Prednisone (Deltasone)
A powerful anti-inflammatory corticosteroid used for a huge range of conditions. Extremely effective short-term, but long-term use carries significant side effects. Never stop abruptly — always taper.
What it's used for
Asthma flares, COPD exacerbations, allergic reactions, rheumatoid arthritis, lupus, inflammatory bowel disease (Crohn's, ulcerative colitis), multiple sclerosis relapses, organ transplant rejection prevention, and many other inflammatory and autoimmune conditions.
Typical dosing (adults)
- Short burst (e.g., asthma flare): 40–60 mg daily for 5–7 days.
- Chronic conditions: 5–60 mg daily, with goal to taper to the lowest effective dose.
- Take with food to reduce stomach irritation. Morning dosing mimics natural cortisol rhythm.
- Important: If taken for more than 2–3 weeks, must be tapered gradually — do not stop suddenly.
Key interactions
- NSAIDs (ibuprofen, naproxen, aspirin): major — greatly increased risk of stomach ulcers and GI bleeding.
- Diabetes medications (insulin, metformin): moderate — prednisone raises blood sugar, may require dose adjustments.
- Warfarin: moderate — prednisone can increase or decrease warfarin's effect; close INR monitoring needed.
- Live vaccines (MMR, varicella, nasal flu): major — avoid while on immunosuppressive doses; risk of vaccine-strain infection.
- Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin): moderate — increased risk of tendon rupture.
- Potassium-lowering diuretics (HCTZ, furosemide): moderate — additive potassium loss.
Common side effects
Short-term: increased appetite, insomnia, mood swings (irritability, euphoria, anxiety), elevated blood sugar, fluid retention. Long-term: weight gain (moon face, buffalo hump), osteoporosis, thin skin and easy bruising, cataracts, high blood pressure, muscle weakness, increased infection risk, and adrenal suppression.
Who should be cautious
- Diabetes (blood sugar will likely rise).
- Osteoporosis (prednisone accelerates bone loss).
- Active infections (prednisone suppresses immune response).
- Peptic ulcer disease (increased bleeding risk).
- Mental health conditions (can worsen anxiety, depression, or trigger psychosis at high doses).
What to ask your pharmacist
- How should I taper off prednisone when my course is done?
- Should I take calcium and vitamin D to protect my bones?
- Can I take ibuprofen for pain while on prednisone?
- Will prednisone affect my blood sugar (I have diabetes)?
- Should I get a bone density scan if I'm on long-term steroids?