Reducing Prednisone Side Effects

Identifying your risks can help you prepare

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Prednisone is a type of steroid drug used to treat many diseases and conditions, especially those associated with inflammation. These include asthma, Crohn's disease, leukemia, lupus, lymphoma, multiple sclerosis, psoriasis, rheumatoid arthritis, ulcerative colitis, and numerous other conditions.

Prednisone reduces inflammation by lowering the activity of the immune system. As beneficial as this effect can be, prednisone can also cause side effects, sometimes severe. These include acne, insomniamood swings, abnormal hair growth, facial swelling, night sweats, and weight gain.

How to reduce the side effects of prednisone.

Verywell / Britney Willson


Using prednisone at high doses over a long period can lead to severe, irreversible complications like osteoporosis (weak, porous bones), cataracts (eyes clouding), glaucoma (eye nerve damage), and type 2 diabetes.

This article explores strategies you can use to reduce the risk of prednisone side effects. This includes how to safely discontinue prednisone to avoid drug withdrawal.

Why Dosage Matters

The risk and severity of prednisone side effects increase with the drug's dosage and how long you take it. The higher the dose, the higher the risk of side effects. The longer you are treated, the greater the risk of complications.

Prednisone is generally intended for short-term use to rein in inflammation and bring a disease under control. When that is achieved, the dose is gradually reduced until the treatment is finally stopped. With some conditions, like autoimmune diseases, other drugs like biologics can then be prescribed to maintain control of the condition.

Prednisone is also prescribed at the lowest possible dose to bring the disease under control. However, for some conditions, this is not possible, and higher doses are needed. If this is the case, your doctor will weigh the benefits and risks of treatment.

If, for example, you are at risk of osteoporosis, your doctor will need to monitor your condition and may prescribe supplements to protect the bones. If you have certain conditions like wide-angle glaucoma, prednisone is avoided simply because the risk is too high.

You play a part in the decision-making process. If you are experiencing side effects that are intolerable, you need to let your doctor know. In some cases, the dose can be reduced. At other times, the treatment may need to be stopped and other drugs explored.

Recap

The risk of prednisone side effects increases with the size of the dose and the duration of treatment. As a rule, the lowest possible dose should be used for the shortest time possible to achieve the desired effect. If the side effects are intolerable, your doctor may be able to reduce the dose to help relieve them.

Timing of Doses

Prednisone mimics a hormone called cortisol. This is a hormone that the body releases at times of stress.Cortisone levels are highest in the morning and gradually taper down as the day goes on.

To reduce some side effects, like insomnia, once-daily doses should be taken in the morning with breakfast. Taking the dose of prednisone too late in the evening may affect your sleep.

Preventing Side Effects

There are ways to reduce the risk or severity of some prednisone side effects. By identifying your risk of these side effects, you can take steps to avoid or reduce them.

Osteoporosis

Anyone taking prednisone for a long time can experience some level of bone density loss. However, there are certain conditions that increase a person's risk of osteoporosis, including:

  • A family history of osteoporosis
  • Older age
  • Menopause
  • Thyroid disease
  • Having a thin frame
  • Smoking
  • Heavy alcohol use
  • Getting little or no exercise

If any of these apply to you, speak with your doctor about ways to prevent or slow bone mineral loss. This includes eating a healthy diet with plenty of calcium, taking a vitamin D or calcium supplement. and exercising routinely including strength training.

Weight Gain

Exercise also helps reduce the risk of weight gain from prednisone. Even when used for a short time, prednisone can increase appetite and cause swelling of the face (called "facial mooning"). With long-term use, prednisone can also cause changes in body fat, leading to fat deposits at the back of the neck or around the belly.

Average Weight Gain on Prednisone

Studies suggest that one in five people who take high-dose prednisone for one year will gain 22 pounds or more (although the weight tends to stabilize after the first six months). Overall, users experience an average weight gain of around 4% after one year.

Reducing salt intake can prevent water retention that contributes to facial mooning. Watching fat and calorie intake can help to prevent weight gain. To deal with an increased appetite, have plenty of low-calorie snacks on hand, including vegetables and fruits. Working with a nutritionist can help.

preventing prednisone weight gain

Verywell / Emily Roberts

Exercise and diet may also help reduce the risk of body fat redistribution, known as lipodystrophy. Even so, it may be difficult to avoid if you are on prednisone for a long time. Speak with your doctor if you begin to notice symptoms of lipodystrophy.

Mood Symptoms

As with the other prednisone side effects, the risk of mood symptoms increases with the dose and duration of treatment. Even after two weeks, prednisone can cause irritability in half of all users. Anxiety and depression are also common.

It helps to prepare for these side effects by letting family and friends know what to expect and how they can support you. Doing so takes off some of the stress. It may help you recognize when mood swings occur.

Exercise may help "burn off" some of the stress. It also can help improve mood by triggering the release of feel-good hormones called endorphins. You can also try stress reduction strategies like yoga, meditation, guided imagery, and progressive muscle relaxation.

Getting plenty of rest is also essential. This can be difficult because prednisone can interfere with sleep. One way to cope is to improve your sleep hygiene. This includes avoiding food and electronics before bedtime and sleeping in a cool, dark room. Some people also benefit from melatonin supplements available over the counter at drugstores.

Stopping Prednisone Safely

Stopping prednisone abruptly is never a good idea. When you're on prednisone, the body has no need to produce its own natural cortisol. Stopping suddenly leaves the body with no cortisol to function normally. This can lead to withdrawal symptoms, such as:

  • Fatigue
  • Fever
  • Headaches
  • Joint pain
  • Muscle pain
  • Nausea or vomiting

To avoid this, doctors will gradually taper the dose, or lower it gradually, so that the body has the opportunity to resume making its own cortisol. Depending on the dose and duration of treatment, the tapering can take many weeks or many months.

Your doctor will provide you with an exact tapering schedule that will allow you to eventually get off prednisone completely.

Recap

Prednisone should never be stopped suddenly. Doing so can cause withdrawal symptoms. To reduce the risk of withdrawal, your doctor will gradually lower your dose over weeks or months until you are able to stop completely.

Summary

Prednisone is an important drug used to treat many inflammatory conditions. However, it can cause side effects, especially at high doses or with long use. To reduce the risk, your doctor will prescribe prednisone at the lowest dose and the shortest period of time possible.

You can reduce the risk of certain side effects like insomnia by taking the drug earlier in the day. Other side effects like weight gain, mood swings, and osteoporosis may be reduced with lifestyle changes like diet, exercise, and improved sleep habits.

Prednisone should never be stopped suddenly; this can lead to withdrawal symptoms. If prednisone is no longer needed, your doctor will give you a tapering schedule during which the dose is gradually reduced until you can stop completely.

A Word From Verywell

Some people feel that the side effects of prednisone outweigh the benefits of treatment. If side effects are interfering with your ability to function normally or decreasing your quality of life, let your doctor know.

There may be other treatments that can help. In some cases, all that may be needed is a dose reduction. However, it's important to never adjust the dose or dosing schedule on your own without first speaking with your doctor.

Frequently Asked Questions

  • How can I avoid weight gain when taking steroids?

    Typically, most weight gain from steroids is related to fluid retention. Discuss the benefits of water pills (diuretics) with your healthcare provider and follow a diet that’s rich in potassium and low in sodium to avoid too much water weight. Also, be aware that your appetite might increase with steroids, but your calorie needs won’t, so exercise regularly and eat a well-balanced diet, avoiding excess calories and fat.

  • How do I stop night sweats caused by prednisone?

    Review your dosage with your healthcare provider to see if adjusting your medication or taking it at a different time of day could help with night sweats. Otherwise, your best approach is to control your circumstances:

    • Adjust your bedroom temperature; use fans to keep air circulating.
    • Wear sweat-wicking pajamas.
    • Use quick-drying bedding instead of cotton.
    • Avoid spicy food, smoking, and alcohol before bed.
    • Reduce night-time stress with relaxation exercise or routines.
  • Will I have mood swings if I take prednisone?

    Mood swings are a possible side effect of prednisone. Women under 40 may be more likely to experience changes in mood. It’s important to discuss these feelings with your healthcare provider and to avoid suddenly stopping the medication.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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