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COVID Vaccine Side Effects for People on Prednisone

COVID Vaccine Side Effects for People on Prednisone

UPDATE 8/11/21 This video was originally published on March 29, 2021. It was the latest data at that time. While there are more updates to the vaccine research since then, my tips at the end about coping with the vaccine side effects are still up to date! Get your printable form so that you are ready to cope with the side effects!

Also, the research updates since March 2021 have made it more and more reassuring for every person to get the vaccine. After the published official opinions from neurologists, rheumatologists, and other specialist doctors, I’m not aware of any condition or any person who should NOT get a COVID vaccine. Essentially, everyone should get the vaccine, and get it right away before the contagious Delta variant gives a terrible infection.

COVID Vaccine? Are you done getting your shot?  So today is March 29th, 2021. And I’ve got some vaccine updates for you for people on prednisone!

The following is a transcript of the video above… 

COVID Vaccine Trial for Immunocompromised Patients

It’s always been a real mystery about what people on prednisone should do about getting the COVID vaccine because we were all excluded from the trials.

None of the vaccine trials in 2020 included people on prednisone or any other immunosuppressants.

The original trials were designed to make sure that they were testing the vaccines in people who are most likely to have a proper response, so they didn’t want to throw any immunosuppressed people into the mix to potentially ruin the results. So now that time has passed, there’s more data. And I want to share that with you.

Last week in JAMA (Journal of American Medical Association), the foremost research journal in America, they published an article about people who had a solid organ transplant.

Whose Vaccine Response Studied

In order to be in this scientific study, the participants either had a kidney, liver, lung, heart–one of those solid organs–transplanted. Because of that transplant, they were taking immunosuppressants–things like prednisonePrednisone could have been one of those immunosuppressants. The other medications that can be taking include tacrolimus or mycophenolate mofetil or several other options.

What they did was find out whether these people had an appreciable immune response after getting the vaccine based on measuring their antibodies.

They found these transplant patients on social media. They said, “Hey, if you have gotten a transplant and you’re getting the COVID vaccine, let us know, and we’ll measure your blood to see if you have any antibodies.” All these people volunteered; it was a totally volunteer-based trial. These people were mostly healthcare workers because the trial went from December 2020 until March 2021.

Because they’re healthcare workers, they knew what to expect as far as like getting their blood drawn and things like that. They knew what they were signing up for. As healthcare workers, they were really concerned about getting COVID because of their double risk from exposure at work and immunosuppression from taking prednisone or another immunosuppressant.

Risk of Immunosuppression with COVID-19 Outcomes

According to the rheumatologists, this is what they said after considering the influence of age and sex.

“People with rheumatoid disease are at higher risk for hospitalized COVID-19 had worse outcomes compared to the general population.”

That’s pretty much true of basically everyone on prednisone: you’re at higher risk of worse outcomes if you get a wild infection of COVID. That’s why we need to do everything we can to protect ourselves. That’s why they did this study: to find out if we can have any benefit of vaccinating people who are taking medications that suppress their immune system.

How the COVID mRNA Vaccine Affects Patients who have Gotten a Transplant

Results of the Study

What they found is that depending on the drug people were taking, some of the drugs completely suppressed their immune response.

In a normal, healthy human, we get nearly 100% antibody response. If we give the COVID vaccine to a hundred healthy people with normal immune systems, then a hundred people will get an antibody to that vaccine. Whereas people who are taking immunosuppressants, there was a much smaller percentage and it really depended on the drug.

Mycophenolate (CellCept, mycophenolic acid)

There’s one type of drug that’s really common in transplants called mycophenolate. It has several different, similar names, such as mycophenolic acid, and its brand name is CellCept. People taking that mycophenolate had almost no antibodies.

It’s amazing–it showed that that drug works. It’s doing its job. It’s protecting that person from losing their organ transplant. Mycophenolate truly causes the proper immune response to keep the organ transplant from rejection.

Unfortunately, it’s a double-edged sword, because that also means it’s stopping them from an appropriate response to the vaccine. So if you’re taking mycophenolate, it’s really hard for you to get a vaccine response. This was only after one dose of the COVID vaccine.

We don’t know what would happen after two doses, or even if maybe people who are on immunosuppressants should get three doses. We just don’t know yet. This is just the very first research that’s out there. And I just wanted to share it with you as soon as I could so that you would know the very top-of-line data.

What about Immunosuppression from Steroids?

They didn’t break out the results for people who were just on prednisone or other corticosteroids. They did break down who was on just mycophenolate. I’m inferring based on this data that essentially about one in two people who weren’t on those drugs and were on prednisone or other immunosuppressants had about a one in two chance of the antibody response having happened.

About half the people who got the COVID vaccine might’ve gotten a response, half the people who didn’t, they didn’t really publish a ton of data on this. So that’s my inference. It’s not a hundred percent clear if that’s precisely what it is, but it looks about like one in two people who got the vaccine and were on certain immunosuppressants, got an immune response. And that means the vaccine worked for one in two people on the other hand it didn’t work.

And so maybe it will work after two doses. Maybe it’ll work after three. We don’t know. We just don’t know yet.

Who were the people within that group who did the best?

The people who did the best with creating immune response to the mRNA vaccine while immunosuppressed were younger females.

Also, those who were younger and not receiving antimetabolites maintenance.

Moderna vs. Pfizer Vaccine Efficacy

Moderna vs  Pfizer Vaccine Efficacy

So that’s not having that mycophenolate drug and those who received Moderna. That was what I, that was my whole point is those who received Moderna did a lot better than those who did Pfizer, not a lot better, but there was a difference.

If you have a chance to choose which vaccine you get at this point based on this one trial of extremely limited data, Moderna is your best option. That’s all we know.

Moderna is the best option compared to Pfizer.

We don’t have any other evidence for any other vaccine at this point.

So if you were my sister or mom or brother, I would say, sign up for the Moderna clinic whenever you can because your chances are maybe one and two that it’ll work but that’s a heck of a lot better than your chances if you actually get infected with COVID.

I love that they want to talk to you, your doctors and share this decision-making they don’t want you to just get it off the internet. They want to consult with you and be like, “okay, you’ve got this going on. You’ve got this going on. Let’s find, you know, where, when is the best time to get it? Where’s the best place to get it?”

Because if you’re on other drugs like Rituxan (that was the drug I took, it’s a chemotherapy drug), it also blunts your immune response. And so there might be the best time to take the vaccine compared to when you’re getting the Rituxan. And so these are important questions you need to be discussing with your doctor. So these are the updates that I want to tell you.

  1. Minimize the risk of getting COVID or if you get infected again with COVID it will lessen the chances of getting the worst outcome of it.
  2. Rheumatologists said that the healthcare providers responsible are responsible for engaging in a discussion within a shared decision-making process.
  3. I got my 2nd dose and the side effects are beast!

Moderna Vaccine Side Effect

So, I got my second Moderna shot and it was a beast!  So I had, I had read online that people on the second shot, it can be pretty, pretty tough!

The first shot for me was pretty mild. My arm was pretty sore. Like I lost range of motion, but it went away and I kind of felt exhausted that day.

The second shot. On the other hand, I had a fever. I had aches and pains, was really fatigued, had a little bit of nausea. And so I want to tell you how to cope. If you’re on prednisone with these side effects that you’re going to experience, especially if you’re like me, you’re female, because they found that women on who get the vaccine have a harder time on that second shot.

fever side effect after vaccine

Reasons Behind the Vaccine Side Effects

It’s just, for some reason, the way female immune systems work, it’s more vigorous. Like we have much more side effects than the men, for whatever reason that is. I don’t know. It’s probably something to do with hormones.

Anyway, if you’re like me and you always seem to be the one who experiences the side effect, then hear me out.

  1. Headache

So first of all, the headache. If you’re on prednisone, you don’t want to be taking ibuprofen or Naproxen or Meloxicam or any of those NSAIDS (Advil, Mobic and Naprosyn are the brand names). You want to avoid those if you can when you’re taking prednisone because when you take prednisone along with one of those drugs it can lead to a side effect that leads to gastrointestinal upset. Like you could get, a bleeding ulcer or you could get GERD like reflux, heartburn, and pain.

So if you are dealing with that headache and that achiness from getting the vaccine, then avoid those drugs. And Tylenol is probably a lot safer option for you. If at all possible if you don’t need to take anything, then don’t take anything!

The very best thing we can do is allow our immune systems to mount a full response.

COVID Vaccine and Prednisone

If you’re taking prednisone, you need all the chance you can get! So only take medication to cope with these side effects if you feel terrible, otherwise just try to tough through it!

You want to give your immune system every chance it can to mount that immune response, and those medications can dampen it.

There’s more research coming out. It used to be the standard was, “If there’s a fever, we got to treat it. We got to give ibuprofen or Tylenol. We got to take it down.”

But there’s more evidence showing that mother nature was probably smart in having fevers that it really helps our immune system do its job. And so if you can tolerate a mild fever then tolerate it. If it’s intolerable, then you need to cope. Right? And so that’s what I’m talking about is if you’re suffering so much, you need help.

This is the best way is Tylenol, which is acetaminophen instead of ibuprofen or those other drugs.

That’s the first thing.

2. Nausea or vomiting

Then you could be getting nausea or vomiting. If that’s causing you to like, not be able to keep food down, yikes. Then you should take an anti-nausea medicine. I’m not aware of those reactions. If it has a drug interaction with prednisone.

So yeah, feel better. And then with the fever and headaches in general, drinking, lots of fluids is really important.

If I had done it over again, why I would have done is I would have the day before I would have prepped myself for the COVID vaccine better. What I would have done is I would have made food for like two or three days. I would have planned out breakfast, lunch, and dinner for two or three days and made it really easy for myself.

How long do you suggest waiting until I get my booster shot?

If you will be stopping prednisone in the next ten days… You should wait two weeks after your last dose.

If you will be taking prednisone longer than ten days… You can get your vaccine right away.

Tips after Getting the Vaccination

Like something I could just throw in the oven, something I could just throw on the pot and not have to sit there and chop vegetables or anything, because I didn’t realize how much I was going to feel like I just want to lie down. I don’t want to have to do anything. So listed below are the tips that I’ve done.

  • Meal plan
  • Having enough water
  • Having enough sleep

Meal Planning

First is meal prep for about two days so that we could get through it or have a plan of what who you’re going to order out to get through it.


I would have had water by my bedside before the vaccine kicked in and like a big jug of it and then had that medicine there, ready for me to take if I needed it, instead of just feeling awful in bed and not being able to like pull myself out of bed to take the medicine.

So that’s what I would have done to cope. Just having it all ready. Oh, and another thing would be a hot pad. That’s what I would’ve done too, because of the aches and pains. That’s a really great way to cope with aches and pains that you can have for that day or two after the vaccine.

So I would have had the hot pad ready, water ready, meal prepped, and the medicine there within arm’s reach, but I wouldn’t have taken it and I didn’t take it until I was suffering enough that I was like, okay, I’ve given my immune system a chance to do its job.


And now, I need to sleep. That was the other thing is I couldn’t sleep because I had such a high fever. And so I would take melatonin. Melatonin has been shown to help our immune system. I’m not saying it’s going to help your immune system with the vaccine. I’m not going to say that, but in general, melatonin helps our immune system.

And so I would have it right there, ready to take if I’m having a hard time sleeping because of my immune system’s aggressive response to the vaccine. Then you’re good.

If you’ve got those things covered, you’ve got your water, hot pad, meal prep. You’ve got a snugly. I don’t know if you’ve got one of those. You got little booties on your feet. If you get cold feet, when you have a fever, all of those things, things get them all ready. While all of those things help you cope with a fever, have them like a cold compress on your arm. If it’s aching on your forehead for your fever, all of those things can help.

And then the other thing I did wrong was I wore thick pajamas. When the fever goes up and down, it was like, “I need to take these off but I’m too tired to take them off.” And so just wear thin clothes and have layers of, of blankets. So you can take off instead of like me where it’s a lot harder to take off pajamas than a blanket. All right.

Old People are at Higher Risks

I’m really excited because my in-laws both have the COVID  vaccine completely done. Okay. And so that means my kids can be with their grandma. They get a hug from their grandparents without any fear of infecting them.

You know, the grandparents are high risk. They’re old. They, they don’t want to be like, yeah, “I’m the one who killed grandma.”

And it’s so nice knowing that they can’t do that now. Their grandparents are fully vaccinated. This is our ticket out of here, people! Get the vaccine, even if it only has a one in two chance of working maybe that means like people suggested maybe it means we need people who are on immunosuppressants, not just one vaccine, but maybe several different COVID vaccines.

Like maybe you’ll get the full dose of Moderna and then you’ll get Johnson & Johnson too. We don’t know. We just don’t know that yet, but they’re doing research right now to figure it out. And that’s why I came on today to tell you the very latest information and go get the COVID vaccine to sign up. In my state, everyone over 12 is eligible. So you’ve got no excuse! Now, at least in my state. And just go get it. Have your plan already that I told you about.

Want a 1-page Printable version of the tips?

I’m going to have a little printout of all the things that I suggested in here. So if you would like a copy of that, enter your email in the form below asking for a copy of the Vaccine Side Effect Tips and I will send you an email with all of those tips I just shared with you! It’s a one-sheet printout summarizing all of my best vaccine side effect coping tips.


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Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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