Monday, August 31, 2009

How to take Prednisone

Be patient. Please be patient.

I see far too many people on forums and at the doctor worrying about how quickly prednisone will do its job, and how quickly they can safely taper off of it.

It is so important while taking this drug that you understand two things:

1) Prednisone works at a different rate for every person and every flare - it will not perform the same way in your body twice.
  • Langhoff et al 2004, Euro J Clin Pharm
  • It takes only 7 consecutive days of prednisone for adrenal suppression and dependency to occur; fatigue after a few days is an indication that prednisone is doing its job. The more you split up your doses, the slower the effect takes hold. If you can manage taking your full dose at one time of day, the hormone response will do its job more quickly.
  • 7 days worth of prednisone is sufficient to induce insulin resistance [Pagano et al, 1983, J Clin Invest], which is what is responsible for high blood sugar, fatigue, weight gain and intestinal bloating. NEVER FEAR - much of this can be helped by keeping your glucose uptake low while on prednisone ( I recommend Boost Glucose Control).

2) Yes, the side effects are miserable. Prednisone (along with many other corticosteroids) is messy and intense... but it will always clean up a fresh flare. And it is so important that you allow yourself to taper off of the drug slowly; the consequences of draining your body too quickly are even more agonizing than the drug itself.
  • Prednisone is a corticosteroid. That means that in your body it is directly involved with your major stress hormone axis, beginning at your adrenal glands. Since your adrenal glands are part of your endocrine system, the high level of steroid interference will take control of regulating of the hormones that control your stress and immune responses. THIS IS GOOD.
  • Specifically, the metabolite of prednisone, prednisolone, mimics the effects of adrenocorticotropic hormone (ACTH) that is naturally produced by your adrenal glands. By producing the steroid for your adrenals, the drug conditions your glands to NOT produce corticosteroids on their own. Tapering off the drug when you are ready is crucial to do slowly because it re-trains your adrenals to produce corticosteroids for themselves.
  • If you taper too quickly, your adrenals may not adequately recover their moderating function. In this case, you can develop Addison's disease. Do not fight your gastro on this one!
  • Chronic prednisone adequately replaces your body's ACTH production which is what allows it to suppress your immune response. However, another corticosteroid called DHEA is uncompensated. The deficiency in this particular hormone is responsible for imbalances of sex hormone production, bone health, and neuropsychiatric status (aka irritability) [Friel et al, 2006; Altern Med Rev]. NEVER FEAR - combat these risks by getting sufficient calcium, reducing salt intake and talking to people about what is going on with your body. Support is a very influential factor.
Patience is probably the most key factor in keeping side effects minimal, and making them disappear as you taper off of the drug. This is a difficult therapy to endure, especially over long periods of time. It is helpful to be able to talk to someone who has been on prednisone or who thoroughly understands its wrath in order to keep yourself sane and to recover with aplomb.


  1. I should have read this sooner! Thanks for the advice...I'll be making a course correction immediately!

  2. so glad it was helpful! i really hope you are able to avoid more joint pain and headaches; it truly magnifies the stress of this disease when your entire body becomes that involved.