Tell me some things about oral Prednisone

I’ve got a killer case of acute bronchitis, coughing my kishkes out for the last 10 days or so. Went to ER Sunday evening to Monday morning. They gave me 5 days of oral Prednisone pills (among other meds) to take home with me.

Can someone tell me any words of wisdom about Oral Prednisone that you think I ought to know. I’ve often seen in mentioned, over the years, in various cautionary ways, but never paid much attention. Are there any special rules or cautions about how to discontinue it when I’m done? I think I’ve read of special rules for switching to/from one kind of corticosteroid to another, or between oral and inhaled, or something of the sort.

Does it cause rebound problems when I’m done? I’d hate if that happens, to start coughing again like I was last week or even worse. It was that bad.

Are there other cautions or useful knowledge any Dopers (heh) have for me about Prednisone. I’ve never used it before, and I’m habitually phobic about all kinds of drugs, as general rule. Or, if anyone can share any links to earlier threads or other useful web pages? I’m going to start doing some googlizing when I’m sufficiently alert and sentient again (but that could be a while). Any getting-started pointers? My attention these days if pretty much fully occupied just trying to breathe, and that’s an exhausting challenge enough just now.

I was on oral Prednisone for awhile to treat some acute colitis. The good news is, it totally put the colitis into remission. The bad news is, it made me gain thirty pounds and gave me a case of not-insignificant bone density loss.

Also, you can’t stop Prednisone cold turkey. You need to taper off. Which can take weeks, depending on your starting dose.

Other than all that, it is a miracle drug. Good luck!


Just 5 days is nothing to worry about, and you don’t have to taper when it’s just for a few days.

I was very recently on a 5 day Rx for prednisone, 40mg once a day, after I was discharged from the hospital on the 7th. I was on a different, injected, steroid while I was in the hospital (started with a D, but don’t remember the name) which was given for two days prior to discharge and the switch to prednisone to take at home. No problems, no tapering, just five days and done.

Unless you have been instructed otherwise, take it in the morning. That’s when your levels of cortisol - your endogenous prednisone equivalent - naturally peak anyway, so it screws with your metabolism less that way. This also helps if you are the type who gets insomnia from pred.

You shouldn’t have rebound coughing worse than before, but if there’s still something causing inflammation - like a persistent infection or an allergen that is still present - then going off will cause your cough to come back. Call your doctor if that happens. In theory, 5 days of prednisone shouldn’t cause symptoms of secondary Addison’s disease/hypoadrenocorticism - which is when your cortisol production is shut down by the prednisone and fails to come back when you stop taking it - but some studies have shown that people are variable in how their bodies react to short courses of steroids. Nevertheless, it is standard for short courses of prednisone to not worry about tapering the dose, and if the prescribing doc were worried, they would have put instructions for tapering on the prescription. Even if you do have mild withdrawal effects, tiredness is the most common one and it will most likely get better in a few days, but call your doc if you feel weird after coming off the prednisone.

IANAD, just a vet student and veteran of multiple short courses of steroids for asthma, bronchitis, pneumonia, poison oak, and, most recently, smoke inhalation.

Thanks for the tips, guys.

How long were you on it, to cause that weight gain and bone loss? Does it start in just 5 days, or even 10 days? Is the bone density loss reversible after you stop? I already have some degree of osteoporosis, so maybe I need to worry about that? I am coughing with intermittent rib-cracking violence, so I guess I should be happy if I get through this with any intact bones left at all.

Sorry, I can’t view the link on this mochine. It’s an old box, not set up for doing media. ETA: But I see the introductory comment below the video box refers to prednisone as “dreaded.” Why is that?

Thanks for the reassurace. I’ve never used this before, and like I said, I’m generally phobic about all the toxic potions doctors stick into people, and about doctors in general. Actually, I’m just phobic about being sick mainly, especially as I live alone and don’t really know anybody around here. I’m on 50 mg, once a day in the AM for 5 days.

Interesting remark. I’ve been noticing that I cough least in the morning hours, and it gets worse as the day goes on. Now I wonder if this is why. OTOH, my waking/sleeping schedule is totally enscrambled now, and I’ve been seriously insomniac for over a week because I’m coughing too much to sleep. I am sitting in front of my computer almost continuously 24/7 with a pillow on the desk – alternately reading a few SDMB posts then putting my head down in the hope of catching a few micro-winks, day and night. And when I DO get some sleep, I can’t even tell the difference because what do you think I dream? Plain-text SDMB post dreams, that’s what, although with mangled or delerious posts that I can never quite read or make out. Did you ever dream in plain text? It’s weird.

It’s scary to be like this, especially in a holiday week when I never know if I could get in touch with my regular doctor. And the 5-day Rx plays out this coming Saturday, too. The prescribing doc was the ER doc, not my regular doc, so my regular doc doesn’t know anything about this case yet.

Thanks again, all three of you, and anyone else who has anything helpful to add. Let me know if there’s anything more you can say. I’ll be watching this space on-and-off all day. It’s just past midnight here, and time for me to go suck albuterol for 20 minutes, then spend the night micro-winking as best I can alternating with reading SDMB I suppose. I can’t just keep my head down on the pillow all night because I’ll just get the world’s worst stiff neck from that. I should be googling all I can about it, but my brain is just too non-functional with all that sleep loss lately.

Another question:

The blurb that comes with the prednisone says, in the “Drug Interactions” section, that it shouldn’t be used with NSAIDS. Of course, I’ve been eating Ibuprofen like they were M&M’s (for years, due mainly to back and joint problems) and now due to this as well.

The blurb implies that this could lead to bruising/bleeding problems, which doesn’t sound too dangerous as long as I live carefully and quietly for a few days. (Aside from all that rib-splitting coughing, I guess.) Anybody know how serious a problem it might be to take Ibuprofen along with prednisone?

The tapering rule only goes into effect if you’ve taken it for just over a week. The 5-day dose is very specifically chosen to avoid that.

I’d watch out for increased appetite and (mild to severe) mood swings, really, and otherwise read the pharmacy’s notes that came with the bottle. Increased bone density loss is really only an issue with chronic use; some people have to be on prednisone for years, and that’s when you start getting scans to make sure your bones are still OK.

(IANAD/N; I worked on a couple studies where people were on prednisone for months or years. Call your pharmacist or doctor if you’re not sure.)

Howdy, just checking in.

I’ve used both extended (for a month+) and the 5 day prednisone regimens. The good news, as noted, is that it is a very powerful drug and it will do the job quickly. You seem to be suffering a great deal of inflammation and inflammation is something prednisone deals with promptly. If your joint/back pain is inflammation related it might well alleviate that as well.

Your 5 day dose is nothing going to cause excessive weight gain and/or rot your bones, it’s not a long enough course of treatment to do that. You might put on a pound or two, mostly fluid weight, but it should come off again next week.

Remember, a lot of the more serious side effects come from long term use. You’ll only be on it 5 days.

You WILL feel more hungry and thirsty. Drink water (you should, anyway) and either don’t worry about eating more for a few days, or nibble on something low-calorie and crunchy to help with that. (Crackers, pretzels, carrot sticks, in-shell sunflower seeds or peanuts, and so forth)

Everyone I’ve ever known who has used prednisone has gotten more moody while on it. In some people it can get extreme. It is, I assure you, temporary.

If you’re as sick as you say, it should help reduce the coughing and let you get some sleep. I also assume you’re not eating all that well right now so that side effect might even have some benefits.

Yeah, as an asthma sufferer, been on it several times. When I was really skinny, the mood disorder side effects were a lot worse. Finally some good coming from the middle age spread.

Long story short, if you are sitting on your bed sobbing hysterically, try to remember it’s just the drugs. Then again, you may be totally fine. :slight_smile:

Prednisone is exactly what I’d want if I had this type of illness. It does the trick and with none of the side affects of long term use. At least that’s how it has been for me the few times my Dr. has prescribed it to me.

I hope you feel better soon. What a terrible time of year to be so ill.

I’ve had short courses several times for asthma or bronchitis, and for me it was a wonder drug. The coughing stopped almost immediately and my worst side effect was a case of the munchies.

I was on prednisone for a few days last year for a sinus/ear infection. I’d been warned about the moodiness/irritability, but instead I felt unusually good and experienced frequent, teenager-esque inappropriate boners. I guess mileage varies.

I was on it for a few months. I agree with the others - if you do five days and out, you shouldn’t have the same problem.

Don’t worry about the link. It was just a goofy song about the drug. Sorry; I usually try to provide a short description if I post a link so people know what they’re getting in to (or missing).

Good luck! I hope you’re in good shape toot pronto.

It shouldn’t be taken with OTC NSAIDs without a doctor’s knowledge, because they can disguise other inflammatory processes, plus both drugs can be really hard on the stomach.

As for 5-day use, don’t worry about osteoporosis or tapering. Any weight gain will probably be from fluid retention, and you’ll lose it when you stop taking it. Take it with breakfast, because it’s most effective when taken first thing in the morning.

Yep, what they said. Used short term, it really is a miracle drug without a huge amount of risk.

It may make your blood sugars high, so if you’re a sugar tester, don’t freak out. Pay attention to how you feel more than the number on the glucometer.

And just to reiterate - even on short term courses - Prednisone can make you moody. Some people it makes angry, even violent, and some it makes really weepy. Remind yourself it’s the meds, not you, and better angry than not able to breathe. Find a pillow to punch if you need to.

While “moodiness” is usually interpreted to mean negative emotions, anger, irritability, and depression, “happiness” and “horniness” are also moods.

When I get on the prednisone roller coaster I get highs as well as lows. Outrageous, inappropriate feelings of well being and/or invulnerability as well as sobbing and anger.

5 days is nothing. You shouldn’t suffer any ill effects, there is no problem stopping it when the course is over. I’ve done 5 days many times for sinus infections and weird rashes. You’ll be fine. Drink lots of water to help with the bronchitis.

Long term use of Prednisone is a different story.

Thanks everybody for your comments. It’s 11:15 a.m. and I’m about to take Dose #3. (1st dose Monday morn by IV in the ER; 2nd dose at home yesterday.)

Am I supposed to expect this near-miraculous coughing relief, like, immediately from this? Or gradually over the 5-day course? I’m already coughing much less often, but still pretty violently when I do. Still, that’s an improvement. Strangely, I’ve lost my voice and can’t talk, although that particular problem didn’t happen last week before I started treatment, and my lower chest is getting really sore and crampy from all the exertion.

I’ll respond more to some of your comments later, if I can get a little sleep first. I’m terribly sleep-challenged due to the coughing, and thus rather mentally dysfunctional for this past week. I’m been cat-napping as best I can (which hasn’t been very good) 24/7 all this time, alternately trying to catch a few micro-winks and reading SDMB messages. I can’t lie down because I start coughing again every time I try (is that a normal or common thing with bronchitis, or just me?), so I have to sleep as best I can sitting up with my head down on the desk. It’s not very comfortable.

Does anything magically bad happen just after 5 days? I got my first dose in the ER on Monday morning, with 5 pills to take home for Tuesday through Saturday, for a total of 6 doses. Do the rules suddenly change in that case?

You wouldn’t want a dose high enough to be truly miraculous - like most courses of drugs, it’s a dance between “high enough to be effective” and “low enough not to cause major problems”.

Healing still requires some time to occur. Prednisone doesn’t help directly with the cough, it helps with inflammation that is presumably causing the cough.

No, it’s not just you. I find when I get that bad that sleeping in a recliner, so I’m leaning back but still significantly upright, is most comfortable for me although “comfort” under such circumstances is a relative term.

My sympathies on your condition. It certainly sounds miserable. Get better soon.