Finding a lupus medication that works can feel like a triumph. Prednisone, prednisolone, and other corticosteroids can be game-changers, significantly easing your symptoms and boosting your quality of life — but could those wins be lost if you build a tolerance to the drug?

It can be frustrating to find that you have to take higher and higher doses of these anti-inflammatory medications to achieve the same level of control. One MyLupusTeam member asked, “Can you build up a tolerance to prednisone? Sixty milligrams used to keep me stable, but now it takes 80 milligrams, and I am starting to get worse again even on that.”

In this article, we’ll discuss whether you can become tolerant to corticosteroids, also known as steroids. In addition, we’ll explore other reasons these drugs may not work for you.

Using Prednisone and Other Corticosteroids To Treat Lupus

Prednisone is a widely prescribed corticosteroid for people with lupus. Corticosteroids are drugs that are similar to the hormone cortisol, a chemical signal made by your adrenal glands. These two small glands sit above your kidneys. The drugs work by binding to certain receptors in cells, which helps calm the immune system and relieve symptoms of lupus. Prednisone is especially helpful for decreasing inflammation and symptoms during a flare.

While steroids can provide significant symptom relief and improve your quality of life, they are not without potential side effects. The side effects of steroids include:

• Weight gain
• Mood changes
• Bone loss
• Increased risk of infections
• High blood pressure

Long-term use or high doses of steroids may increase your risk of developing these side effects. The goal is to find the lowest dose of steroids that manages your symptoms while minimizing side effects. During your lupus journey, you’ll work closely with your health care providers to find the treatment option that works best for you.

Drug Tolerance and Resistance to Prednisone

When it comes to drugs like corticosteroids, it’s useful to understand the difference between tolerance and resistance. These terms describe how your body responds to drugs and why medications may become less effective over time.

Tolerance

Tolerance occurs when a drug works well at first, but its effectiveness decreases over time. To overcome tolerance, you may have to take more of the drug to see the same effect. This can happen due to various factors, such as changes in your body’s response or the presence of certain cells that are naturally less affected by the drug.

There’s little research published on whether you can build a tolerance to prednisone or other steroids, but the consensus is that it’s unlikely. Instead, there’s a greater chance that the level of inflammation in your body caused by lupus has risen, requiring a higher dose of steroids to bring the inflammation back down.

Resistance

Resistance means that cells or tissues don’t respond to a drug at all. This can happen if certain changes in your genes or how they work make your cells less responsive to the drug. You may have been born with these genetic changes, or you might develop a mutation that makes you less sensitive to steroids.

About 30 percent of people with systemic lupus erythematosus (SLE), the most common type of lupus, are thought to be resistant to corticosteroids. Researchers have reported that the inflammation caused by inflammatory conditions like lupus and rheumatoid arthritis may interfere with how steroids work. Rather than developing resistance, however, you’re more likely to be less sensitive to steroids at the start of therapy because of changes in your DNA (hereditary material). Scientists are continuing to develop ways to test for and treat corticosteroid resistance in people with lupus.

You Can Become Dependent on Steroids

Taking steroid medications, even at a low dose, for a long time can lead to dependence. With long-term steroid use, your adrenal glands can begin to make less cortisol or even stop working. This dependence can make it harder for your body to function normally without the drug, causing you to experience withdrawal symptoms after you stop taking it. Symptoms of steroid withdrawal include:

• Fatigue
• Weakness
• Weight loss
• Low blood pressure

The potential to become dependent on steroids makes it very important that you don’t simply stop taking them. Instead, your doctor will have you slowly lower your dose over a long period of time in a process called tapering.

Avoiding Corticosteroid Dependence

To reduce the risk of becoming dependent on steroids, your doctor will work with you to find a balance between managing your lupus symptoms and minimizing the effects of long-term treatment. This may involve taking only short-term steroids for lupus flares or exploring other options that can reduce the need for steroids. Lifestyle changes such as managing stress, staying active, and eating a balanced diet can also support your overall health and might decrease the need for high doses of steroids.

It’s essential to work closely with your health care providers to create a treatment plan tailored to your situation. Regular checkups and open communication with your doctor are important to determine if you still need corticosteroids, manage any side effects, and explore alternative treatments.

Everyone’s experience with lupus is different, and finding the right treatment for you might take some time and experimentation. By educating yourself about lupus, speaking up for your needs, and connecting with others who are going through similar experiences, you can better manage the challenges of living with lupus.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you take prednisone or glucocorticoids to treat your lupus symptoms? Have you needed to increase your dosage to get the same benefits? Share your experience in the comments below, or start a conversation by posting on your Activities page.