Prednisolone & Prednisone

• You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
• You should have regular blood tests as suggested by your rheumatologist.
• Do not increase or reduce the dose of prednisolone or prednisone unless your doctor or rheumatologist tells you to.
• It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• If you plan to become pregnant, you must discuss the timing with your rheumatologist.

Prednisolone works very quickly. Within a few days you may notice your pain and stiffness is much better and/or your joints are less swollen.

Stopping prednisolone/prednisone

• You should not stop taking either medication suddenly or increase or reduce the dose you have been prescribed unless your doctor tells you to.
• Your adrenal glands, which are just above the kidneys, normally make glucocorticoids in small amounts. These are important for many normal body functions.
• If you take prednisolone/prednisone, your body begins to make less glucococorticoids or even stops making glucocorticoids completely.
• If the medicine is then suddenly stopped there may be a problem as the adrenal glands won’t have had time to make the glucocorticoids needed. This problem is called adrenal insufficiency.
• Signs of adrenal insufficiency include weakness, fatigue, fever, weight loss, vomiting, diarrhoea and abdominal pain. Severe adrenal insufficiency can be life threatening. If you experience any of these problems, seek medical help.

• Blood sugar and cholesterol levels can be increased by corticosteroids, so you may need to have blood tests to check these levels. Your doctor will tell you when the blood tests are required.
• Your GP will let you know the tests you need. If they ask to see you, it is important to go see them as they help to monitor your condition.

Prednisolone can be swallowed as tablets or liquid. It is usually taken once or twice a day. Sometimes it is taken every second day. It is usually taken in the morning, with or immediately after food.

Other corticosteroids can be given by injection into joints, soft tissues or muscles. An injection into a vein (intravenous) may also be given if required.

What is the dosage?

There are a different strengths of corticosteroids available and can be adjusted to suit your needs without you having to take large numbers of tablets. It is important to check the strength of the tablets as they look very similar.

The dose depends on the severity of the disease. A high dose may be used initially and then reduced by your doctor as symptoms improve. To minimise the risk of side effects the smallest dose possible will be used.

Sometimes your doctor may increase the dose temporarily when your body is under stress, for example during a surgical procedure or if you have a severe illness such as an infection.

After you have stopped prednisolone/prednisone your doctor may prescribe it again for a short period in certain situations as described above.

Can other medicines be taken with prednisolone/prednisone?

This medicine may be used alone or with other arthritis medicines including:

• other disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate. 
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen, Nurofen) with caution as the risk of side effects such as stomach ulcer is increased.
• pain relieving medicines such as paracetamol.

Low dose corticosteroids taken for a few days or even a few weeks, does not normally cause any unwanted side effects.

If you take prednisolone in high doses or for a long time, you might experience some side effects. Some of these improve after prednisolone is stopped. Many can be minimised by giving the lowest effective dose over the shortest possible period.

Most common possible side effects

• Weight gain: The most common side effects are rounding of the face and weight gain around the stomach. These are due to altered metabolism, increased appetite and salt retention.
• Skin: The skin, especially on the arms and legs, can become thin, easily bruised and slow to heal. This occurs mostly after long term use, on higher doses and in older people with skin problems related to aging. In younger people, acne may be a problem.
• Diabetes: Prednisolone can cause the onset of diabetic symptoms or cause a rise in blood sugar in people with diabetes. This may require a change in their diabetes medicine. You should consult your GP if you experience an increase in blood sugar levels.
• Osteoporosis (thinning of the bones): While very low doses of prednisolone (less than 5 mg/day) are not very likely to cause thinning of the bones, moderate and high doses taken for long periods usually cause this problem. Your doctor will tell you if you need a bone density (BMD) test to check your risk of osteoporosis.  
• Blood pressure: Prednisolone may cause an increase in blood pressure or make it more difficult to control. This can be monitored and changes can be made to your blood pressure medicine if required.
• Cholesterol: Prednisolone can cause a rise in blood cholesterol. This can be monitored and changes can be made to your treatment if required.
• Psychological effects: Prednisolone can cause changes in how you feel and act such as a mood swings or feeling irritable, restless or depressed. While these effects are quite common, they usually don't cause big issues. It might also make it hard to sleep, but taking the medicine in the morning can help.
• Infections: There may be an increased risk of some infections, including mouth infections (such as oral thrush), shingles and lung infections. Pre-existing infections such as tuberculosis (TB) may become active again. It is important to tell your doctor if you have a chronic infection or if you have been exposed to TB earlier in your life.
• Indigestion or heartburn can occur. Taking prednisolone with food can reduce this.
• Ulcers: If taken with nonsteroidal anti-inflammatory medicines (NSAIDs), it can further increase the risk of stomach or duodenal ulcers. Your doctor will advise you about how to reduce this risk.

Less common or rare possible side effects

• Eyes: With long-term high-dose treatment prednisolone may increase development of cataracts.
• Other: Facial flushes, constipation and avascular necrosis (a painful bone condition usually seen in the hip or knee) can occur very rarely.

Many of the above side effects can be managed or prevented by close medical supervision and by following your doctor’s recommendations.

• Corticosteroids can interact with other medicines. You should tell all your doctors about all medicines you are taking or plan to take. This includes over-the-counter or herbal/naturopathic medicines.
• You should also mention your treatment when you see other health professionals, even if you have stopped taking corticosteroids within the last 12 months.

Vaccines

• Most vaccines can be given safely with prednisolone/prednisone. Talk with your rheumatologist before receiving any vaccines.
• If you are on high doses of prednisolone, it is recommended you should not be immunised with ‘live’ vaccines such as MMR (measles, mumps and rubella), BCG (Bacillus Calmette Guerin), OPV (oral polio vaccine) or yellow fever. Talk with your rheumatologist before receiving any live vaccines.
• Pneumococcal and COVID-19 vaccines and the yearly seasonal flu vaccinations are recommended. 
• For more information on vaccination including the COVID-19 vaccination go to: https://rheumatology.org.au/For-Patients/COVID-Information/COVID-Vaccination-Information

Surgery

• If you are going to have an operation it is important to tell the anaesthetist that you are taking or have been taking prednisolone or other corticosteroids in the last year.
• Your doctor may tell you that you need some additional prednisolone at the time of surgery.

• Store prednisolone/prednisone in a cool, dry place away from direct heat, moisture and light (e.g. not in the bathroom).
• Keep all medicines out of reach of children.