I know that struggle between “It’s helping, but how long can I be on Prednisone safely, right?”

Is there a time period where it’s like suddenly more dangerous? Is one dose enough to cause terrible side effects?

Watch now!

How Long Can You Take Prednisone Safely?

Transcription autogenerated from the video above so some errors are possible.

I got this email from a prednisone warrior and it says;

“Hi Dr. Megan! I have been trying to taper to zero for about two years. I’ve gotten down to 1 mg and had to go back up twice due to polymyalgia symptoms. I’m at 2.25 mg right now tapering every two weeks by a quarter of a milligram. How dangerous is it for me to stay on prednisone? Is it okay to take 3-5 mg forever?”

This is a really understandable question because this condition, PMR or Polymyalgia Rheumatica is completely debilitating and miserable. 3-5 milligrams isn’t much, it’s only just barely above our naturally occurring amount of cortisol, which is the hormone in our body that prednisone is mimicking. 

Is there a Safe Dose of Prednisone?

Since our human body makes somewhere between 1 to 2 ½ milligrams equivalent to prednisone, can you just keep taking that amount? Is that safe? It’s a tricky question because essentially there is no safe dose of prednisone.

No safe dose of prednisone, and no amount of time that prednisone is considered safe. If you’re going to go by strictly, does it cause side effects or not? 1 milligram is enough to cause side effects, but that’s not the real question here. The real question is, is it okay to take it forever? And that’s a question of do the benefits outweigh the risks?

Does your Benefits Outweigh your Risks?

Now you have to talk to your doctor about the benefits because I can’t tell you what those are in your situation. Prednisone can be used for almost anything from autoimmune diseases, and allergic reactions to kidney transplants. You have to know precisely what the benefits are for you.

What I can tell you is what are the risks. Because then you can make a more educated decision of what the benefits versus the risks are.

What are the risks of staying on prednisone forever? Personally took it for nine months and these are the side effects I personally suffered. They were no fun. I don’t wish this on my worst enemy, but it was necessary for me. I had a bleeding disorder where I could possibly bleed to death if I hadn’t taken prednisone.

Bleeding versus these side effects, because definitely I don’t wanna die. That’s what I went for and so it’s understandable. I understand the need to get off of prednisone and also the need to stay on prednisone. Prednisone is a miracle and it makes us miserable, right?

What are the Duration Dependent Side Effects?

Some of prednisone side effects are worse the higher the dose,  and some of the side effects are worse, the longer the time you’re on them. 

The milligrams over your lifetime, how many milligrams of prednisone do you get? Whether it’s 3 milligrams a day for 3 years or 300 milligrams a day in 1 day, right? Either way, that’s a lot of prednisone.

Is it safe to take prednisone long-term? The duration-dependents side effects of Prednisone, does it matter? 

First of all, is Cushing’s syndrome or moon face, the big fat belly, weight gain, and the possible movement of fat to your neck area, the back of your neck, that’s called the buffalo hump. And just body fat accumulation in general. That can happen within 2 months of treatment.

That doesn’t happen within the first few days. It’s something that happens in the long term. And even at 5 milligrams a day, you can have it. Is it worth it to have a round face and also be able to function? Good question. 

Increasing duration of use was significantly associated with weight gain.

Side effects you’re most likely to have

The longer you’re on it, the more likely you are to gain weight. It’s just one of those things to be aware of. That’s the first one is weight gain or Cushing syndrome.  

Second is mood changes or neuropsychiatric side effects. After just one dose, you can have this amazing improved sense of well-being. This euphoria, like life is great and feeling like a million bucks.

In the longer term, you can have other side effects from anxiety to hypomanic reactions to depression. Depression is the most common side effect. Mental, mood change, side effect in long term. So it’s possible you might have more depression the longer you’re on prednisone. 

Number three is heart disease. Prednisone can be rather hard on our heart. Because prednisone mimics this cortisol that is designed to help us survive a threat, whether it’s of war or famine. It’s stealing from all the reserves in our body,  our bones and muscles to get through that short period of badness. Because it’s rather better to survive than to have a strong heart or strong bones. It’s cutting corners, right? Your risk for heart disease is increased risk for high blood pressure goes up to long term and arrhythmias heart attacks. You can have harder cardiovascular risks, even less than five milligrams a day. 

And overall you’re more than 2.5 times more likely than patients who did not receive glucocorticoids to experience a cardiovascular event. So it’s 2.5 times more likely to have heart problems if you had never taken prednisone than if you had.

What happens after 30 days of treatment with Prednisone?

They did a study of 327,000 adults in the United States who had to take prednisone. This was just to see what happened in the first 30 days after treatment. What was more likely for people who had been prescribed it versus the 30 to 90 days before? They were looking at insurance records and they saw that in the first 30 days you are more likely to have a VTE, which is a Venous thromboembolism or clot. You are 3.33 times more likely in the 30 days after you took prednisone than the 30 to 90 days before. 

And then osteoporosis, you’re 1.88 or almost two times more likely to have a fracture, or a broken bone in the first 30 days after taking prednisone, than 30 to 90 days before you had taken it. 

And the third thing they looked at was infections. The worst kind of infection is called Sepsis where it’s like your whole body is infected. And that was a five times greater risk after taking prednisone. So it’s like prednisone is causing immunosuppression. These things does not mean prednisone is not safe. There is no safe dose of prednisone and safe time for prednisone. These things can happen. 

Next is diabetes or glucose intolerance. Your relative risk increases from 1.8 in patients treated with the equivalent of less than 10 milligrams a day. You have almost a 2.2 times greater risk if you’re on less than 10 milligrams a day and it increases up to 10.3 in those with the equivalent of 30 milligrams a day or more of prednisone. Anywhere between a two to 10 times greater risk of diabetes if you’re on prednisone.

Finally, cataracts or glaucoma side effects in your eyes. The longer you’re on prednisone, the greater your risk for cataracts, which is like clouding of the lens of your eye. And glaucoma is  increased blood pressure or increased pressure in your eye. Those get worse the longer you’re on prednisone. 

There is No Safe Dose

Now you know the main side effects to be aware of. There’s no safe time period. It’s all a benefit-risk calculation for you. 

Is prednisone worth it? Is it going to keep you functioning as a happy member of society or not? And if so, these are the price you’re willing to pay and increased risks of all of those side effects. Is it worth it? It was for me. I was really grateful for the chemotherapy I was able to go on to get off of it. Those risks went way down.

How can you Decrease your Risk?

There are some things you can do to decrease your risks? And one of those things is replenishing the nutrients prednisone is depleting.

Osteoporosis is because prednisone is depleting calcium, vitamin D, magnesium and vitamin K2. Your bones are becoming thin and are more likely to break, right? You have a 1.88 times greater risk of fracture. If we replenish the calcium, vitamin D, magnesium, vitamin K2, folate, and all the good things, that’s theoretically going to decrease your risk.

How to Replenish the Nutrients Prednisone Depletes?

In fact, they did a study that if all you did was to replenish calcium, it wasn’t any better than if you had done calcium and vitamin D. It’s more important to have the vitamin D together with calcium to decrease your risk for osteoporosis from prednisone. You can’t just do the calcium, you have to do other nutrients to make it work. 

It’s not just osteoporosis that you can decrease your risk by replenishing nutrients. In fact, diabetes is likely affected by the fact that prednisone is making us deplete our chromium, so we need to replenish chromium as well. 

Heart disease has many factors, but there are a lot of nutrients depleted that have an impact on your heart. Prednisone is causing all these side effects by stealing from your reserves, so we need to give it back. If we give it back and replenish the nutrients depleted; it’s going to help our experience on prednisone for whatever time we need to be on it and be safer. There’s no safe dose, but it can be safer if you replenish. 

If you’re thinking how are you going to figure out all the things you need to replenish? Well, don’t worry, I did that for you because I don’t ever want you to be suffering all of these horrible side effects while on prednisone.

The First and Only Supplement to Support You While on Prednisone

I invented Nutranize Zone. It’s the first and only supplement for people on prednisone. It replenishes the nutrients that prednisone depletes and helps you feel better. I made it in this handy dandy twin pack. So all you have to do is take 2 in the morning of the morning bottle and 2 at bedtime, and it helps you to get restful sleep to support your bones, immune system and blood sugars to decrease your risk as much as possible.

I can’t say it’s going to cure any of those conditions, but it’s going to support you while you’re on prednisone. You can just go to Nutranize.com and take it while you’re on Prednisone, and for at least three weeks after to support you while you’re recovering from taking Prednisone.

Frequently Asked Questions about Prednisone Safe Doses

FAQs #1

Is there a prednisone safe dose range?

Not really. Any dose of prednisone could be considered “unsafe” or “safe” depending on what you’re taking it for. The normal dose of prednisone ranges from 5 mg to 60 mg for most conditions.

FAQs #2

Is 2 mg of prednisone safe?

The dose of 2 mg of prednisone is safer than higher doses. 2 mg is nearly the same as what our bodies naturally secrete as cortisol, so it’s about the same as what your body is normally exposed to. However, every individual is different on what dose will suppress the HPA axis and lead to adrenal insufficiency.

FAQs #3

Is 1 mg of prednisone safe?

The dose of 1 mg of prednisone is safer than higher doses. It’s the lowest strength of prednisone tablets available in the USA. 1 mg is less than the equivalent of what our bodies normally secrete as cortisol, so it’s safer than higher doses. However, every individual is different on what dose will suppress the HPA axis and lead to adrenal insufficiency. 

FAQs #4

Is prednisone safe while breastfeeding? 

Read my article all about prednisone and breastfeeding.

FAQs #5

Is prednisone safe for heart patients?

Prednisone can cause many heart-related side effects. It may worsen heart disease or cause new heart disease, so prednisone is not necessarily safe for heart patients. However, prednisone may be helpful for a condition that your doctor considers even worse, so be sure to discuss your concerns with your doctor.

FAQs #6

Is it safe to drink alcohol while taking prednisone?

Read my article all about alcohol and prednisone.

FAQs #7

Is prednisone safe to take?

Prednisone is a drug that is helpful but causes many side effects. There is no safe dose, but it may be so helpful that your doctor considers it “safer” than not taking prednisone.

FAQs #8

How long is it safe to take prednisone?

There is no length of time that is “safe” to take prednisone. Even one dose can cause disabling side effects in a few rare situations. The general recommendation for prednisone is to take the lowest effective dose for the shortest period of time.

Read more about “how long” things take with these articles about “how long”.

FAQs #9

Is prednisone safe for kidneys?

Yes, prednisone is generally considered to be safe for kidneys. In fact, it is often given as a treatment for several kidney conditions.

FAQs #10

Is it safe to take prednisone and loratadine together?

Yes. Check out my article all about prednisone drug interactions for more drugs to watch out for.

FAQs #11

Is it safe to take ibuprofen with prednisone?

That’s a tricky question. Yes and no. Read my article all about taking ibuprofen with prednisone.

FAQs #12

What are the dangers of prednisone?

Read my article and watch this whole video that lets you know “What your doctor won’t tell you about prednisone.”

References

1. Almayali AAH, Boers M, Hartman L, et alThree-month tapering and discontinuation of long- term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: placebo-controlled double blind tapering after the GLORIA trialAnnals of the Rheumatic Diseases 2023;82:1307-1314.