Coping with Prednisone
Last updated: October 2021
With a diagnosis of myasthenia gravis comes medication. The most common treatment is Mestinon (pyridostigmine).
This drug targets the defect in communication at the junction of the nerve and muscle that is common to all forms of MG. In a large number of cases, treatment with prednisone begins at the same time.1
Many people have already taken prednisone at some time. It is classed as a corticosteroid (different than the anabolic steroids often used by bodybuilders.) It might have been prescribed for short periods to treat an insect bite, a hives reaction, or a sinus infection.2
How is it used?
In those cases "it works by reducing swelling and redness and by changing the way the immune system works." Its anti-inflammatory power helps tissues heal and slows out-of-control allergic reactions. An initial high dose is usually "stepped down" quickly in a very regimented way.2
The use of prednisone for myasthenia gravis is different. Physicians often prescribe increasing doses for long periods of time, only beginning the step-down process after weeks or months.2
Over time, the side effects of the drug become more evident and more significant to daily life. Two of those most often mentioned by those on long-term prednisone treatments are weight gain and mood swings.2
The weight gain from prednisone isn’t imaginary. It comes on in 2 ways, water retention and changing how your body deposits fat.
Prednisone causes cells to retain water more easily. Cell membranes maintain a delicate balance between the inside and outside environment.3,4
Prednisone upsets that balance. More "water weight" can stress your heart and raise your blood pressure. These are things you’ll want to monitor throughout treatment.3,4
Minimizing water retention
There are ways to minimize this water retention. Many people find that carefully limiting salt in the diet can minimize this side effect, even though that’s not fool-proof.3
Try to limit your salt to 2000 milligrams or less a day, remembering that it isn’t just what you add but what’s in the food you eat in prepared soups and frozen dinners.3
Increasing your potassium intake can also help to counterbalance the sodium. Foods like baked potatoes, bananas, tomatoes, and orange juice are high in potassium.3
Prednisone also changes the way that your body deposits fat. Fat cells — especially around the face, back of the neck, and abdomen—are targeted. Moving from "simple" carbohydrates like sugars to more complex forms like fruit or vegetables can help some.3,4
Whole grains are better than refined white flour. Prednisone can also raise your blood sugar, so moving to those more complex carb has a double benefit.3,4
One long-term effect of prednisone is often hidden. The drug can interfere with your body’s ability to maintain strong bones (calcium metabolism) and result in osteopenia.3,4
The high-quality snacks you’ve socked away (like those vegetables above) can minimize that problem too. And listen carefully if your medical team suggests a bone scan.3,4
Managing increased apetite
There’s a feedback loop from prednisone that can be a real trap. The change in water balance in your system can cause behavioral changes like sleeplessness and impulsivity.2
The drug increases appetite in many. Prednisone can interfere with sleep. If you are jumpy and sleepless that’s often a sure path to snacking!2
Knowledge is power — especially with prednisone. You know you might crave snacks, so plan ahead and have low-calorie, complex carb snacks handy.
A half-cup of cherry tomatoes may not seem as appealing as a chocolate bar, but if one is at hand and the other at the store down the block, you’ll have time to make a better decision.
Finally, drink a lot of water. It may seem odd but more water does not increase the fluid content of your cells. It reduces the sodium content and the water weight, while it pumps your metabolism to burn more calories.5
Tracking your diet
Realizing that your sleep might be affected by prednisone, make a plan. Establish a clear schedule in the evening. The rigid schedule for taking Mestinon can actually help; plan both your day and your diet around it.
It’s easy to get complacent and lose control. Keep a journal. Record what you eat, how much you move, how well you sleep, and any impulsive behaviors that don’t seem right for you. Being conscious of prednisone’s effects on your body can be the first step to avoiding them.
An effective treatment
Despite all these potential side effects, prednisone is recommended because it is often quick and effective as a treatment for the autoimmune havoc caused by MG.
Your neurologists may gradually replace it with drugs that work more slowly but have fewer side effects. In the interim, understanding and caution can make the drug really valuable.
How often do you experience MG exacerbations/flares?