From the Guidelines
Prednisone can cause muscle weakness as a side effect, particularly when taken in high doses or for extended periods, and this weakness is typically temporary and often resolves after reducing the dose or discontinuing the medication. The relationship between muscle weakness and prednisone therapy is well-documented, with studies suggesting that high-dose corticosteroids can interfere with protein metabolism and cause muscle breakdown 1.
Causes of Muscle Weakness
- High doses of prednisone
- Extended periods of prednisone use
- Interference with protein metabolism
- Muscle breakdown
Management of Muscle Weakness
- Maintain a balanced diet rich in protein
- Engage in regular light exercise as tolerated
- Ensure adequate rest
- Consult healthcare provider for dosage adjustment or tapering schedule
- Consider supplements or other strategies to manage side effects
Important Considerations
- Do not stop prednisone abruptly, as this can be dangerous
- Seek immediate medical attention if weakness is severe or accompanied by other concerning symptoms
- Monitor for signs of muscle weakness, such as difficulty standing or lifting arms
- Consider alternative treatments or adjustments to prednisone dosage if muscle weakness persists or worsens 1.
Note: The most recent and highest quality study 1 provides guidance on the management of muscle weakness in patients taking prednisone, and this information should be prioritized in clinical decision-making.
From the FDA Drug Label
An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs (e.g., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Concomitant use of anticholinesterase agents (e.g., neostigmine, pyridostigmine) and corticosteroids may produce severe weakness in patients with myasthenia gravis.
Muscle weakness is a potential side effect of prednisone (corticosteroid) therapy, particularly at high doses or in patients with disorders of neuromuscular transmission.
- Acute myopathy may occur, resulting in quadriparesis and elevation of creatinine kinase.
- Severe weakness may also occur in patients with myasthenia gravis when anticholinesterase agents are used concomitantly with corticosteroids 2, 2.
From the Research
Relationship Between Muscle Weakness and Prednisone Therapy
- Muscle weakness is a known side effect of long-term corticosteroid therapy, including prednisone 3, 4
- Studies have shown that chronic corticosteroid administration can induce skeletal muscle weakness, with inverse correlations found between skeletal muscle strength and total amount of corticosteroids administered 3
- In patients with interstitial lung disease (ILD), chronic corticosteroid treatment has been shown to contribute to muscle weakness, with significant differences in quadriceps muscle force and handgrip force between patients on corticosteroids and those not on corticosteroids 3
- Similarly, in elderly patients with asthma, higher cumulative lifetime oral corticosteroid exposure has been associated with a higher prevalence of frailty and muscle weakness, as well as lower hand-grip strength and lean mass index 4
Adverse Side Effects of Prednisone
- Adverse side effects of prednisone have been reported in various studies, including fluid retention, insomnia, mood changes, and increased appetite 5, 6
- However, these side effects can often be minimized by reducing the dosage or using alternative treatment regimens 5, 7
- In some cases, the addition of prednisone to other treatments, such as methotrexate, may actually alleviate certain side effects, such as nausea and elevated liver enzymes 7
Compliance with Prednisone Therapy
- High compliance rates have been reported among patients taking oral prednisone for acute relapses of multiple sclerosis, with most patients preferring oral medication for future relapses 6
- However, the potential for muscle weakness and other adverse side effects should be carefully considered when prescribing prednisone therapy, particularly for long-term use or in vulnerable patient populations 3, 4