Do you have systemic lupus erythematosus (SLE) and take prednisone? Almost 27,000 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. It’s used to mimic a hormone called cortisol that your body makes naturally in your adrenal glands. It’s a corticosteroid (a glucocorticoid), often called a steroid. Prednisone is available as a tablet or liquid you take by mouth.

Prednisone is commonly prescribed to treat and prevent lupus flares. People with SLE can have inflammation and pain in any part of their body, caused by an overactive immune system. Prednisone’s anti-inflammatory and immunosuppressive effects can help relieve lupus symptoms quickly and 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
• Methylprednisolone
• Dexamethasone
• Hydrocortisone

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. This is because prednisolone does not need to be activated by your liver.

A MyLupusTeam member commented, “I have taken a methylprednisolone 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 milligrams of prednisone is equivalent to 4 milligrams of methylprednisolone, 0.75 milligrams of dexamethasone, or 20 milligrams of hydrocortisone.

Low-Dose Prednisone

A low dose of prednisone is usually 5 milligrams or less per day. In the past, doctors said that anything up to 7.5 milligrams was a low dose, but newer guidelines recommend aiming for 5 milligrams or less to lower the risk of serious side effects.

Some people with lupus take a low dose of prednisone for a long time to help prevent flares. However, specialists now suggest reducing the dose as soon as it’s safe to do so — and even stopping prednisone completely if possible. This helps protect your bones, heart, eyes, and other organs from long-term damage.

Medium-Dose Prednisone

Doses between 7.5 milligrams and 30 milligrams are usually considered 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, with fewer side effects. The length of time you stay on a medium dose of prednisone can vary, but it might be a few weeks to several months.

High-Dose Prednisone

Prednisone doses over 30 milligrams 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 dose of prednisone for a few days, weeks, or months before decreasing your dose.

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

When you stop taking medium or high doses of prednisone, you will likely need to taper (decrease your dose gradually) before you stop taking it. When you take higher doses of prednisone for a long time, your body can stop making cortisol, its own natural hormone. Tapering your prednisone dose slowly over time gives your body time to start making its own cortisol again.

How Prednisone Dose Impacts 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 improve when you stop taking it. These side effects can include:

• Headaches
• 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 — From hypertension (increased blood pressure) and high 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 milligrams of prednisone (or a total of 540 milligrams per month). They also found that people taking an average daily dose of 6 milligrams of prednisone or less (or a total of 180 milligrams per month) had a far lower 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.

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.

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On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

Have you taken prednisone for lupus? Let others know about your experience in the comments below.