M Toronto Myositis Centreat St. Michael's Hospital
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Prednisone

a corticosteroid · say “PRED-ni-zone”
Corticosteroid
!
Never stop suddenly.

Prednisone must be tapered gradually under your doctor. Stopping abruptly can cause a dangerous drop in your own cortisol (adrenal crisis).

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What it is

A fast, powerful anti-inflammatory.

Prednisone is a synthetic corticosteroid, very similar to cortisol, a hormone your adrenal glands make naturally. It is a powerful anti-inflammatory that rapidly calms an overactive immune system, controlling the inflammation that causes pain, swelling, and tissue damage in myositis and other autoimmune diseases. It usually works within hours to days, which is why it is often the first medication started while slower medications build up.

How to take it
  • Usually taken once daily in the morning with food or milk, to reduce stomach irritation.
  • The dose is set by your doctor and can range from 1 mg to over 60 mg daily.
  • Sometimes given as divided doses or every other day, depending on your situation.
  • Take it at the same time each day. If you miss a dose, take it when you remember; if the next dose is near, skip it and never double up.
  • Store at room temperature, away from children.
What to expect
  • It often works quickly, and many people feel significantly better within hours to days.
  • It is usually a short to medium term treatment while slower medications take effect.
  • The goal is to taper to the lowest effective dose, and off prednisone entirely when possible.
  • You may feel a lift in energy early on, which is a normal effect of the medication.
Benefits

How it helps you.

Rapid symptom relief

Reduces pain, swelling, and stiffness faster than almost any other medication, often within hours to days.

Powerful anti-inflammatory

Controls severe inflammation in myositis, lupus flares, vasculitis, and polymyalgia when fast control matters.

A bridge to long-term therapy

Provides relief while slower DMARDs such as methotrexate or mycophenolate build to full effect.

Prevents organ damage

In severe flares, it can prevent lasting damage to muscles, lungs, kidneys, and other organs.

Flexible dosing

Available in many strengths, so the dose can be tuned from low maintenance to high for an acute flare.

Usable in pregnancy

One of the few options that can be used safely in pregnancy and breastfeeding when needed.

Risks & side effects

What you should know.

Your doctor prescribed this because the expected benefits outweigh the risks for your situation. Here is the honest, full picture.

Common side effects
Increased appetite and weight gain
Very common. Mindful eating and a lower-sodium diet help manage it.
Sleep and energy changes
Feeling wired or having trouble sleeping, especially at higher doses. Morning dosing helps.
Mood changes
Irritability, restlessness, or mood swings, usually dose-related and better as the dose comes down.
Stomach irritation
Nausea or indigestion. Always take with food or milk.
Fluid retention
Swollen ankles, feet, or a puffier face. A low-salt diet reduces this.
Serious but uncommon
Bone thinning (osteoporosis)
With prolonged use. Managed with calcium, vitamin D, exercise, and sometimes bone-protective medication.
Higher blood sugar
Can cause or worsen diabetes. Monitored with blood tests.
Cataracts and glaucoma
Long-term use raises eye risk. Regular eye exams are recommended.
Higher infection risk
Weakens immune defences and can mask early signs of infection.
Avascular necrosis
Very rarely, loss of blood supply to a bone (often the hip). Report new severe hip or groin pain.
!
Never stop prednisone on your own.

Your adrenal glands slow their own cortisol production while you take prednisone. Stopping abruptly can cause adrenal crisis: fatigue, weakness, low blood pressure, and potentially collapse. It must be tapered gradually under medical supervision.

Staying safe

Monitoring and precautions.

Regular monitoring
  • Blood sugar may be checked regularly, since prednisone can raise glucose.
  • Bone density (DEXA) may be ordered on long-term therapy, with a bone-protective medication if needed.
  • Blood pressure and weight are watched, since prednisone causes fluid retention.
  • Take calcium (1000 to 1200 mg/day) and vitamin D (1000 to 2000 IU/day) as directed to protect your bones.
Daily precautions
  • Take it in the morning to match your body’s natural cortisol rhythm and reduce sleep disruption.
  • Follow a low-sodium diet and choose whole, nutrient-dense foods to limit fluid retention and weight gain.
  • Avoid live vaccines. Flu and COVID vaccines are safe and recommended.
  • Carry a medical alert card stating you take corticosteroids, especially on long-term therapy.
  • Tell any surgeon or dentist you take prednisone, as stress dosing may be needed.
When to call your doctor

Contact the clinic if you notice:

Fever or signs of infection
Any fever, chills, persistent cough, or painful urination. Prednisone can mask infections, so they can be more serious than they appear.
New severe hip or groin pain
Sudden severe pain may signal avascular necrosis. Rare, but report it for urgent evaluation.
New blurry vision
Blurred vision, halos around lights, or eye pain may point to raised eye pressure or cataracts.
Significant mood or sleep changes
Severe insomnia, mood swings, agitation, or low mood that interferes with daily life.
Rapid swelling or weight gain
Swollen ankles or a gain of 5 or more pounds in a week may mean the dose needs adjusting.
Wanting to change or stop the dose
Never stop or reduce prednisone on your own. It must be tapered under medical supervision.

Pregnancy & breastfeeding

Prednisone can be used in pregnancy and breastfeeding when needed. Always tell your doctor if you are pregnant, planning pregnancy, or breastfeeding, so the dose can be adjusted and monitored more closely.

!

This guide is for education, not medical advice. Myositis treatment is individual, and many of these medications are used based on specialist experience and research rather than a single approval for myositis. Never start, stop, or change a medication without your own doctor. Your doses and choices are decided with your care team at the Centre.

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