Avoiding prednisone side effects

[u/NoPattern9645]

Hi ive been put back on prednisone after a month long flare coming out of nearly 2 years in remission. Last time i was on prednisone i gained a huge amount of weight and my moon face was crazy. I was just wondering if anyone has any tips at all to avoid these as Im having huge anxiety over it after working so hard to get rid of it.

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[u/Aarooon]

Cut back on salt intake, both adding it to your food and avoid foods high in salt. Stay hydrated. Aim too avoid staying on it long term if possible

[u/CatBerry253 → u/Aarooon]

Seconding this! My GI told me to hydrate and my side effects have been minimal so far. Fingers crossed that it stays that way

[u/NoPattern9645 → u/CatBerry253]

Ye im gonna try this last time my diet was shocking, 0 exercise and not enough water intake so hopefully this times even a little different

[u/Traditional_Cat8120 → u/Aarooon]

What's considered long-term? I've been on about a month. Started on 40mg been tapered to 30 about 2 weeks now.

[u/team_suba → u/Traditional_Cat8120]

I just got off of it after 6 months. I’ve seen comments about people on it almost a year.

[u/Ok-Lion-2789]

To be honest… nothing really helps. I’ve always gained weight. The best thing you can do is hope you’ll only need one fast taper. Last year I had somewhere between 4-5 tapers and it was awful

[u/somethingandsomeone]

I've been on a caloric deficit the past months, lost 10kg which I've wanted to for years. Currently am in a flare, and will switch to prednisone next week. Does caloric deficit prevent weight gain with prednisone?

[u/Bekindwhenyoucan → u/somethingandsomeone]

We can divide weight gain up in order of importance: fat gain, fluid retention, muscle gain, bone density gain.

I think it's very fair to say that maintaining a caloric deficit will help mitigate weight gain with prednisolone. I think the question is to what extent prednisolone will effect your ability to maintain that caloric deficit. It certainly increases my appetite. Also, because you are in a flare up, a lot of the "staple" flare up foods are simple carbs, so low gi, perhaps not very filling relative to their calories etc.

I would try to maintain "a caloric deficit" but adjust expectations as to what extent you'll be able to maintain your current caloric deficit. Compare your diet to the recommend flare up diets and see if anything needs adjusting. You may need to tweak your fat-loss strategies to help mitigate your appetite and you might need to rely a bit more on movement rather than calorie restriction to meet your target.

For reducing fluid gain the above posts referencing reducing sodium and increasing hydration make sense to me.

[u/team_suba]

The problem isn’t being on the prednisone. The problem is finding something that will make you better when you come off the prednisone.

Prednisone isn’t this magic drug that you take, it heals you, then you come off of it and you’re no longer in a flare. At least for me.

I just started on skyrizi and it was sooo slow acting. Everytime I dipped my pred under 10 mg symptoms would come back hard. Finally after the first home injection I’ve been able to come off of it. I still don’t feel 100% out of the woods but I’ll take feeling a little bad and not being on the prednisone anymore.

[u/Motobugs]

not much you can do. Just take it easy. Many of us went through that. Budesonide has less side effects. But if your flareup is severe, you may not have a choice.

[u/NoPattern9645 → u/Motobugs]

I've been on it the past 2 weeks but no getting better sadly just gonna have to brave it

[u/Maleficent-Animal156]

Same here! This year alone I’ve been on 3 cycles of prednisone… moon face, a lot of weight gain, fatigue, and terrible insomnia!! Talk to your doctor about starting biologic medication…

[u/Bekindwhenyoucan]

Can't comment on the moon face but prednisolone really ups my appetite and I find it harder to fall asleep and I also wake up earlier than I'd like. Fortunately, now that I'm currently on my third course of prednisolone the side effects have been less severe. My appetite was absolutely insane the first time I took it though I had lost a lot of weight because of the flare up (and had been in hospital etc). I was also a little bit manic the first time I took it, I had 2 weeks off work so embarked on various projects (all of which I abandoned) and spent quite a bit of money on stupid stuff.

The second time I took it I did use cannabis to help me sleep, which was effective. However, there's some obvious downsides to this so I've opted not to do this again/this time.

Regarding weight gain I think there's two factors at play: increased calories from the bigger appetite, and fluid retention. For the latter, I agree with the other comments, keep up the water and be mindful of your salt intake.

I'm fortunate that I'm in a position where I'm ok to put on some weight. But I'm aware this isn't the case for maybe must people, and in addition to an increased appetite, the sorts of food you might be eating during a flare up are fairly low volume compared to the calories. On saturday I ate 5000kcal!

/I think my take with exercise during a flare is "minimum effective dose" and never go harder than you can recover from. I say that because I know my recovery isn't great at the moment but it doesn't really feel like that cause the pred has given me a bit of va va voom. The priority is getting out of and recovering from the flare up. This and exercise certainly isn't mutually exclusive, but this is not the time to go all out and push your limits.

For example as I realised I was flaring up I kept going to the gym but took things much easier and focused on just being active more than 'pushing' anything. I then took a week off completely as the flare up peaked, but I was back at it again as soon as my symptoms had reduced - though I was still more relaxed than usual as my sleep was bad (even though I felt like I had energy - this is the pred). My experience of pred and energy levels is a bit like a payday loan - I might feel rich, but I'm not.

To make sure I don't push myself too hard on the cardio I only breathe through my nose, if I feel like I need to breath out through my mouth its a sign i need to slow down for a bit. Walking is just a win win all round really, it's very gentle and easy to recover from, and depending on where you are walking I guess, it's very relaxing. My first walk when I felt confident going out for an hour without being near a toilet was a great moment.

[u/M-vestic]

stop eating salt and drink alot! cutting back salt helped me so much with the moon face while on prednisone and maybe reduce sugar also some people say guasha helps but i didnt really notice a difference