Arthritis Treatment What to Know About Rayos (Prednisone) for Rheumatoid Arthritis A delayed-release corticosteroid for RA By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Grant Hughes, MD on May 31, 2015 linkedin Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Review Board Grant Hughes, MD Updated on September 17, 2020 Print Table of Contents View All Uses Before Taking Dosage Side Effects Warnings/Interactions Rayos (delayed-release prednisone) is delayed-release formulation of low-dose prednisone, which is a corticosteroid. In 2012, this oral drug gained U.S. Food and Drug Administration (FDA) approval as a treatment for rheumatoid arthritis (RA); it's also used to treat several other conditions. Prednisone itself has been on the U.S. market since 1955. In RA (and other autoimmune diseases), the immune system mistakenly identifies a healthy type of tissue as a threat to your health, as if it were a virus or other pathogen. It then launches an attack and tries to destroy that tissue. Prednisone is a common treatment for RA because it counters resulting inflammation and changes how the immune system functions. Rayos is known in Europe by the brand name Lodotra. So far, it's not available in generic forms or under other brand names. Daniel Grill/Brand X Pictures/Getty Images Uses In RA, the joints (synovium) is the primary target for an immune system gone awry. The immune response triggers inflammation in the joints, which leads to pain, limited range of motion, and, eventually, permanent damage. Early, aggressive treatment can prevent or delay permanent damage and the disability associated with it, and corticosteroids like Rayos—an anti-inflammatory and immunosuppressive agent—can be a useful part of that. Rayos works differently than immediate-release prednisone. Due to Rayos's formulation, taking the drug before bed allows it to take effect in the middle of the night—when certain cells in the immune system, called cytokines, start to increase. This mechanism of action appears to provide better control of cytokine-related inflammation in some people. Rayos and other types of prednisone are typically used for short-term relief of inflammation in RA and autoimmunity in general, but some people do take these drugs long-term. Rayos is also FDA-approved for organ transplantation along with an array of conditions from other rheumatologic diseases to dermatologic issues, endocrine conditions, gastrointestinal diseases, respiratory concerns, infectious diseases, and more. Besides RA, rheumatologic conditions Rayos may be used for include: Gouty arthritisAnkylosing spondylitisDermatomyositisPolymyositisPolymyalgia rheumaticaPsoriatic arthritisRelapsing polychondritisSjögren's syndromeSystemic lupus erythematosusVasculitis Before Taking Your doctor may consider Rayos for you if you've recently been diagnosed with RA and are waiting to see the effects of a DMARD disease-modifying anti-rheumatic drug (DMARD) such as methotrexate, sulfasalazine, or Enbrel (etanercept). The effects of DMARDs can take several weeks or even months to become evident, so prednisone and other corticosteroids play an important role during that time. Later in the course of the disease, you may be given Rayos during RA symptom flares to help get your inflammation levels back down quickly. People with severe disease that's not adequately controlled by DMARDs or non-steroidal anti-inflammatory drugs (NSAIDs) may take prednisone long-term. What You Should Know About DMARDs Precautions and Contraindications Before taking Rayos, tell your doctor if you've ever had an allergic reaction to prednisone, similar drugs, or any of the active ingredients in Rayos. Also, be sure to mention whether you've had recent or ongoing infections and whether you've recently had any vaccines. Always be sure your doctor knows all the treatments you're using, including prescription drugs, over-the-counter medications, and supplements. This can help you avoid dangerous side effects and interactions that may be caused by certain combinations of therapies. People with certain health conditions shouldn't take Rayos, may need special monitoring while they're on it, or may need to discontinue other drugs before taking Rayos. Be sure to tell your doctor if you have: Recurrent eye infections (present or past)ThreadwormsDiabetesHigh blood pressureEmotional problems or mental illnessMyasthenia gravisOsteoporosisSeizuresTuberculosisUlcersLiver diseaseKidney diseaseIntestinal diseaseHeart diseaseThyroid disease You shouldn't start taking prednisone while you're pregnant, if you're trying to conceive, or while you have an infection. Other Corticosteroids Corticosteroids have been around a long time, and many of them are sold under numerous brand names. Because of this, they're often best known by their generic names. Generic names of corticosteroid drugs include: HydrocortisoneCortisonePrednisoloneTriamcinoloneBetamethasoneTriamcinoloneMethylprednisoloneDexamethasoneFludrocortisone Some of these are primarily taken orally, while others may be used topically or taken via injection. Some are available in multiple forms. Dosage Rayos is available in delayed-release tablets of 1 milligram (mg), 2 mg, and 5 mg strengths. Your doctor should determine the correct dosage for you based on several factors including your disease severity and whether you've been using immediate-release prednisone. Typically, the starting dose is 5 mg of Rayos once a day. However, if you've been taking rapid-release prednisone, prednisolone, or methylprednisolone, you should be given an equivalent initial dose of Rayos. (This may not be the same in milligrams, but it will be the same in strength.) You should remain on the lowest amount that's effective for your symptoms (a.k.a. the maintenance dose). Don't stop taking Rayos without talking to your doctor. Especially when going off of long-term or high-dose Rayos, you should do so gradually. Your doctor can advise you on how to properly taper your medication. How to Take and Store This medication should be taken daily and with food. The pill must be swallowed whole—not cut, broken, or chewed—as this will interfere with the rate of release. Rayos should be stored at about room temperature, with the optimal temperature being 77 degrees F. If you're carrying the medication with you while away from the house, short stints of temperatures down to 59 degrees F and up to 86 degrees F are acceptable. You should keep Rayos tablets away from light and moisture. Side Effects As with any drug you are considering taking, Rayos's benefits must be weighed against potential side effects. Common The most common side effects of Rayos include: Fluid retentionElevation in blood pressureChange in glucose toleranceMood changesWeight gainIncreased appetite If any of these side effects become severe or don't go away with time, talk to your doctor. Severe More severe side effects are possible with Rayos and can stem from several body systems. Allergic reactions: Hives, low blood pressure, trouble breathing, weak and rapid pulse, dizziness or fainting, nausea, vomiting, diarrheaCardiovascular: Cardiac arrest, arrhythmias, vasculitis, fainting (syncope), and many moreSkin: Acne, dry scalp, impaired wound healing, increased sweating, hair loss, and moreEndocrine: Menstrual irregularities, abnormal fat deposits, development of Cushingoid state, new-onset diabetes, altered insulin requirements in people with diabetes, suppressed growth in children, and many moreFluid and electrolyte disturbances: Fluid retention (edema), potassium loss, high blood pressure, hypokalemic alkalosis, sodium retentionGastrointestinal: Abdominal distention, elevated serum liver enzyme levels, hepatomegaly, hiccups, nausea, pancreatitis, peptic ulcer, and moreGeneral: Increased appetite and weight gainMetabolic: Negative nitrogen balance due to protein catabolismMusculoskeletal: Osteonecrosis of femoral (thigh bone) and humeral (arm bone) heads, loss of muscle mass, muscle weakness, osteoporosis, steroid myopathy, tendon rupture, vertebral compression fractures, and othersNeurological: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure (usually following discontinuation), insomnia, meningitis, neuropathy, paraplegia, sensory disturbances, vertigo, and many moreOphthalmic: Glaucoma, increased eye pressure, posterior subcapsular cataracts, and moreReproductive: Decrease in sperm count and lowered motility If you experience any new symptoms while taking this medication, contact your doctor right away. Need for Monitoring While you're on Rayos, especially long-term, you'll need to be monitored for suppression of the hypothalamic-pituitary-adrenal axis (your body's stress-response system), Cushing's syndrome, and high blood sugars (hyperglycemia). Your blood pressure, sodium levels, and potassium levels should be closely watched as well.Be sure to get all of the tests your doctor suggests and to do so on schedule. Warnings and Interactions This drug will make you more susceptible to new infections and could cause a reactivation of latent chronic infections, so it's especially important to bring symptoms of infection (e.g., fever, chills, sore throat) to the attention of your doctor should they occur. That said, you should not get live or live-attenuated vaccines while taking an immunosuppressive dose of prednisone. Pregnant/Nursing Women Taking Rayos during the first trimester of pregnancy can harm your baby. It's associated with an increased risk of cleft lip and cleft palate, restricted growth, small birth weight, and premature birth. In animals, it's also been associated with miscarriages. This drug does pass into breast milk and may cause problems with your child's growth and development. You and your doctor should carefully weigh the benefits of this drug with the risks it poses to your baby, before and after birth. Drug Combinations Prednisone can negatively interact with a long list of drugs and supplements, including common over-the-counter products such as: AspirinMotrin/Advil (ibuprofen)Aleve (naproxen)St. John's wort (an herbal supplement) Some common classes of drugs that can cause problems with Rayos are: Anticoagulants (blood thinners)Antidiabetic agentsAntidepressantsAntifungalsOther corticosteroidsCYP3A4 inducers and inhibitorsCyclosporineDiuretics (water pills)HIV protease inhibitorsHormonal contraceptives, including birth control pills, patches, implants, and other formsPotassium-depleting agents You and your doctor need to carefully evaluate the potential risks and benefits of Rayos before you start taking it, as your health changes over time, and whenever you start new medications. Treating Rheumatoid Arthritis—Effectively Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. Johns Hopkins Arthritis Center. Rheumatoid arthritis treatment. Kim D, Choi CB, Lee J, et al. Impact of early diagnosis on functional disability in rheumatoid arthritis. Korean J Intern Med. 2017;32(4):738-746. doi:10.3904/kjim.2015.364 Palmsten K, Bandoli G, Watkins J, Vazquez-Benitez G, Gilmer TP, Chambers CD. Oral corticosteroids and risk of preterm birth in the California Medicaid program [published online ahead of print, 2020 Aug 11]. J Allergy Clin Immunol Pract. 2020;S2213-2198(20)30805-9. doi:10.1016/j.jaip.2020.07.047 National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Prednisone. Updated March 15, 2020. Additional Reading U.S. Food and Drug Administration: FDA AccessData. Rayos: Highlights of prescribing information and Full prescribing information. Updated July 2012.