Prednisone (oral steroids)

Rongoā whakakaha ā-waha

This page has links to information in te reo Māori.

Prednisone is in a class of medicines known as corticosteroids, which are similar to the steroid hormones your body naturally makes. Prednisone is different to the steroids athletes take to build muscle (anabolic steroids).

Prednisone is used to treat many illnesses related to inflammation. For example, it's used to treat allergies, asthma, COPD, rheumatoid arthritis, gout, ulcerative colitis, Crohn's disease and other auto-immune diseases. Prednisone calms or suppresses the body's immune system to reduce inflammation anywhere in the body. This helps to reduce the symptoms associated with these conditions, especially in flare‑ups. It doesn't cure them.

Prednisone dosage

Your dose of prednisone will depend on which condition you're being treated for and how you respond.

Doses range from 5 mg to 60 mg daily. Some people may need a short course of prednisone (such as five days), while others may need to take it for longer (weeks to months).

Prednisone tablets come in different strengths. Check the strength of your tablets and your prescribed dose. Often you may need to take more than one tablet. If you're unsure about your dose or the number of tablets to take, ask your pharmacist.

Always take your prednisone exactly as your general practice team has told you. The pharmacy label on your medicine will tell you how much prednisone to take, how often to take it and any special instructions.

How to take prednisone

Take your prednisone tablets with food and a full glass of water.
If you take it once a day, it's best taken at breakfast time.
If you need to take it more than once a day, space your doses out during the day. Try not to take it too close to bedtime because it may keep you awake.
If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Special instructions

Do not stop prednisone suddenly. If you've been taking it for more than two weeks, stopping suddenly can cause withdrawal symptoms, which can be serious or even life-threatening. Instead, you'll be given a tapering dose meaning your dose of prednisone will be gradually reduced over a few days or weeks.
Before taking other medicines or supplements, check with your doctor or pharmacist. Do not take other anti‑inflammatory medications such as ibuprofen (Nurofen) or diclofenac (Voltaren) when on prednisone.
Tell any health professional taking care of you that you're taking prednisone. Consider wearing a medical alert bracelet or pendant so medical staff know how to treat you in an emergency. Search online for medical bracelets NZ to find medical bracelet suppliers.
Tell your doctor if you come into contact with someone who has a contagious illness such as chickenpox or measles or if you feel unwell. Taking prednisone for a long time can increase your risk of all types of infections.
Ask your doctor for advice before you have any vaccines while you're taking prednisone. It's safe to have most vaccines including the flu vaccine while you're taking prednisone, and protecting yourself against infection is important because prednisone suppresses your immune system. But you should postpone any vaccinations with live vaccines.
If you go overseas, make sure you have enough pills. Carry a summary of your medical history with you in case you need to see a doctor. Do not take any risks with hygiene, as tummy bugs can be very unpleasant.

If you get sick

If you're taking 20 mg or less of prednisone daily, it's important that you increase your dose if you get sick: When people get sick or have an accident, their body usually makes more cortisol to help them recover. If someone cannot make this extra cortisol, they might go into shock or collapse unless they get extra steroids.

For a mild illness when you're sick enough to stay in bed or take a day off work with something like the flu or a fever, take double your usual oral dose for one to two days. Provided you're getting better, you can then reduce the dose back down to normal.
If you're more unwell, for example with pneumonia, or if you aren't responding to the treatment outlined above, you should contact your general practice team urgently. Your general practice team may give you a steroid injection or admit you to hospital.
If you have vomiting or diarrhoea, you might not absorb the steroid medication. If you vomit within three hours of taking your oral steroid, take it again but take double the dose. If you vomit again or have diarrhoea, you should contact your doctor urgently because you might need a steroid injection or to be admitted to hospital.
See your doctor if you're taking more than 5 mg of prednisone daily and you get sick.
You'll also need to take extra oral steroids if you have a serious accident of any kind (such as a broken bone or burn) or have surgery. You do not usually have to increase your dose because of emotional stress, a head cold or increased exercise.

Possible side effects

Like all medicines, prednisone can cause side effects, although not everyone gets them. Most side effects are to do with how much prednisone you're taking and for how long.

Side effects	What to do
Trouble sleeping	Take prednisone in the morning or at least three hours before bedtime.
Headache, weak muscles, feeling tired	These are common when you first start taking prednisone and usually go away with time. Tell your general practice team if troublesome.
Increased appetite	Eat well for good health and to maintain your weight. Develop an eating schedule and stick to it.
Fluid retention causing swollen ankles and feet	Whenever possible, sit with your feet raised. Avoid foods with high salt content. Tell your general practice team if this happens.
Raised blood glucose (sugar)	If you have diabetes, you may need to increase the dose of your diabetes medication to control your blood glucose. Talk to your general practice team. Your general practice team will monitor your blood glucose levels regularly if you're at risk of getting diabetes.
High blood pressure	You should have your blood pressure checked regularly. If it goes up, you may need treatment to bring it down.
Skin changes	Your skin might get thin, bruise more easily and take longer to heal after injuries. You might develop stretch marks. Try to prevent unnecessary trauma to your skin.
Changes in mood or behaviour, mood swings, irritability, anxiety, bad dreams	Tell your general practice team if troublesome. If severe, phone your general practice team immediately. Outside your general practice team's normal hours, your call will be answered by a nurse who will be able to offer advice.
Eye pain and changes to your vision	Phone your general practice team immediately. Outside your general practice team's normal hours, your call will be answered by a nurse who will be able to offer advice.
Problems with your stomach such as stomach pain, blood in your stool or dark‑coloured stool	Phone your general practice team immediately. Outside your general practice team's normal hours, your call will be answered by a nurse who will be able to offer advice.
Thinning of bones (osteoporosis)	This can happen if you're on prednisone long‑term. Talk to your general practice team about treatment to protect your bones.
Increased risk of severe infections	Prednisone may suppress your immune system. See your general practice team straight away if you think you might be developing an infection.

HealthInfo recommends the following videos

RheumInfo – Prednisone
A video describing how prednisone is used to treat rheumatic diseases in Canada (Schulich School of Medicine, University of Western Ontario).

HealthInfo recommends the following pages

My Medicines – Prednisone
A printable information sheet about prednisone.

This information is also available in Māori.

Content shared between HealthInfo Canterbury, KidsHealth and Health Navigator NZ as part of a National Health Content Hub collaborative. Last reviewed June 2023.

Sources

Page reference: 75997

Review key: HIORS-75997