Understanding prednisone 20 mg

In this article:

• Prednisone 20 mg uses
• How long can you take 20 mg of prednisone?
• How to take prednisone
• Prednisone vs. prednisolone

In this article

• Prednisone 20 mg uses
• How long can you take 20 mg of prednisone?
• How to take prednisone
• Prednisone vs. prednisolone

Prednisone is a prescription drug in the corticosteroid drug class. While it can’t be bought over the counter, a healthcare provider can prescribe it. Prednisone treats inflammation, autoimmune diseases, and various other conditions. Patients may also take a brand-name version, such as Deltasone, Predone, Sterapred, or Sterapred DS.

Prednisone tablets and delayed-release tablets, in particular, have various dose strengths. A 20 mg dose of prednisone may be used to quickly reduce inflammation.

What is 20 mg of prednisone used for?

“A 20 mg dose of prednisone is usually prescribed when inflammation needs to be brought under control quickly,” says Dr. Gail Clifford, MD, MMM, CPE, FACP, FHM, an executive physician with ARRC LED specializing in internal medicine. “The goal is to calm down an overactive immune response and help relieve symptoms like swelling, pain, or trouble breathing.” 

She says it’s a common choice for treating asthma flare-ups, severe allergic reactions (like hives), autoimmune conditions (such as lupus and rheumatoid arthritis), skin conditions (like eczema), and gut inflammation related to Crohn’s disease or ulcerative colitis. However, higher or lower doses of prednisone are often used for these and other conditions.

Dr. Martina Ambardjieva, MD, a urologist with Dr Telx, adds, “In urology, prednisone is commonly used as an immunosuppressant in patients who receive a kidney transplant or to reduce inflammation in various conditions, including certain kidney diseases,” she says. “The dose may vary depending on the severity of the condition being treated.”

Is 20 mg of prednisone a low dose?

Dr. Clifford explains that 20 mg of prednisone would be considered a moderate dose. “It is stronger than what we would call low dose (usually under 10 mg) but not as high as the doses used in more aggressive treatments.”

But as with anything, it depends. “The exact definition of ‘low dose’ can vary based on the individual’s condition and the specific treatment plan prescribed by the healthcare provider,” Dr. Ambardjieva says.

Typical doses and lengths of treatment range greatly depending on the condition. The dose may also be based on weight, especially in children. 

The good news about a 20 mg dose, adds Dr. Clifford, is that side effects are usually limited, especially if the prednisone is taken for a short period of time.

How does 20 mg of prednisone make you feel?

While you may not experience major side effects, some are still noticeable and may show up within a few days. Both doctors say that patients commonly experience restlessness, insomnia, an increased appetite, and mood swings. Dr. Ambardjieva also adds stomach irritation and fluid retention.

Consult with a healthcare professional before changing how you take a medication or if you experience concerning side effects.

How long can you take 20 mg of prednisone?

The length of time a person is on prednisone will depend, in part, on the condition it’s treating. But for short-term issues—like asthma attacks, allergic reactions, and immune system flare-ups— the duration of treatment is often around five to seven days.

“In longer-term conditions, the dose might be tapered slowly over a few weeks or more, depending on the situation,” Dr. Clifford says.

Regardless, she continues, doctors prescribe prednisone for the shortest possible time. “It can be used long-term if necessary, but that is generally a last resort.”

That’s because long-term use comes with a risk of serious side effects, such as bone thinning, diabetes, and immune system suppression, Dr. Ambardjieva says. Long-term use of corticosteroids, or prescribing them in high doses, can also lead to an increased risk of cataracts, according to the FDA label for Rayos, a brand name of prednisone. 

How to take prednisone 

The best time to take a prednisone dose is with breakfast. “It’s best to take prednisone in the morning to mimic the body’s natural cortisol rhythm,” Dr. Ambardjieva explains. “Taking it early can also help avoid insomnia.”

Regarding the “with breakfast” piece, she says taking this medication with food can help reduce stomach irritation.

What you eat matters somewhat, too. Patients who take prednisone may want to avoid alcohol and high-sodium foods. Conversely, some of the best foods to eat while on steroids include foods rich in calcium, vitamin D, potassium, and protein. More specifically, that entails broccoli, dairy products, salmon, nuts, eggs, bananas, oranges, and baked potatoes.

Prednisone’s drug interactions include NSAIDs (such as ibuprofen), immunosuppressants, live vaccines, diabetes medicines, blood thinners (such as warfarin), diuretics, some antibiotics, medications for fungal infections (such as ketoconazole), phenytoin, and rifampin.

Before taking prednisone, let your doctor know if you have glaucoma, hypertension (high blood pressure), kidney disease, an infection (such as herpes or chickenpox), myasthenia gravis, osteoporosis, thyroid disease, are pregnant or breastfeeding, or have any other medical condition.

If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose as scheduled. When putting the medication away, ensure the space is room temperature.

Prednisone vs. prednisolone

Prednisone and prednisolone are similar but have a few general differences, shown in the table below.

Additionally, the two forms metabolize differently. “The key difference is that prednisone has to be converted by the liver into its active form, prednisolone,” Dr. Clifford says. “So if someone has liver problems, doctors may prescribe prednisolone directly. Otherwise, 20 mg of prednisone is generally considered equivalent in strength to 20 mg of prednisolone in healthy individuals.”

In Dr. Ambardjieva’s experience, patients with liver issues typically prefer prednisolone for that reason, and it works just as well. “Efficacy is similar between the two, but some patients may respond better to one than the other,” she adds.

Corticosteroids like prednisone affect the adrenal glands, which are responsible for producing cortisol. 

“If you take prednisone for a long time and stop it suddenly, your adrenal glands might not bounce back right away,” Dr. Clifford adds. “That is why it is important to taper off gradually.”