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How to Take Prednisone (the RIGHT way)

How to Take Prednisone (the RIGHT way)

What your doctor or pharmacist was taught, so what they told you, may be the wrong way to take prednisone. Find out the right way of how to take prednisone in this article and video.

Prednisone is a commonly prescribed steroid medication that is used to treat a variety of conditions, including inflammation, allergies, and autoimmune disorders. While prednisone can be a highly effective treatment, it is important to take it correctly in order to maximize its benefits and minimize potential side effects.

Watch How to Take Prednisone (the RIGHT way) now!

Take your prednisone dose first thing in the morning

Prednisone is mimicking our body’s natural hormone called cortisol. Cortisol is naturally secreted by your body in a daily rhythm where right before sunrise it’s really high and then it goes slowly down throughout the day. What we want to do with the prednisone is mimic that as closely as possible.

Cortisol’s diurnal cycle: The daily cycle of cortisol release in normal sleepers is characterized by: (a) a nadir in secretion falling between 11:00 p.m. and 5:00 a.m., (b) a rapid rise prior to awakening with a post-awakening peak between 7:00 and 7:30 a.m., (c) a gradual decline across the waking hours, and (d) minor rises following the midday and evening meals. Adapted from W.R. Lovallo, 2000.”

If your doctor prescribed five pills to take per day, you take it all at once first thing in the morning, in one swallow with a glass of water.

#1 Side Effect Tweeted is Insomnia

Prednisone causes more insomnia than most drugs. You want to avoid that by taking it early enough in the day. Prednisone’s half-life, which is somewhere between one to three hours, can wear off before bedtime.

Adapted from Rayos. Deerfield, IL: Horizon Therapeutics USA, Inc.; 2021

That way, once you go to bed, the prednisone is out of your system and you can sleep restfully. You don’t want to have to deal with the horrible insomnia that this medication causes.

See this article and video about “9+ Tips for Prednisone Causing Insomnia”

Should you take prednisone with food?

When I graduated from pharmacy school, they taught all the future pharmacists that prednisone had to be taken with food. Recent research shows that that’s probably not necessarily true.

They were trying to avoid the side effects from this medication that cause gastrointestinal (GI) upset, gastrointestinal bleeding, stomach ulcers, and any issues with the gut lining. They thought it had to do with whether or not a person took prednisone with food.

More recently they’ve discovered it’s because people are taking things like ibuprofen along with prednisone and it might be a drug interaction. For most people, you can take it with just a tall glass of water and that’s all you need.

One scientific abstract said:

To mimic the normal diurnal rhythm, one would ideally take prednisolone immediately before waking, which is not possible. Taking prednisolone after breakfast causes an unnecessary delay and does not improve absorption. We would advise taking prednisolone immediately on waking, before breakfast to produce a detectable concentrations of prednisolone as early as possible.

Choudhury SM, Williams EL, Tan TM, et al. The pharmacokinetic profile of prednisolone is not affected by ingestion of food – how should patients be advised? Endocrine Abstracts (2016) 44 P23 | DOI: 10.1530/endoabs.44.P23

Do not suddenly stop taking the medication

Prednisone should not be stopped suddenly, as this can lead to withdrawal symptoms and a potential flare-up of your condition. If you need to stop taking this medication, it is important to do so gradually under the guidance of your doctor.

Prednisone works by suppressing the body’s natural production of cortisol, so if you suddenly stop taking the medication, your body may not be able to produce enough cortisol on its own, leading to a condition known as adrenal insufficiency.

It is important to understand that tapering is a slow process taking at least several weeks if not several months. There are different methods depending on your situation. Choose the prednisone taper chart that fits your situation.

Prednisone Taper Chart

Receive a free Prednisone Taper Chart to help you know when to taper down in prednisone dose. This does not substitute your doctor’s prescription.

Monitor for side effects

While prednisone can be an effective treatment, it can also cause a range of side effects. Some common side effects include weight gain, mood changes, and increased blood sugar levels. It is important to monitor for these side effects and to report any concerns to your doctor.

It is important to stay in regular communication with your doctor or pharmacist while taking Prednisone. They can provide guidance on how to manage any side effects you may experience and may adjust your dosage or treatment plan if needed.

If you experience any severe or concerning side effects while taking Prednisone, such as difficulty breathing, swelling, or severe mood changes, it is important to seek medical attention immediately.

Monitoring for side effects while taking this medication, is an essential part of managing your treatment and ensuring your safety. By staying vigilant and communicating openly with your healthcare provider, you can effectively navigate any potential side effects and ensure the best possible outcomes from your treatment.

Prednisone Q&A: Your Top Questions Answered

Do I take all 3 at once or 1 every meal? Can I take 3 at a time?

Yes, you can take three at a time. You can take five at a time, or whatever your doctor prescribes.

Why does prednisone have so many side effects?

Prednisone is a miracle medication. It saved my life and millions of other people’s lives. However, it caused more side effects for me than I can count. It was a horrible experience taking prednisone. I was grateful for it and also it made me completely miserable. The reason it’s doing that is because prednisone is mimicking our natural hormone cortisol.

But cortisol is normally secreted at a maximum of the equivalent of Prednisone, 2.5 milligrams a day. And most people taking prednisone are taking 10, 20 or even a hundred times more than your body’s naturally occurring prednisone, cortisol.

So you are 10 or 20 or a hundred times causing the side effects in your body. Cortisol is normally released in times of severe stress, it’s our stress hormone. It helps us deal with disasters, whether it’s a famine or a war. Cortisol was strategically created by Mother Nature to help us deal with those horrible times and isn’t worried about the future, it’s worried about right now, survival. That is it–it’s not holding back at all; it’s giving your body every reserve it can find. It’s only concerned with survival and not your future or whether you will have side effects.

Cortisol (and prednisone) is causing all of these side effects because it’s stealing from parts of your body. It’s stealing from your muscles, it’s stealing from your bones, it’s stealing all of these wonderful nutrients your body has stored up so that you can survive right now. Taking prednisone is doing wonderful things, but it’s at a cost.

Treatment starts with a high dose of prednisone. When symptoms improve, the dosage is lowered, why?

It’s because your body needs you to let it kick back in. When you took that prednisone, it immediately shut off a system of your body called the HPA axis. It turned off your ability to make cortisol.

You need to give your body time to recover that system. If you go “cold turkey” off of prednisone,
that’s a big problem. We do not want to go cold turkey. You want to slowly decrease in dose until you’re back to closer to the 2.5 milligrams a day. That is what your body normally makes.

You want to follow the taper your doctor prescribes. If you’re still not feeling good after you stop taking prednisone, definitely be in touch with your doctor because you might be going through prednisone withdrawals.

Generally, if you’re only taking five to 10 days of prednisone, you don’t need to taper. You just take it exactly as your doctor prescribed.

Are there side effects of taking prednisone and what if I’m only taking it for five days?

Yes, there are side effects. Everything from insomnia, moon face, weight gain, high blood pressure, high blood sugar, you can get eye issues like cataracts and glaucoma. There are up to 150 side effects of prednisone.

That’s why you need to download my Prednisone checklist. It includes the top seven mistakes people make while taking Prednisone. You’ll know exactly how to avoid those mistakes so that you can take prednisone the right way and avoid the mistakes that other people commonly make.

  1. Arnold A. Primary hyperparathyroidism: molecular genetic insights and clinical implications. Presented at Society for Endocrinology BES 2017, Harrogate, UK. Endocrine Abstracts 50 PL1.
  2. Tembo AV, Sakmar E, Hallmark MR, Weidler DJ, Wagner JG. Effect of food on the bioavailability of prednisone. J Clin Pharmacol. 1976 Nov-Dec;16(11-12):620-4. doi: 10.1002/j.1552-4604.1976.tb01500.x. PMID: 791973.
  3. Frey BM, Frey FJ. Clinical pharmacokinetics of prednisone and prednisolone. Clin Pharmacokinet. 1990 Aug;19(2):126-46. doi: 10.2165/00003088-199019020-00003. PMID: 2199128.
  4. Esteves GP, Mazzolani BC, Smaira FI, Mendes ES, de Oliveira GG, Roschel H, Gualano B, Pereira RMR, Dolan E. Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy. Rheumatol Adv Pract. 2022 Apr 21;6(2):rkac029. doi: 10.1093/rap/rkac029. PMID: 35539442; PMCID: PMC9080102.
  5. @inproceedings{Lovallo2000StressHI,title={Stress hormones in psychophysiological research: Emotional, behavioral, and cognitive implications.},author={William R. Lovallo and Terrie L. Thomas},year={2000},url={https://api.semanticscholar.org/CorpusID:151328229}
  6. Jones C, Gwenin C. Cortisol level dysregulation and its prevalence-Is it nature’s alarm clock? Physiol Rep. 2021 Jan;8(24):e14644. doi: 10.14814/phy2.14644. PMID: 33340273; PMCID: PMC7749606.

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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