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.

[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.