Prednisone: will a short course make me puffy & fat?

Factual Questions
1

I went to the dermatologist today for my eczema-cracked hands. It’s gotten so painful that I can barely type or open a bottle or put my hands in my pockets. (I’ve tried those new non-steroid ointments with no improvement.)

Along with a script for the strongest topical corticosteroid available (halobetasol) and oral antibiotics for infection, he wants me to do a short course on prednisone and taper off right away. The script is for 50 mg/day for four days, then down to 25 mg/day for four days, and finally 25 mg every two days for ten days.

Now, oral steroids are the last resort big guns when it comes to dermatitis, but I’m fed up with the cracking and inflammation and pain, so I’m willing to try it. However, I’m reading on the web that prednisone has a billion nasty side-effects, including excessive thirst, frequent urination, bloating, facial puffiness, and sudden weight gain. And this, even from short term use.

It’s the puffiness and weight gain I’m concerned about. If I start this stuff Saturday, will I go back to work Monday with a big pink moon face? After two days on the stuff?

2

Probably. But the good news is, it goes away just as fast as it comes on.

However, appearance isn’t the biggest problem. IME, when I’ve had to take oral steroids, I’ve had really bad problems with mood swings and general bitchiness. So behavioral changes are common, too.

Robin

3

I would think that significant weight gain would only result from long-term use of the drug, and that after several days even any side effects would be slight.

I took a similar course for a severe case of poison oak. I did suffer from side effects, notably euphoria/mood swings. This was only on the first day or two, however; this is what makes me think that by the time it tapers off you won’t have any noticeable effects.

Disclaimer : I’m not a doctor nor a pharmacist. I’m only guessing and relating a personal anecdote about a short-course usage of Prednisone. I’m not Panamanian, either.

4

That’s the thing - the stuff works fast, which is great for relieving whatever it’s been prescribed for, but apparently the side-effects come on quickly as well.

5

I took a 5 day dose pack (5 pills, then 4, 3, 2, 1) and they followed that up with 4 more days (2, 2, 1, 1) and I wasn’t any puffier or redder than usual…that I noticed. Since it was for a nasty contact dermatitis, though, I was already puffy, red, itchy, and miserable in some places, so I may not have noticed.

6

Now it’s turning into a psycho killer queen that’s worrying me. I’m agitated enough as it is.

7

I’ve taken prednisone twice…

Once for 9 months and once for three months combined with cytoxan.

I did gain a lot of weight the first time but not the second. I felt the mood swings were the worst part of the whole endeavor personally.

I was taking 200 mg a day though…

Just be more aware of what you put into your body and you shouldn’t be too bad off. Drink plenty of fluid to help with the puffiness and don’t give into the hungry horrors! Good luck!

8

I know I shouldn’t, I know I shouldn’t, I know I shouldn’t

But really, how will the rest of us tell?
(I do hope you feel better soon, non-specific dermatitis seems to be Dermatologist for “Fuck if I know” and that’s not very helpful. BTW, have you seen an allergist lately? Might be worth seeing one that’s thorough and patient.)

9

No. Prednisone does not commonly cause these symptoms if taken for less than two weeks in a patient who hasn’t had it before.

Dr_P MD

10

I can’t comment on you specifically of course, and I can’t and won’t give medical advice over the net, but for that dosing regimen and duration, most people would not experience obvious cosmetic (side)effects.

There are, indeed, many potential side effects from prednisone use. Most come from doses much higher, and treatment durations much longer, than you’ve described. In fact, for ten of the eighteen days of your proposed therapy, the dose you’d be taking is quite modest (averaging 12.5 mg daily).

Acute side effects of prednisone, as mentioned here already, include effects on mood (up or down or both) and appetite (increased). In addition blood pressure can go up early, and diabetes precipitated or worsened. Yeast infections can occur fairly soon after starting treatment. Acne can be an early skin manifestation.

With longer term use, you get into moon faces, “buffalo humps”, thin and bruised skin, rotten bones, serious infections, glaucoma, cataracts, hip problems, etc, etc.

Bottom line: The prednisone regimen you’ve listed has been well tolerated by essentially everyone I’ve used it on except for the mood changes (and worsened sugar levels in diabetics)

11

That I can’t help you with, as I definitely got some psycho effects from it. Though I stayed ruggedly manly the whole time…right? RIGHT?!

12

You’re joking about turning into a psycho killer queen, but that’s practically what happened to my mother (except for the killer part). Seriously.

A couple of years ago my mother, then in her late sixties, was given prednisone by the local hospital emergency room for some minor complaint. I forget what it was, and I don’t know the dose, but I’m sure it was only a single application, not a long course.

Within a day she became psychotic. At first she was only a little loopier than normal, but a few hours later she was manic, delusionary, wandering around outside (leaving her 90-year-old mother, then living with her, unattended) accosting strangers with wild stories and generally behaving like a crazy person.

I am not making this up.

We took her back to the emergency room, but they had no advice for what to do, other than just let it wear off. We kept an eye on her for the next several hours, tried to get her to sleep, or at least stay in her bedroom, and by the next morning she seemed to be more or less normal. So I left her (and my grandmother) and went home. But a few hours later she was as crazy as ever. I got a call that she had interrupted a meeting at her church with incomprehensible ranting.

It is now 48 hours since she took the prednisone, and she’s behaving as bizarrely as ever. She’s barely controllable, although fortunately for us, she’s a happy and pleasant psychotic, not violent or angry. Nevertheless, we are all naturally scared and very worried. It seems clear that the prednisone has caused it, but no one has any idea when, or even if, it will wear off.

Back to the emergency room and their only solution is to transfer her to a nearby psychiatric hospital. She stays there for about two weeks, during which she gradually comes down and begins to understand that this was a drug-induced psychotic incident, not some marvelous higher reality she’s discovered. Within a month she was essentially back to normal, and she’s been fine ever since.

The whole incident was easily the most traumatic thing that’s happened to my family in many years. So you can see why I don’t have pleasant associations with prednisone.

Obviously, this kind of experience is highly unusual, but steroids can have strange and unpredictable side effects.

13

Hi

I have taken a lot of prednisone in my life, and only gained weight and had the wacky face on the times I have had to have it for months (highest dose, 50mg/day then stepping down; and let me say EEEEK for that 200mg note, above!).

You’ll be fine.

14

I didn’t go bonkers, like commasense is talking about, but I did get pretty wired when I took my first dose.

15

Have taken Prednisone for eczema-cracked hands a couple times. I never noticed any side effects. Or any front effects, either. Didn’t really do squat for me. So I requested and got a cortisone shot. Worked great, also no side effects.

If it comes up again, ask your doc about a shot.

I found that Eucerin Original Moisturizing Cream works wonders, and is over the counter.

I offer you my sincerest best wishes…the annoyance factor can be brutal.

16

I know of a lady that was put on Prednisone at some moderate dose. After a week or two, the Virgin Mary appeared to her and adjusted her daily dose to a higher level. Mary came back several times, increasing the dose each time. Then the prescription ran out, and the pharmacy wouldn’t refill it, and then the doctor wouldn’t refill it, at least not the way she wanted, and the whole trip came grinding to a halt.

Apparently the Virgin Mary didn’t call in a script like she was supposed to…

17

I’ve had to take prednisone on 3 seperate occassions over the last 20 years for multiple sclerosis exacerbations. It has been a while since my last attack so I don’t remember the exact dosage.
Anyway, I was on prednisone for about a month (including the ‘taper’) for each of those episodes. It sure as heck makes you hungry and I’d say I was “manic” but not to any psychotic degree - just wanting to do lots of things.
In my case, the puffiness was not very bad and I was on it for a longer period and higher dosage than what has been prescribed for you.
I wouldn’t worry about your situation especially if the skin condition is severe. You’ll find the benefits of prednisone will outweigh any disadvantages. Heck, I’d take prednisone over dealing with multiple sclerosis any day.

18

Good question. But seriously, I do have a really nasty anxiety disorder, one that SSRIs do nothing for, so I have no choice but to take BZDs. That’s why I’m worried about the psych effects of the prednisone: I’ll be adding it to an already hyper-anxious brain. (No, really, it’s bad enough that they wanted me to try a low dose of anti-psychotics, which I refused because of the risk of tardive dyskinesia.)

When I first saw this dermatologist in August, he did give me a referral to an allergist but I never followed through. He brought it up again yesterday and said that I should go and make an appointment anyway even if I change my mind later, since it’ll take two to three months before I’ll get in. So he is a good derm in that way. Very thorough; even took scrapings off my feet.

Back to prednisone, usually the whole “potential side-effects” thing doesn’t bother me, and I’ll take anything, but like I said, I hear that oral steroids work fast, and as a consequence their side-effects also come on quickly. But the replies to this thread have been reassuring.

Interestingly, after posting this last night, I went and did something else the doctor suggested, which was to soak my hands in lukewarm salt water (1 tsp. per liter); following this I put on ointment and protectant cream. As a result, my hands are much better this morning, and the cracks look like they’re starting to heal. Never underestimate home remedies, I guess. :slight_smile:

19

Oh yeah, the super-hunger and weight gain: can I get more info on this? I gain and lose weight very quickly and easily, and I’m incredibly vain and obsessed with my body image. Should I be worried? Is it a hunger for sweets, or just to be full, or what?

I know what the pharmaceutical (i.e. non-pot) munchies are like because I take trazodone at night (otherwise I thrash about), and if I don’t fall asleep fast enough, then I suddenly want to eat everything in the kitchen, and usually do.

I can increase my cardio time, and that might help me if I go psycho, but… I hate cardio. Ugh.

20

I was on Prednisone for 5 - 6 months back in 1991. I ballooned up like crazy, but the worst side effect didn’t become apparent for many years. Apparently cortisone based drugs, in some cases, can reduce normal blow flow to the joints. After 13 years, significant portions of both my knees are dead, which pretty much sucks.

On the other hand, I don’t think a very limited Prednisone course will have this kind of effect. You might want to check with your doctor, though.