I maintain that it is my body and if the low doses of prednisone restore my sense of taste and smell, I am willing to suffer the potential side effects.
I just need to find someone who will consider my wishes and not worry about extending my time.
I'm going for quality not quantity. I have logged in 64 times around the star that we call the Sun.
If my body had only 20 years on it, I would pursue some other treatment, but at 64 years and not wanting to live anymore in a world that is rapidly disintegrating, I'm willing to opt for a shorter amount of time left here on Earth before my departure date, with my taste and smell sensors intact and fully functional.
I've just started this research so I appreciate all input and any references you can give me as it relates to treating anosmia with low doses of prednisone and any clinical studies to support that.

Thanks!

Joe Stark 503-848-6815

I have had very bad back pain for years. I had surgery and have been seeing a pain management doctor for over 6 years. I am in Mexico and can get prednisone over the counter very inexpensive. I took 50 mg for two days and I can say I have had no pain. I have read under 30 mg is safe and considered low dose. I will start cutting them in half for 25 mg and see if the pain is relieved. It has even helped with my rotator cuff pain . My doctor wouldn't be happy I am sure and I have to watch my bone density. I can't believe how much better I feel. I haven't been pain free for about 10 years. I want to go dancing!! wow

Kathleen Rae
I also took 30/40 prednisone… be very careful and have someone watch your behavior. Read about physcosis from steroid use. It’s real and can change your personality to very aggressive… like being in a dream with no consequences to actions. Long term use will give you diabetes and heart disease. I cut down to 5 mg a day. I am trying not to take that. But yes… it is wonderful for the pain.
Just an FYI

Thank you for your honest comment.
I was on prednisone for 13 years for Polymialgia Rhumatica now my esr and crp levels are fine and I came off the drug very slowly and was fine for 3 weeks . They told me I don’t have PMR anymore. Now all the muscle pain and weak feelings are back and I’m battling with my Gp for to start back on 4mgs.

I experimented Saturday with 5 mgs and I was pain free for around 30 hours, now it is back. I’ve had a stroke last year too, which I’m getting over and have spinal lumbar and cervical stenosis too recently diagnosed. Medication High dose of Garpbentin which doesn’t touch my muscle pains.

So I’m worried incase it damages my spine more taking a low dose of prednisone starting at 4mgs and getting back to 2. Any advice is welcome please. Thanks

Every drug has a cost. It is up to you in consultation with your doctor to get he balance right. Low dose Prednisolone has side effects but they are worth it if your pain is controlled.

I also have pms. Been on 40 msg but on 40 at moment they help with the pain but will have to stay on low doze till next year. If I were you I’d see a different Doctor. And get back on the low doze or go to your local hospital. And see a doctor at a and e.

I had a serious case of Covid two years ago, and could not get over it. I had chest pain, and most other symptoms. An emergency room doctor put me on Prednisone, and some antibiotics for an infection concerning my lungs.Then my physician put me on the same amount of prednisone, for the same length. I finally started to get well.
So, should I not have taken this medication, since I now have insulin resistance. I am so upset about this. Are doctors not familiar with this delima? What do patients do, when they are so ill.

Iam taking Pred . Regiment 16 mg 4 days, 12 mg4 days, 8 mg 4 days, 4 mg 4 days. I can refill and start the regiment again . How much time in between regiments is safe before starting over? Thank you

yeah under 30mg a day is not safe Iam in the same boat in terms of pain and i take prednisone maybe twice a year-if you really want something safe for your pain you must try methadone it is amazing for pain-30 mg of prednisone a day will destroy your stomache for sure-good luck

I love prednisone. It is the only thing that keeps me going. It takes away my pain. My drs want me to take a new crazy medication. I want to stay on prednisone. It always make me feel better.

What caused the loss of smell and taste?
In your place I would find a different doctor.
Good Drs will listen and honor yore needs unless the issue would cost e them their lic. Also as steroids address inflammation has anyone worked with you to see if you have a serious sinus infection or other underlying infections, oddly, these infections that result in underlying inflammation can be the cause of secondary problem that mimic even other problems and go undiagnosed.

I believe Loss smell & taste are common w sjogrens. When you are not able to produce saliva, these senses fade. I have it and have lost both. Dental problems from loss of saliva too. Vision problems too as I have dry eyes.

I have severe Sjögren’s as well as other auto- immunological problems. I have not lost my sense of smell and taste…in fact they have heightened funnily enough. I cannot bear to cook and even shopping is a chore for me with all the smells/aromas in supermarkets.

The Sjögren’s has worsened as I have got older- no saliva, incessant dry cough, dental problems, sore, burning mouth and lips , mouth ulcers and very severe eye discomfort , pain in joints and soft tissue now being treated since the 1980’s.

I now have no appetite at all, can not tolerate any spicy food, which I loved previously and in the last few months have lost 20kg. Diabetes seems to have disappeared, cholesterol is good and this has probably also helped the joint pain too. Nutrition is a problem now though and I try to take supplements….not always possible because of dry throat and nausea, as well as all the other medications I have to take. At the. Moment a possible crocodile pharyngeal spasm is being investigated.

Because I think the doctors could not bear the sound of the incessant coughing ( no that is probably unfair)I am now taking 25mg of cortisone daily for I do not know how long yet—was on 15mg.

Have had stomach and bowel and oesophageal problems for decades. Need to have blood infusions more recently…..but now have given up Naprosyn 200mg and usually I have little pain which is wonderful. I have for about a year had shocking headaches, perhaps migraine, accompanied and I think relieved ultimately, by vomiting and diarrhoea.

I have to wait and see if cough improves. How long I will be on it is a bit of a worry as I already have osteopenia and have no desire to have osteoporosis and propensity to break bones at my age.

I am quite happy to have lost the weight and even look forward to attaining my elite sport’s weight in the future…..that is probably not healthy. Previously for years on a 500cal diet and competitatively rowing masters I lost nothing in fact put on weight. I also have an inactive thyroid and take200mmg of thyroxine a day.

So I , in time, will see what the good and bad affects of the 25mg cortisone are. Certainly it reduced the dreadful pain I used suffer. It is a wonder drug but does need to be monitored. I think I have been a bit hyper and can’t allow that to worsen…..but certainly in my case it has not given me a moon face or put on weight, which pleases me.

Recently I have been nearly driven mad by my eyes and mouth and throat….not to mention other affected mucosal glands.

Good luck to you all!

One of the worst things about my ?”allergy” to taste and smell, my heightened senses, is that I can no longer enjoy meals restaurants with my husband and other people, nor can I cook for him.
This certainly is a bad affect of Sjögren’s as it for me has become more severe.

Hi Theresa,

Your post resonated with me because I am starting my journey, but I want to know your secret strength. I am starting on my journey. I am at 40mg a day for a month. I am a active 28 year old and just got diagnosed with Sjögren’s and I got it pretty aggressive post covid. I have a rare interstitial lung disease (LIP) so the medication is to help with the inflammation to my lungs. As of now, I still go to the gym and work but how do you talk with your support system with some of the changes that may come?

Maria

Loss of smell & taste ? Any head/brain injuries ? Then possible Olfactory Nerve Damage. Go See A Neurologist To Rule These Out ! Good Luck & Regards To You.

Joe:

I was a pharmacist in the State. I started my own business in 1988 in Taiwan.

I am now 72 years old.

Therefore, I know a bit about prescribed drugs.

I also am a long-term sufferer of anosmia. Therefore, I know exactly how you are suffering. Food has no taste and, worst, you cannot smell nature!

I have started the experiment for the treatment of my anosmia by taking a long-term low dose of prednisone 5 mg per day for the last two years.

It works!

I taper off the dose over a week by taking 5 mg every two days for a week and completely stop taking the drug for a few weeks. The anosmia comes back immediately. I would suffer for a week or two. Then, I started the 5 mg prednisolone every day for a month again. The anosmia is gone within three days of the treatment. It works like a clock.

I hope more people will know this special treatment protocol and live a better quality of life.

Of course, I take vitamins, do annual medical check-ups with daily exercise and run 2K three times a week.

I am lucky to live in Taiwan, so I usually get 5 my prednisolone from a local drugstore with no prescription!

Please take my experiment to treat anosmia with your own discretion. Any open-minded ENT doctor would help you with this treatment protocol.

If it works for you, please tell your ENT doctor so that more people will have this choice.

Kindness is a choice,

Ping

Ping,
It’s encouraging to hear your news and I appreciate that you are a pharmacist. Is prednisolone just a different name for prednisone? What are the differences? I have taken prednisone and prednisolone. When I have taken prednisolone it’s always in a blister pack laying out specific doses.
Thank you for your kind response to this post.
Heidi

Thank you for your advice Ping!
I am a sufferer of no smell and allergies. I developed an allergy to Balsam of Peru which is is everything from Soaps to tooth paste! My big trigger is Sodium Benzoate but I am discovering that I am allergic to so many foods too!

I have been a life long tea drinker and drink maybe 10 cups a day of all kinds of varies teas. Last Friday I thought I had poison Ivy because I broke out in a rash of tiny blisters on my neck and face. It has since spread and each day it is worse. I have a reaction to many steroids, high blood pressure and blood sugar. I’m not sure what dose the last steroid shot was, but I feel it was high! Sometimes the cure is worse then the ailment.
I will try anything at this point!
Because
I am lost for answers!
Your kindness is appreciated!
Becky

I have inflammatory arthritis post covid. Covid caused it to inhibit my physical abilities. I am taking 2.5mg of prednisone and have stopped for a week and then resumed because of return of inflammation. I am also receiving infusions of remicade which seem to help also. I was hoping to stop the prednisone completely after the infusions.

I feel sorry that you have lost your sense of smell and taste, I have Scleroderma and Sjogrens I take Predsolone every day my GP prescribed for me to help with inflammation of my mouth but unfortunately I cannot eat food because Sjogrens destroying my Saliva glands and also losing my teeth I no longer can swallow solid food and live on liquid foods my sense of smell is messed up and everything smells terrible, You just have to live the best you can and keep busy.

Hi Joe, this is an old post, but replying anyway. My experience with pred was because I went blind due to Multiple Sclerosis which I did not know I had. Long time ago so don’t remember timeline. Think it was prescribed by neurologist for 1 month. High dosage daily, think 40 mg, slowly weaned to 0. My vision returned. I refuse most pharmaceuticals, but it seemed to be necessary. Have not needed since. Hope you are improving.

I too lost smell, hearing and taste, but due to vasculitis. I encourage you to ask your doctor if you have any markers for vasculitis. I was on prednisone, but, alas, no return of taste or smell. I wish you the best.

Hi Joe, I have the same thing I am 38 years old and I lost my sense of smell after I had my son it’s been nine years. My doctors just kept saying it’s allergies and that I had a lot of polyps in my nasal passage. As of the last result I got the nasal surgery a year ago and I snuck great right after but it quickly went away as soon as the prednisone was done after the surgery. It’s definitely information and I’ve been doing some research myself and when I was a kid I had mono. Epstein bar virus comes from mono. I think my body is inflamed because of the virus so I am trying for 90 days tonight I have a milk egg or gluten… so sad because I love all those things. I’ll let you know if it does anything for me. But you’re right if that medicine helps you someone should be able to prescribe it for you. Good luck and live as many years as you possibly can every day is a gift my friend! Xo

First thing -change your doctor! I understand completely not wanting to continue living with a low quality life. Your doctor should understand this as well. If this works you may want to live longer, and even enjoy life again! Try an osteopathic doctor. I have found they are frequently more compassionate. Such a low dose of steroids, I think are worth the long term effects. I am on 5mg a day (started at 20 and decreased to 5 daily) for another condition. I am living again! I don’t care if I die tomorrow! I’ve enjoyed the last 2 months! Good luck.

Laura
I have taken Prednisone sporadically for last 20 years. It has taken away my
Severe backache each time. But now I am 76 years old with no major
Health issues and cannot find one Doctor in Florida that will give my a script
Even for short time. What is the problem!!!!!

I have had the same problem for 25 years!!! I too wanted to always take prednisone and did for many years! However, I developed full blown osteoporosis due to prolonged use of steroids and now have chronic joint pain! My allergist started me on the medication Dupixent about a year and a half ago and it has made the difference of night and day for my smelling and tasting issues! It is a twice a month self injection that is a miracle drug in my eyes! Although, it is still being studied to see how long you can safely take this medication without complications. Hope this helps!

Hi Joe,
I am very intrigued over your story. With the amount of high-end public health failures in recent years, I would think a "good news" story would capture the attention of someone... anyone, hoping to salvage what's left (if anything) of governmental regulators.
Anyhow, I am a writer, close to your age, and bothered by stories such as this. Can I ask if you have discussed this with any media? While this isn't really a topic I cover much, for whatever reason I came across your post and perhaps there is a reason I did... who knows. Lastly, as we're coming up on a couple years since your posted, can you tell me if anything major has changed? Please feel free to write back directly if you wish at tatattersoniv(at)gmail(dot)com and should you decide not to I fully understand. Regardless, I sincerely hope you've found some solution be it temporary or permanent. I don't know what I would do with my smell (or taste)... what an incredible bummer and absolutely infuriating what you have come up against.
Regards,
TA Tatterson IV
Washington State, USA

— Jan 10, 2022

I have been taking prednisone between 5 and 20 mg up and down for a year because I have dermatitis around my lips and cracked lips. The prednisone causes thrush in my mouth medication has not cleared it up, and in which I have had for a long time. Can thrush in the mouth have long term side effects?

I too had the same problem. My primary had me on 40 mg. Daily so I got oral thrush. My primary give me a couple of meds that didn't work so I went to EMT and they put me on Majic mouthwash. Didn't even have to take the whole bottle. It comes in a bottle that you keep in the fridge. After I seen my new Rheumatologist she lowered the dose to 15. Never was bothered with oral thrush again. I had taken Prednisone for over 8 months. Off for about a year but now back on 10 mg. for my R.P which is horrible. Plus got 7 compression fractures this past year from early osteoporosis and taking steroids. Good luck.

gargle with salt water in the morning after every meal and at bedtime if that don't work then there must be an underlying condition

— Jan 25, 2022

I started a script for Prednisone 10mg. 1-2 tabs daily. I was only given 15 tabs. How to a stop taking abruptly or cut in half ????

— Feb 2, 2022

How long-term use of15 mg be considered dangerous because they keep my nasal polyps at bay

PLEASE ASK YOUR ALLERGIST ABOUT DUPIXENT! I have had chronic sinusitis with nasal polyps for 30 years and have been on enough steroids to kill an elephant! That was the only thing that kept my polyps at bay UNTIL my allergist started me on Dupixent injections...let's just say it is a MIRACLE! It was developed for asthma and eczema but was shown to reduce nasal polyps so he tried me on it and it has worked wonders!!! Good luck!

— Feb 3, 2022

nice post

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