Prednisone is a corticosteroid available under many different brand names all over the world. The applications of Prednisone are numerous. Its uses cover an impressive range of conditions and ailments, from asthma to cancer, lupus, arthritis, eye problems, skin conditions, multiple sclerosis, and others.
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The pharmacology of this medicine explains why it is useful for the treatment of such a wide range of conditions. It addresses inflammation, reducing it in a two-pronged manner. On the one hand, it attacks inflammation directly. On the other, it suppresses the immune system. Inflammation within the body results from the action of the immune system over a real or perceived infection. As such, it is unsurprising that Prednisone is highly effective against autoimmune conditions.
In this overview, we take a close look at what Prednisone is, how it works and what side effects it produces.
- The pharmacology of Prednisone explains its effects and side-effects.
- What are Prednisone’s most significant side-effects?
- Does Prednisone in particular and corticosteroids in general cause insomnia?
- What can you do against Prednisone-triggered insomnia.
- How do users rate the efficacy of this drug for various conditions?
What is Prednisone and How Does it Work?
As mentioned, Prednisone is a systemic corticosteroid. It exerts effects upon inflammation in a two-pronged manner.
- Its direct impact on inflammation is a result of the suppression of polymorphonuclear leukocytes. According to Drugs.com, the drug also reverses increased capillary permeability that accompanies inflammation.
- Prednisone accomplishes the suppression of the immune system through the lymphatic system. It reduces the volume and activity of the latter. At high doses, it also suppresses adrenal function.
- In addition to these effects, Prednisone also exerts an antitumor effect. Researchers believe it accomplishes this through the inhibition of glucose transport. It also kills off the immature cells of lymphocytes.
- Although vomiting may be one of its side effects, Prednisone is an antiemetic. It inhibits prostaglandin syntheses and this way, it blocks the emetic center.
This pharmacology explains why the drug does what it does. It also explains some of its side-effects.
We also know that between 50-90% of the drug is absorbed. In patients with IBS (inflammatory bowel syndrome), hepatic failure, renal failure, and in the elderly, absorption rates may differ.
The body metabolizes the drug through the liver, which is why hepatic failure hinders its absorption. In its pill/liquid concentrate form, prednisone is inactive. It only becomes active after the liver metabolizes it into prednisolone.
The body excretes Prednisone through the urine.
Prednisone’s Side Effects
Prednisone is very efficient for most of its labeled and off-label uses. It is, however, a prolific source of side effects as well.
The menagerie of its side effects is truly daunting. Whenever your doctor prescribes Prednisone, he/she does so being fully aware of the adverse effects it may trigger. He/she will, however, decide that in your particular case, its benefits will outweigh its side-effects.
Due to the dangerous nature of this drug, you should never take it at a whim. You should follow your doctor’s instructions and dose to the letter. Do not suddenly discontinue Prednisone use if you find its side-effects unbearable. Always call your doctor and seek his/her advice in this case.
Some of these side-effects may become much worse with sudden discontinuation of the medication. Your doctor will adopt a tapered approach to discontinuation, to minimize your suffering.
According to WebMD.com, the common side-effects of Prednisone include but are not limited to:
- Lack of appetite.
- Insomnia – the side-effect on which we will focus in this article.
If you experience these side-effects, your doctor may tell you to endure them. The benefits you receive from the medication outweigh these issues.
While some people experience no side effects at all, some will encounter serious side effects.
- Unexplained weight gain with fat redistribution in unusual areas, such as the face and neck.
- Irregular heartbeat.
- Sore muscles.
- Persistent fever.
- Bone pain.
- Mood swings.
- Bloody stools, or vomit that looks like coffee grounds.
- Haywire menstrual cycle.
- Difficult/slow healing of wounds.
- Thin skin.
- Hair loss.
- Elevated blood sugar.
If you happen to experience any of these side-effects, call your doctor immediately. Do not discontinue medication before your doctor tells you to. If you discontinue suddenly, you may experience steroid withdrawal syndrome.
In addition to the above-listed effects, you may also experience an allergic reaction. While rare, such reactions are very serious and require immediate medical attention.
- Swelling of your face or throat.
- Difficulties breathing.
…can all be symptoms of an allergic reaction.
What Can You Do to Alleviate These Side Effects?
To address the possible withdrawal symptoms, using Prednisone for less than two weeks is recommended. Remember, however, that it is solely up to your doctor to determine for how long you need to use to drug.
If your doctor determines that you do not have to take Prednisone for more than two weeks, you can taper faster. If you take it for more than two weeks however, you have to taper slowly.
Steer well clear of possible sources of infection while taking Prednisone. The drug suppresses your immune system. As a result, you become more susceptible to infection. Take special care to avoid people infected with chickenpox, tuberculosis, etc. Do not get any vaccines while on Prednisone.
As far as gastrointestinal side-effects are concerned, take the Prednisone pills after a meal. Antacids can also help with stomach irritation.
Osteoporosis is a serious risk that Prednisone will significantly intensify. To protect yourself in this regard, you may have to resort to calcium supplements. Please note that smoking and alcoholic beverages further increase the risk of osteoporosis.
According to Theodore R Fields of the Weill Cornell Medical College, you should be mindful of the risk of falling. Exercise can help stave off osteoporosis. In this regard, you may want to stick to load-bearing exercises.
Exercise will also help you combat another Prednisone side-effect: weight gain. Weight gain may adversely affect your self-image. Be aware, however, that you will find it quite easy to shed this “Prednisone-weight” after you discontinue the medication. In six months to a year, you will likely be back in your pre-Prednisone shape.
You can fight fluid retention through a low-sodium diet. Be aware that in some patients, Prednisone can raise blood pressure.
If you feel thirsty all the time and urinate often, you may have elevated blood sugar from Prednisone. Keep a close eye on your blood sugar. Corticosteroids may trigger diabetes or aggravate an existing condition.
To address the increased risk of atherosclerosis, consider a diet low in cholesterol. If you experience chest pain while on Prednisone, get urgent medical help.
Does Prednisone Cause Insomnia?
Theoretically, using a corticosteroid like Prednisone for less than two weeks should reduce the frequency of its side-effects.
According to a 1984 study by Lozada F, Silverman S Jr, and Migliorati C, fluid retention and insomnia are the most frequent side-effects among those using Prednisone short-term.
Why does this happen?
As mentioned, Prednisone fights inflammation by acting upon the adrenal function. When a person is subjected to stress, his/her adrenal system is slowly exhausted. This system regulates the body’s fight-or-flight response. With exhaustion, the adrenal system stimulates the body, keeping the person awake.
The same thing happens under the effect of Prednisone. The result is not just missed sleep, but sleep of poor quality interspersed with bad dreams.
According to a 2016 study on Prednisone and sleep, by Lauren C Daniel, Yimei Li, et al, Prednisone’s impact on sleep in children is less significant than that of other corticosteroids like dexamethasone.
A 1993 study by R Turner and E Elson, flatly states that “Steroids cause sleep disturbance.” This study concludes that the effect of steroids on sleep is dose-dependent. Sleep disturbances can be alleviated by reducing the dosage.
In some cases, doctors cannot modify dosage. They can, however, have the patient take the full daily dose of Prednisone in the morning. Thus, the effects of the drug are less present by bedtime.
According to patient feedback, Prednisone’s insomnia-related side-effect is very bothersome.
Patients have reported tiredness and willingness to sleep, and the frustrating inability to do so, due to a racing mind.
Under such circumstances, exhaustion is inevitable. People have reported feeling “like a zombie” for the better part of the day. Some have tried taking sleeping pills with the steroids, to address the issue, only to make the insomnia even worse.
Among patient feedback stories, it seems to be a common theme that high doses of Prednisone make people exhausted and hyped-up at the same time. The brain thinks that the patient is in some sort of danger, and thus its fight-or-flight response keeps firing.
How Can You Handle Prednisone-induced Insomnia?
Since you likely cannot tinker with the dosage, the first step towards alleviating Prednisone-induced insomnia is to take the drug in the morning. Only adopt this approach with your doctor’s approval. In some cases, patients have to take two doses per day. For such patients, this morning approach is not an option.
Above and beyond what we have already touched in this article, there are a few herbal options for improving sleep.
– According to the Memorial Sloan Kettering Cancer Center, valerian alleviates anxiety in cancer patients.
According to leaf.tv it should, therefore, work for improving sleep in patients on Prednisone as well.
That said, patients who frequently experience headaches should avoid this herbal solution. Doctors do not recommend the long-term use of valerian either.
– Another herbal remedy, which works well with valerian is hops. According to a 2010 study by Salter S and Brownie S, the combination of the two herbs improves certain sleep parameters.
Hops also improve insulin sensitivity and have a phytoestrogenic effect.
– Chamomile has been widely used as a herbal calming solution for ages. It too should, therefore, be included in a herbal regimen that addresses Prednisone-induced insomnia.
– Kava is a central nervous system sedative. Unfortunately, it does not offer a long-term solution either. The FDA has pointed out its negative effects on liver health. As such, it is not an ideal component of a sleep-promoting herbal regimen for Prednisone patients.
It is worth pointing out that eventually, following discontinuation, Prednisone’s side effects will go away. There is only a handful that can be permanent.
- Osteoporosis and osteonecrosis.
The best way to avoid the negative side-effects of Prednisone is to avoid the drug altogether. Try not to get into a condition that requires Prednisone. Adopt an anti-inflammation diet and work out.
How Effective Is Prednisone for Various Ailments?
One way to subjectively assess the effectiveness of drugs is through patient reviews. What do people say about Prednisone, in the context of various ailments?
Inflammatory conditions represent the primary focus of the drug. At drugs.com 115 people have provided feedback on Prednisone. The resulting score is a solid 7.5 out of 10.
Based on the reviews, the drug acts quickly for most patients. Those who have only taken it in the short-term do not complain of side effects.
- One person says his/her neck swelling and pain subsided within two days on Prednisone. This patient did not report any side effects.
- Another person, who took the drug for optic neuritis, complained of splitting headaches. He/she also listed insomnia, acne, weight loss, dry skin, sinus problems and frequent urination among the side-effects. This patient ended up giving a rating of 1/10 to Prednisone and calling it “an awful drug.”
- A patient who took Prednisone for droopy eyelid, had stubborn dermatitis clear up as a result of the medication. She paid for it through a bevy of awful side- effects, such as anxiety, acne, headaches, etc.
For Rheumatoid Arthritis, Prednisone obtained a rating of 7.9 out of 10 from users.
- One patient who took 20mg of Prednisone per day, for advanced RA in the shoulders, wrists, and fingers, noted significant improvement. He/she also reported a series of side effects, including moon face and weight gain.
- Another feedback provider complained that Prednisone had masked the symptoms of pneumonia in his/her father, leading to the patient’s death. This is indeed a real danger all Prednisone users have to consider.
- Yet another patient took Prednisone for RA, for five weeks without any side-effects. The said person expressed concern, having read negative feedback from other contributors.
In regards to asthma, 53 people rated Prednisone 7.0 out of 10.
- One person called a 20-40mg daily dose of the drug a “miracle” for asthma. This patient rated Prednisone 10/10.
- Others have been more reserved about the efficacy of the drug for this condition. One such patient pointed out that while Prednisone worked for him/her, he/she could not go without the drug.
- Another patient received Prednisone for a chronic cough. According to him/her, the drug made the condition worse. This patient rated Prednisone 1/10.
From the anecdotal evidence provided by reviewers, it is clear that Prednisone works better for some ailments than others.
Users rated it best for osteoarthritis, and least effective for Tennis Elbow and Allergic Rhinitis.
The Bottom Line on Prednisone
Prednisone is a glucocorticoid, the efficacy of which is remarkable. It alleviates inflammation by suppressing the immune system. Some of its side effects are horrifying, though its benefits often outweigh them.
Doctors who prescribe this drug carefully weigh its benefits against its side-effects. Always tell your doctor what measures you intend to take to alleviate these side effects.
I was taking 60mg a day of prednisone for 10
days, no tapering, for sudden hearing loss in
one ear. Got my hearing back. Now after 3 weeks off Prednison, still problems with sleeping.
Another thought on Prednisone-induced insomnia:
Due to a severe chemical burn and resulting pain to my face and neck from Fluorouracil (chemo cream), I was prescribed oxycodone and prednisone. Had horrible and vivid nightmares, likely from the Oxycodone and did not complete that drug for that reason.
I did, however, finish the 10 day prescribed dosage of prednisone – yesterday. I have not slept more than two to three hours consecutively in a week and am plagued with depression and malaise. I’m irritable and have feelings of hopelessness. I will never take prednisone again.
I would give is a rating of – 0/10
I wish I had never been prescribed or taken Prednisone. I had a sinus infection and was given a 6-day pack. I was then given a second 6-day pack and started having adverse reactions, including heart palpitations. It made me so agitated I abruptly stopped it and am paying a heavy price physically and mentally through withdrawal.