Do you have systemic lupus erythematosus (SLE), and have you taken prednisone (Deltasone)? More than 25,000 MyLupusTeam members have indicated that they’ve taken prednisone at some point in their treatment. Your rheumatologist might have referred to your prednisone dose as high-dose or low-dose treatment, but what exactly does that mean?

What Is Prednisone?

Prednisone is a synthetic (laboratory-made) drug made to mimic cortisol, a hormone your body makes naturally in your adrenal gland. Prednisone is part of a group of medications called corticosteroids, also referred to as a glucocorticoid or simply a steroid. It’s available as a tablet or liquid you take by mouth.

Prednisone is commonly prescribed to treat and prevent lupus flares. People with lupus can have inflammation and pain in any part of their body, caused by an overactive immune system. Prednisone’s anti-inflammatory and immunosuppressive activity can help relieve lupus symptoms quickly and help prevent them from coming back.

Equivalent Steroids

Prednisone is the most commonly used steroid for lupus, but your doctor may prescribe a different type of steroid, such as:

• Prednisolone (Orapred)
• Methylprednisolone (Medrol)
• Dexamethasone (Decadron)
• Hydrocortisone (Cortef)

Your rheumatologist may choose a different type of steroid based on availability and your health conditions. If you have liver problems, your doctor may prescribe prednisolone instead of prednisone because prednisolone does not need to be activated by your liver.

A MyLupusTeam member commented, “I have taken a Medrol dose pack many times. It’s 4- milligram pills of methylprednisolone, but now I’ve been on prednisone 20 milligrams, and I don’t have a frame of reference, so I was wondering if 20 milligrams is considered a high dose or not.”

The differences in doses between steroids are due to differences in their potency. A steroid’s potency refers to the amount of drug — how many milligrams (mg) — needed to produce the same effect.

If you use a steroid other than prednisone, your dose may be converted into an equivalent dose of prednisone. For example, 5 mg of prednisone is equal to 4 mg of methylprednisolone, 0.75 mg of dexamethasone, or 20 mg of hydrocortisone.

Low-Dose Prednisone

A dose of 7.5 mg of prednisone or less per day is typically considered a low dose.

Low-dose prednisone might be taken long term (months to years) to help prevent lupus relapses (flare-ups). Although recent research suggests that long-term use of low-dose prednisone may result in fewer relapses and lower disease activity than stopping prednisone, most lupus guidelines recommend stopping steroids as soon as possible.

Medium-Dose Prednisone

Doses between 7.5 mg and 30 mg are usually considered to be a medium dose of prednisone. You might take a medium dose of prednisone to help control a lupus flare while preventing more severe steroid side effects.

Clinical studies have found that treating a lupus flare with a low to medium dose works at least as well as taking high doses of steroids — but with fewer side effects. The length of time you stay on a medium dose of prednisone can vary but might be a few weeks to several months.

High-Dose Prednisone

Prednisone doses over 30 mg are considered a high dose. High-dose steroids can be used to reduce symptoms of a lupus flare. Depending on your symptoms, you may take a high prednisone dose for a few days, weeks, or months before decreasing your dose.

If you are in the hospital, you might receive a methylprednisolone pulse dose — very high doses (up to 1,000 mg) of methylprednisolone intravenously (directly into your vein) for up to three days before starting prednisone. The use of methylprednisolone pulses may allow you to take a lower dose of oral prednisone.

If you take medium or high doses of prednisone and are planning to stop, you’ll likely have to decrease your dose gradually — known as tapering. When you take higher doses of prednisone for a long time, your body can stop making its own natural hormone — cortisol. Tapering your prednisone dose slowly over time gives your body time to start making its own cortisol again.

How Prednisone Dose Affects Your Side Effects

While prednisone can help improve your lupus symptoms, some people experience bothersome side effects. Like many medications, prednisone’s side effects are typically worse at higher doses.

A MyLupusTeam member asked, “Does anyone else have trouble sleeping when taking high doses of prednisone? I feel like I’m pregnant all over again. Hungry, mood swings … such a love/hate relationship.”

You might feel some of prednisone’s side effects as soon as you start taking it or shortly after, but they usually get better when you stop taking it. These side effects can include:

• Headaches
• Increased appetite
• Weight gain
• Mood changes
• Acne
• Changes in the way fat is distributed in your body (such as moon face)
• Increased sweating
• Insomnia (difficulty falling or staying asleep)
• Increased hair growth
• Increased blood sugar

Taking higher doses can also increase your risk of more serious side effects that can result from prednisone damaging different organs in your body. Examples of organ damage that can result from prednisone use include:

• Bone damage — Causing osteoporosis (weak bones)
• Heart damage — Caused by hypertension (increased blood pressure) and cholesterol
• Eye damage — Causing cataracts (cloudy areas in the lens of your eye)

One study found that compared to people not taking prednisone, the risk of organ damage was doubled in people taking an average daily dose of 18 mg of prednisone (or a total of 540 mg per month). They also found that people taking an average daily dose of 6 mg of prednisone or less (or a total of 180 mg per month) had a small or nonexistent risk of organ damage.

Higher doses of prednisone can also increase your risk of infections. One study from the journal Lupus found that medium to high doses of prednisone were associated with a higher risk of infection in people newly diagnosed with lupus.

Factors That Affect Your Prednisone Dose

The dose of prednisone that your rheumatologist recommends depends on the severity of your symptoms and the other medications you take. In general, more severe symptoms are treated with higher doses of prednisone.

Taking other medications for lupus may allow you to take a lower dose of prednisone for a shorter amount of time. This can help you avoid some of prednisone’s serious side effects. Examples of lupus treatments that may be used in addition to prednisone include:

• Azathioprine (Imuran)
• Belimumab (Benlysta)
• Cyclophosphamide (Cytoxan)
• Hydroxychloroquine (Plaquenil)
• Methotrexate (Rheumatrex)
• Mycophenolate (CellCept)
• Rituximab (Rituxan)

Talk to your rheumatologist about the risks and benefits of your current prednisone dose. They can provide valuable information to help you make informed choices about your treatment. Your rheumatologist is there to support you and ensure your prednisone therapy is optimized for your overall health.

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.

Have you taken prednisone for lupus? What was your dosage? Share your experience in the comments below, or start a conversation by posting on your Activities page.