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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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— Feb 7, 2022

I have severe RA, fibromyalgia and Sjögren’s. I recently was taking 5 mg of prednisone daily for an RA flare. Surprisingly, my Sjögren’s symptoms (dry eyes, dry mouth, dry shin) improved. So I stayed on the prednisone for a month. When I told my rheumatologist that, he responded that I couldn’t stay on it for so long. He then proscribed a weaning off schedule. As I took less of the prednisone, my Sjögren’s came back with a vengeance! I want to resume a low dose regimen, but I’m fearful of the side effects. I need some advice.

I have scjogrens and also have cardiac problems long term steroids use is not healthy for your organs I know when I take them I feel great but also know that long term use is not good for you. I also take them wait a few months then again so its not daily and so often.

I have been taking prednisone for about four years I am taking three 1mg every morning my GP has never told me to go off them and at my age of 81 Years I will stay on them as I believe in
quality over quantity they have helped me to some degree although life is not easy as I no longer can eat of swallow food everything has to be puréed not the best way to have to live particularly when you have to sit and watch people enjoying food that I will never be able to taste again but can smell, haven't eating a meal in seven years.

Omgosh why have I been suffering for so long when I hear of everyone on prednisone with fibromyalgia / arthritis osteoporosis and I'm suffering like hell but not anymore ,I'm begging for some tomorrow ...I will keep you posted...there is hope!!!

Kim, if you're believing you're improving that much from fibromyalgia from taking a glucocorticoid, then you may be misdiagnosed as fibro is not an inflammatory disorder but rather a disorder of central sensitization. As far as your arthritis, again - what kind of arthritis? There are many, many kinds and so if you have osteoarthritis, that too is not known to be an inflammatory condition

— Apr 5, 2022

I have been on pregniselone for a week now. I am taking 20 mg per day. 2 times 10 mg. I suddenly feel psychotic scared. Feel like vomiting. Everything looks strange.
I took it for severe inflammation following thf pfizer vaccine.
How can I come off it asap safely. As last time I took it a month ago I came off it quickly. I tried coming off it 2 days ago and my entire body broke down. Severe side effects. I gave extreme nausea and psychosis. What do I do? I’ve tried walking. I’ve lost my appetite. I have haemerriods. I stare into space. If I ate something other than fruit would I feel better?
I just want to come down off it snd I don’t know what to do???? Please help asap.

best thing would be to detoxify preferably with an iv drip at the hospital other than that you have to wait it out it will go away-your side effects sounds more like the side effects of zyban ot some forms on anti depressants- anyways I will pray for you tc and good luck

— Apr 10, 2022

I only started this yesterday for lung inflammation due to an infection and having Lupus. I took three out of the 6 tabs for the first day which would be 12mg . I felt wired and squirrelly all day like shakey and foggy headed, but still in a good mood and just tried to ignore the weird feelings, because atleast I could breathe more easily atleast. By the evening, suddenly I felt the worst panic/fear type feelings for no reason and bordering psychosis. Jumping at every sound or movement, my heart was pounding for hours and having sharp chest/stomach pains. Everything looked scary to me in my peripheral vision. I felt like a zombie and could barely talk, but heart pounding wildly…. Throughout the day I also had increasing deep pain radiating from my hips, knees, through my entire legs until I could not bear to stand at night. I am a pretty small person… 5’2” and 105-110lbs. I also have had a problem with my heart skipping beats in the past… I wonder if the dosing for this packet I got is just too much for me personally…I am supposed to be on it for four more days and there’s no way I can handle that without being in a psych ward lol 😖😵‍💫 It was prescribed to me by someone that is not my primary doctor because I went for emergency breathing trouble. It is the weekend now and can’t get in touch with my doctor until the week unfortunately… I stopped taking the medication last night and have no intention of continuing it. I felt like I was in hell. I was nervous about everything that said it’s dangerous to stop taking it… :/ but after how horrible that felt, I’d rather have some physical complication than mental honestly…

yeah you needed a much lower dose like 1 mg a day -the only thing that wouls help you calm down would be like lorazapam or valum or a strong sleeping pill like zopiclone-prolly hit your hard cause of your size and perhaps not use to taking strong drugs tc

— May 8, 2022

hi I have been suffering for allergic sinus inflammation on and off since 2019 with either change of weather , cold, dust or pollen grass. It gives right side headache and back of head with moderate white mucus discharge .Every time i try decongestant, steam vapour and other antihistamines it gives very slow response. ENT sinus specialist prescribed 25 mg prednisone

— Jun 12, 2022

I have been taking prednisolone 1% for over a year 3 times a day in my left eye. Along with the following: brimonide tartrate .2% solution (twice a day in both eyes over 6 months in my right eye and over a year in my left eye) timolol maleate .5% in both eyes (about 6 months in both), and ketorolac tromethanine ophthalmic solution .5% in my left eye 3 times a day. What side effects should I expect?

I'm not if I should start low dosage
No pain.abd soft just notice urinary frequency..doesn't feel like UTI
I know they r watching for cataract change but don't have an appt til August
Just notice a little balance issue I'm 80

Elevated eye pressure has been a side effect of Prednisolone for the treatment of uveitis caused by my HLA-B27 gene. When I’m not having a flare I use one drop of prednisolone in my right eye twice per week and Rhopressa nightly before bedtime. When I’m having a flare Prednisolone eight times per day for the first week and then the tapering begins. During this time Brimonidine three times per day, Dorzolamide three times per day and Rhopressa before bedtime. I also take 120 mg of Mirtogenol daily. I get eye pressure checks every 6-8 weeks when my eye is calm and more often when I’m having a flare. This has worked for keeping my eye pressure in range and my eye calm.

— Jul 31, 2022

Good day. I have been taking Prednisones for almost 2 years now...been treated for Polymyalgia. I started with 20mg. I am now on 5mg for almost 6 months...havent seen a doctor for approx the same period of time. I just need to get off it. Can i stop taking it completely now or do i need to taper to 2.5 mg and for how long? I still have some pain in the back though. I would like to know if there is alternative medication i could use instead of preds pllease?

When weaning off...once down to 5mgs you need to wean VERY slow. It takes time for your adrenal glands to kick in. Infact weaning to swiftly causes pain and often is mistaken that the PMR is still there. Every few weeks drop a mg. You may not feel the best for a couple days as your adrenal glands adjust. Be kind to yourself and rest and take Tylenol if needed. At 2.5mgs I went down in half mgs every week to two weeks.

For those that may have additional autoimmune problems PMR may be a long term problem with flares. Much like fibromyalgia. I still get flares but opted not to do very long term low dose prednisone. I posted here in another post why.

I am on an anti inflamatory diet. I use cannibus gummies for sleep. I just bite a piece off...not a whole one. It works. On bad days I take 1 Tramadol and Tylenol. Not daily...just as needed. I also take vitamins and minerals.
Best to you😊

— Aug 2, 2022

I have ongoing pyaderma gangriosums which keep appearing over my body. I have seen a heamotologist , rheumatologist, gastroenterologist & dermatologist. Am currently on 39mgms a day and they don’t seem to be helping. I have been on prednisone for the past 2 years off and on anywhere from 75mgs to 5 over this period. I also have COPD and they help considerably with this and help me breath more easily. I also have issues when not on the prednisone with eating, food is simply repulsive to me and I actually gag at the thought of eating, no matter what the food is. I have lost a considerable amount of weight. The gastroenterologist is treating me for chrones disease that the infusions are working to some extent, but they now at 8 weekly intervals and don’t have the immediate effect. My appetite is lagging in between doses and the pyodermas seem to escalate in between doses. Any suggestions, comments or advice would be greatly appreciated as this has been an ongoing, painful ailment for about 2 years now.

— Sep 16, 2022

I have developed itching all over my body for about one year for which I see dermatologist.He has prescribed me prednisone 10 mg on and off which controls itching very well.If I stop prednisone itching starts.I am 80years old.Can I take low dosage like 2.5 to 5 mg a day for the rest of my life?Mydermatologist has done biopsy and blood tests a few times but everything is normal.

— Nov 2, 2022

I have terrible fibro I. Pain all rhe time. But I have electrical pro lem (bigemeney) so my heart dr said no I eas o. Ir for a few days it leaped sooooo much wish u could take it

— Nov 3, 2022

Man I just had a awful experience with 10mg a day prednisone.
Obviously more an allergic reaction than side effect.
I think the word is gastro issues. Any how couldn’t keep food down, in, out. You name it, persevered for week until really was forced to stop due to weakness and dehydration. 2 days latter appetite returning , nausea diminished.
I’m writing this because symptoms were extreme for low dose, and didn’t seem to fit. So may help someone else in similar circumstances.
I should of stopped well before, 6 days
Thanks to others that shared.
I have no idea where this is based , but I’m in New Zealand

— Dec 1, 2022

I enjoyed reading the comments. I've had autoimmune problems for years and developed sjorgrens and then Polymylagia Rhuematica. The doctor wanted long term 5mgs. I opted for 3mgs and was on it three years until the PMR somewhat subsided.

It left me with some permenant effects and feel badly about it. I had phenomenal bones. Now they are just good and have developed the very beginning of osteoporosis in my hips. I always had perfect sugar numbers and now they are mildly elevated and despite losing pounds to my ideal weight remain elevated. I have severe muscle loss in my back. It shouldn't be as I'm very active. I had horrendous vision problems. Thank goodness no cataracts. It took over a year for my vision to return to normal. I know I'm older...but my skin thinned and aged fast. I did research and it can destroy collagen which can't be replaced. My hair thinned and as of this date has not thickened back. The whole time on it I had stomach distress despite taking Prevacid. It elevated my liver numbers. They seem to slowly be improving.

Did it help with pain? Absolutely and I had energy galore. I thought it was a miracle medicine. I supose I needed it with PMR. I was so sick. Now I wonder if it was the right thing to do.

Everyone is different, but I advise to be your own advocate and research it throughly and listen to your bodies symptoms. Best to everyone suffering pain. We are all in the same boat trying to find the best quality of life with chronic pain.😊

— Jan 3, 2023

I'm really struggling with my mum's health how it has deterated in short space of time since my mum became ill in Blackpool before boxing day and she is getting worse in my oppion can please let me know how long it will take to see a improvement to my mum health please email me back with your advice so I know long before my mum will take before she is feeling better many thanks Stephen ollier

— Jan 29, 2023

Although steroids should not used as a first line of treatment or be used long term if at all possible, healthcare professionals should stop being scared of prescribing steroids to patients and educate themselves. Inflammation can cause irreversible damage and pain and steroids may prevent this. Stop making patients suffer.

— Jan 29, 2023

Do side effects of steroid vs inflammation and organ damage by not prescribing steroids give an excuse for healthcare professional not to prescribe steroids? CERTAINLY NOT

— Jan 29, 2023

Could I take prednisolone 5mg daily? For life time.

I'm dealing with multiple sclerosis since 2015.

— Feb 14, 2023

PMR here - started at 10mg then tapered to 7.5 after 1 week. After 3 month down to 6mg a day with return of symptoms in the AM that are not as severe as untreated and abate during the day. Weirdly, I also have Sjogrens antibodies (asymptomatic) AND I lost sense of taste and smell several years ago though the prednisone on the dose I am on did not help with that... I can't function with PMR without some intervention - the pain is unbelievable and no painkiller of any kind touches it. Definitely don't want to be taking prednisone because of all the negative side effects mentioned but I can't get out of bed without it.

— Mar 18, 2023

Several weeks ago I got Ptosis where my left eyelid drooped and closed while my right eyelid was fully open. It looks weird and makes anything visual more difficult (driving, watching TV, computer use). It was getting worse and I went to my doctor. She ordered MRI scans of my neck and head (brain was normal) along with blood tests (normal). She also prescribed 50mg Prednisone to clear up redness in my left eye from taping it open which reduce blinking. After about eight days my eyes went back to normal. She has me tapering down on the dosage but I may need to stay at a low dose. I feel better than usual with minor side effects which I think will go away at a low dose. On my Medicare Advantage plan it is no cost.

— May 5, 2023

What can I take to improve muscle strength and growth along side prednisone.
Have lupus and take 5mg prednisone since forever.
I take vit D and have osteoporosis. 48 years old

— Jul 11, 2023

Hi! I was on 5mg prednisone for 18 years to help with my RA. I’m in remission now. Asked doc if I could wean off. I’ve been weaning off for the last 6 months and now finish on July 1st. I’m experiencing knee and calf pain and have difficulty walking at times. I know it’s withdrawal symptoms but how long before I’m not in pain? Anyone have this happen to them? Did you ever go back to normal? Thanks

Update…I couldn’t take it anymore. I went back on the 5mg. It was so difficult to walk or go down the stairs. I guess my body needs it. I really tried, but let me say it was rough. I’ll continue to get my bloodwork done. Thankfully I never had any issues with low dose. Hopefully you all have better luck than me trying to get off of it.

Hi Stephanie. I was interested reading your posts as I was just diagnosed with RA in January of 2022. I've been on 7.5 mg of pred since then along with plaquenil, methotrexate, and Humira. I just recently started trying to slowly taper my pred and it's miserable. My doctor says there is no harm in staying on 7.5 mg indefinitely. Did you have any side effects from many years on 5 mg?

I just started methotrexate a couple of weeks ago. I take 2.5 mg once a week. I feel like I have the flu. But the medication is working to reduce inflammation and itching on my face. What was your experience with methotrexate? Will the feeling sick go away? I’m considering stopping the medication.

— Aug 9, 2023

Hi i have been taking predisone 30mg for 6 days for copd my breathing has improved but i'm getting really thirsty heart palpitations, blurred vision dizziness and a tingly face, not sure if i'm being paranoid, will these symptoms go away once i stop i only have one more day to do. Thank you

— Aug 10, 2023

I have been on Prednisone for just over 2 years for PMR, started at 20 mg managed to get down to 5 mg but had a flare went up to 17 mg and finally have worked down to 7 mg..however the side effects even at this low dose are frightening. I have had significant weight gain, more then 45 lbs, my hair is thinning, my skin has developed small bumps that bleed easily then form a white crust appearance, and worst of all is a change in my personality...I have become very moody and find small things set me off.
So yes this is a wonder drug but there are times when I wish I had never started it...I also have moderate RA and am about to start a new Biologic called Orencia..hopefully with decreased inflammation I can get off the Prednisone. As a result of elevated SED rate I have developed anemia which required a total of 7 I/V infusions of Venofer...Hard to keep going some days but love of family keeps me present. Best to all ...

— Aug 26, 2023

I have been on Prednisone for inflammation in both lungs started with 30mgmd and now tapered down to 5 mgm once a day a breakfast I have awful weight gain. Specialist advised to take five mgms for another six months. By then I will be the size of a house. Can I cut down myself the dosage. Thanks for any help

— Sep 15, 2023

I've just been prescribed 40mg prednisone for lung fibrosis and I'm terrified of the side effects it's going to be a tapered dose over four months anyone had experience with this and how did it effect you and your symptoms.

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