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What is prednisone?

Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

Prednisone is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

Important information about prednisone

Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

You should not take prednisone if you have a fungal infection anywhere in your body.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Avoid being near people who are sick or have infections. Do not receive a "live" vaccine while using prednisone.

Call your doctor at once if you have shortness of breath, severe pain in your upper stomach, bloody or tarry stools, severe depression, changes in personality or behavior, vision problems, or eye pain.

You should not stop using prednisone suddenly. Follow your doctor's instructions about tapering your dose.

Before taking prednisone

You should not use this medication if you are allergic to prednisone, or if you have a fungal infection anywhere in your body.

Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks.

To make sure prednisone is safe for you, tell your doctor if you have:

  • any illness that causes diarrhea;

  • liver disease (such as cirrhosis);

  • kidney disease;

  • heart disease, high blood pressure, low levels of potassium in your blood;

  • a thyroid disorder;

  • diabetes;

  • a history of malaria;

  • tuberculosis;

  • osteoporosis;

  • glaucoma, cataracts, or herpes infection of the eyes;

  • stomach ulcers, ulcerative colitis, or a history of stomach bleeding;

  • a muscle disorder such as myasthenia gravis; or

  • depression or mental illness.

Long-term use of steroids may lead to bone loss (osteoporosis), especially if you smoke, if you do not exercise, if you do not get enough vitamin D or calcium in your diet, or if you have a family history of osteoporosis. Talk with your doctor about your risk of osteoporosis.

Prednisone can cause low birth weight or birth defects if you take the medicine during your first trimester. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Use effective birth control.

Prednisone can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medicine.

How should I take prednisone?

Take prednisone exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take prednisone with food.

Your dosage needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Do not change your medication dose or schedule without your doctor's advice.

Measure liquid prednisone with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not crush, chew, or break a delayed-release tablet. Swallow it whole.

While using prednisone, you may need frequent blood tests at your doctor's office. Your blood pressure may also need to be checked.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using prednisone.

You should not stop using prednisone suddenly. Follow your doctor's instructions about tapering your dose.

Wear a medical alert tag or carry an ID card stating that you take prednisone. Any medical care provider who treats you should know that you are using a steroid.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of prednisone is not expected to produce life threatening symptoms. However, long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while taking prednisone?

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using a steroid.

Do not receive a "live" vaccine while using this medicine. Prednisone may increase your risk of harmful effects from a live vaccine. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Avoid drinking alcohol while you are taking prednisone.

Prednisone side effects

Get emergency medical help if you have any of these signs of an allergic reaction to prednisone: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • blurred vision, eye pain, or seeing halos around lights;

  • swelling, rapid weight gain, feeling short of breath;

  • severe depression, feelings of extreme happiness or sadness, changes in personality or behavior, seizure (convulsions);

  • bloody or tarry stools, coughing up blood;

  • pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Other common prednisone side effects may include:

  • sleep problems (insomnia), mood changes;

  • increased appetite, gradual weight gain;

  • acne, increased sweating, dry skin, thinning skin, bruising or discoloration;

  • slow wound healing;

  • headache, dizziness, spinning sensation;

  • nausea, stomach pain, bloating; or

  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Prednisone Dosing Information

Usual Adult Dose for Nephrotic Syndrome:

Initial (first three episodes): 2 mg/kg/day (maximum 80 mg/day) in divided doses 3 to 4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1 to 1.5 mg/kg/dose given every other day for 4 weeks.
Maintenance dose for frequent relapses: 0.5 to 1 mg/kg/ dose given every other day for 3 to 6 months.

Usual Adult Dose of Prednisone for Anti-inflammatory:

5 to 60 mg per day in divided doses 1 to 4 times/day.

Usual Pediatric Dose for Nephrotic Syndrome:

Initial (first three episodes): 2 mg/kg/day (maximum 80 mg/day) in divided doses 3 to 4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1 to 1.5 mg/kg/dose given every other day for 4 weeks.
Maintenance dose for frequent relapses: 0.5 to 1 mg/kg/ dose given every other day for 3 to 6 months.

Usual Pediatric Dose for Asthma:

< I year:
acute: 10 mg orally every 12 hours.
maintenance: 10 mg orally very other day.

1 to 4 years:
acute: 20 mg orally every 12 hours.
maintenance: 20 mg orally every other day.

5 to 12 years:
acute: 30 mg orally every 12 hours.
maintenance: 30 mg orally every other day.

>12 years:
acute: 40 mg orally every 12 hours.
maintenance: 40 mg orally every other day.

Usual Pediatric Dose of Prednisone for Anti-inflammatory:

0.05 to 2 mg/kg/day divided 1 to 4 times/day

Usual Pediatric Dose for Immunosuppression:

0.05 to 2 mg/kg/day divided 1 to 4 times/day

What other drugs will affect prednisone?

Many drugs can interact with prednisone. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with prednisone, especially:

  • amphotericin B;

  • cyclosporine;

  • digoxin, digitalis;

  • St. John's wort;

  • an antibiotic such as clarithromycin or telithromycin;

  • antifungal medication such as itraconazole, ketoconazole, posaconazole, voriconazole;

  • birth control pills and other hormones;

  • a blood thinner such as warfarin, Coumadin;

  • a diuretic or "water pill";

  • the hepatitis C medications boceprevir or telaprevir;

  • HIV or AIDS medicine such as atazanavir, delavirdine, efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir;

  • insulin or diabetes medications you take by mouth;

  • a non-steroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;

  • seizure medications such as carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone; or

  • the tuberculosis medications isoniazid, rifabutin, rifapentine, or rifampin.

This list is not complete and many other drugs can interact with prednisone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

For the Consumer

Applies to prednisone: oral solution, oral syrup, oral tablet, oral tablet delayed release

Along with its needed effects, prednisone may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking prednisone:

More common
  • Aggression
  • agitation
  • anxiety
  • blurred vision
  • decrease in the amount of urine
  • dizziness
  • fast, slow, pounding, or irregular heartbeat or pulse
  • headache
  • irritability
  • mental depression
  • mood changes
  • nervousness
  • noisy, rattling breathing
  • numbness or tingling in the arms or legs
  • pounding in the ears
  • shortness of breath
  • swelling of the fingers, hands, feet, or lower legs
  • trouble thinking, speaking, or walking
  • troubled breathing at rest
  • weight gain
Incidence not known
  • Abdominal or stomach cramping or burning (severe)
  • abdominal or stomach pain
  • backache
  • bloody, black, or tarry stools
  • cough or hoarseness
  • darkening of skin
  • decrease in height
  • decreased vision
  • diarrhea
  • dry mouth
  • eye pain
  • eye tearing
  • facial hair growth in females
  • fainting
  • fever or chills
  • flushed, dry skin
  • fractures
  • fruit-like breath odor
  • full or round face, neck, or trunk
  • heartburn or indigestion (severe and continuous)
  • increased hunger
  • increased thirst
  • increased urination
  • loss of appetite
  • loss of sexual desire or ability
  • lower back or side pain
  • menstrual irregularities
  • muscle pain or tenderness
  • muscle wasting or weakness
  • nausea
  • pain in back, ribs, arms, or legs
  • painful or difficult urination
  • skin rash
  • sleeplessness
  • sweating
  • trouble healing
  • trouble sleeping
  • unexplained weight loss
  • unusual tiredness or weakness
  • vision changes
  • vomiting
  • vomiting of material that looks like coffee grounds

Some side effects of prednisone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Increased appetite
Incidence not known
  • Abnormal fat deposits on the face, neck, and trunk
  • acne
  • dry scalp
  • lightening of normal skin color
  • red face
  • reddish purple lines on the arms, face, legs, trunk, or groin
  • swelling of the stomach area
  • thinning of the scalp hair

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Applies to prednisone: compounding powder, oral delayed release tablet, oral solution, oral tablet

General

Adverse effects have occurred less frequently when minimum dosages were employed. Dosages greater than 10 mg per day have been associated with an increased incidence of adverse events.

Adverse effects of prednisone may be subdivided into those associated with short-term therapy (to three weeks) and those of long-term therapy (> three weeks).

Short-term effects have included sodium retention-related weight gain and fluid accumulation, hyperglycemia and glucose intolerance, hypokalemia, gastrointestinal upset and ulceration, reversible depression of the hypothalamic-pituitary-adrenal (HPA) axis, and mood changes ranging from mild euphoria and insomnia to nervousness, restlessness, mania, catatonia, depression, delusions, hallucinations, and violent behavior.

Long-term effects have included HPA suppression, Cushingoid appearance, hirsutism or virilism, impotence, and menstrual irregularities, peptic ulcer disease, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, and vertebral compression fractures.

Metabolic

Metabolic side effects have included hypernatremia (rare), hypokalemia, fluid retention, negative nitrogen balance and increased blood urea nitrogen concentration. Glucocorticoids have been reported to decrease the secretion of thyrotropin (TSH).

Cardiovascular

Cardiovascular side effects have included hypertension and congestive heart failure due to long-term fluid retention and other direct vascular effects.

Up to 12% of patients may develop systolic hypertension. Hypertension has been associated with long-term therapy with prednisone and is thought to be due to fluid retention. One author has associated these changes in blood pressure with advancing age.

Endocrine

Endocrine side effects have included glucose intolerance and hyperglycemia. Diabetes-like symptoms may develop in some individuals. Hypothalamic-pituitary-adrenal activity may be suppressed for up to 12 months following long-term therapy with prednisone. Cushingoid appearance commonly has occurred with chronic therapy. In addition, hirsutism or virilism, impotence, and menstrual irregularities may occur with chronic therapy.

Corticosteroid therapy may induce glucose intolerance by reducing the utilization of glucose in tissues and increasing hepatic glucose output. Patients on alternate day therapy may exhibit significantly higher serum glucose on the day prednisone is taken. Diabetes mellitus requiring therapy with diet modifications and hypoglycemic agents has developed in some patients.

Adrenal suppression may persist up to twelve months after long-term corticosteroid therapy. Adrenal suppression may be reduced by giving corticosteroids once a day or once every other day. After corticosteroid therapy has been tapered, supplemental corticosteroid therapy during times of stress (illness, surgery, trauma) may be required.

Gastrointestinal

Gastrointestinal adverse effects most commonly have included nausea, vomiting, dyspepsia, and anorexia. Peptic ulcer disease has been associated with long-term corticosteroid therapy, but is relatively uncommon. Routine prophylactic therapy is not warranted in all individuals. Aluminum/magnesium containing antacids generally have been used to manage GI complaints without significant drug interactions.

Gastrointestinal side effects have included gastrointestinal upset, nausea, vomiting, and peptic ulcer disease. Pancreatitis, gastrointestinal perforation and hemorrhage have also been reported.

Immunologic

Patients treated with an average of 10 mg per day over several months developed 50% fewer infections compared to those treated with an average of 20 mg per day. Significantly fewer episodes of aseptic necrosis and a trend toward fewer complications in general have been reported with lower dosages.

Immunologic side effects have included impairment of cell-mediated immunity with increased patient susceptibility to bacterial, viral, fungal and parasitic infections. In addition, the immune response to skin tests may be suppressed.

Musculoskeletal

Corticosteroid myopathy has presented as weakness and wasting of the proximal limb and girdle muscles and generally has been reversible following cessation of therapy.

Corticosteroids inhibit intestinal calcium absorption and increase urinary calcium excretion leading to bone resorption and bone loss. Bone loss of 3% over one year has been demonstrated with prednisolone 10 mg per day. Postmenopausal females are particularly at risk of loss of bone density. Sixteen percent of elderly patients treated with corticosteroids for 5 years may experience vertebral compression fractures. One author reported measurable bone loss over two years in women on concomitant therapy with prednisone 7.5 mg per day and tamoxifen.

Musculoskeletal side effects have included myopathy, osteoporosis, vertebral compression fractures, and aseptic necrosis of bone. Aseptic necrosis has been reported most often to affect the femoral head.

Ocular

In renal transplant patients maintained on prednisone 10 mg per day, 33% developed posterior subcapsular cataracts. Mean time to cataract development was 26 months. Increased intraocular pressure has occurred in 5% of patients.

Ocular side effects have included increased intraocular pressure, glaucoma, and posterior subcapsular cataracts.

Other

Other side effects have included a glucocorticoid withdrawal syndrome which has been associated with abrupt discontinuation of prednisone therapy and may not be associated with adrenal suppression.

Pseudorheumatism, or glucocorticoid-withdrawal syndrome, has occurred upon withdrawal of corticosteroids but was not related to adrenal insufficiency. Patients experienced anorexia, nausea, vomiting, lethargy, headache, fever, arthralgias, myalgias and postural hypotension. Symptoms resolved when corticosteroid therapy was reinstated.

Psychiatric

Psychiatric side effects have included psychoses, behavioral changes, and pseudotumor cerebri.

Hematologic

Hematologic side effects have included thrombocytopenia, lymphopenia, and, platelet alterations resulting in thrombolic events.

Dermatologic

Dermatologic side effects have included easy bruising, ecchymosis, petechiae striae, delayed wound healing, and acne.