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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.

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

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.

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 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.

— 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

— Feb 3, 2022

nice post

— 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.

— 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?

— 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.

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