What is the effect of Prednisone 5 mg?

Effects of Prednisone 5 mg Daily

Prednisone 5 mg daily causes measurable adverse effects including weight gain (up to 5 kg over 2 years), suppression of bone formation markers, and increased cardiovascular risk, though these effects are generally less severe than higher doses.

Weight Gain and Metabolic Effects

Weight gain is one of the most common and clinically significant effects of prednisone 5 mg daily. 1

• Studies demonstrate weight gain ranging from no change to 5 kg over 1-2 years in patients treated with 5 mg prednisolone, compared to 0-3 kg in untreated groups 1
• The greatest difference between treatment and placebo groups was 4.7 kg over a 2-year period with 5 mg prednisolone 1
• Increased appetite is a common mechanism driving additional weight gain beyond fluid retention 2
• Weight gain and fluid retention typically occur within the first few weeks of therapy and represent the most frequently reported patient concerns 2

Bone and Musculoskeletal Effects

Even low-dose prednisone 5 mg daily significantly suppresses bone formation, which may lead to long-term skeletal complications. 3

• Prednisone 5 mg daily rapidly and significantly decreases serum markers of bone formation including PINP (p < 0.01), PICP (p < 0.01), and osteocalcin (p < 0.01) in postmenopausal women 3
• These changes suggest that even low doses may reduce bone repair or renewal and potentially have adverse effects on bone mass and strength 3
• The bone formation suppression is largely reversed during recovery periods after discontinuation 3
• Primary adverse events in long-term observational studies include skin thinning and bruising, which are dose-dependent 4, 5

Cardiovascular Effects

Prednisone 5 mg causes elevated blood pressure through multiple mechanisms, requiring monitoring even at this low dose. 6

• The American College of Cardiology and American Heart Association recognize prednisone as a medication that elevates blood pressure through mineralocorticoid-like effects, direct increase in cellular potassium efflux, and promotion of atherosclerosis 6
• Regular blood pressure monitoring is recommended even during short courses, with baseline assessment before initiating therapy 6
• Blood pressure effects can occur without other obvious systemic side effects 6

Endocrine and Metabolic Complications

Hyperglycemia and worsening diabetes are common metabolic effects that require monitoring. 2

• Blood glucose monitoring is recommended as hyperglycemia commonly occurs and may contribute to cardiovascular risk 6, 2
• The American Diabetes Association recommends monitoring for hyperglycemia and worsening of diabetes, particularly with prednisone 2

Comparative Safety Profile

Prednisone 5 mg daily appears safer than higher doses but is not without risk, particularly with prolonged use. 4, 5, 7

• Long-term observational data (up to 25 years) shows that doses <5 mg/day appear acceptable and effective for many patients with rheumatoid arthritis 4
• New hypertension, diabetes mellitus, and cataracts occurred in <10% of all patients and <13% of those treated longer than 8 years with doses averaging <5 mg/day 5
• However, doses of 5-10 mg/day still correlate with adverse events (OR = 4.5,95% CI 2.1-9.6) compared to no prednisone use 7
• The risk of serious adverse events shows a dose-response relationship, with 5-10 mg/day having significantly lower risk than >10 mg/day 7

Clinical Effectiveness

Prednisone 5 mg daily demonstrates clinical effectiveness comparable to higher doses in certain conditions. 4, 5

• Similar improvements in clinical status were seen over 12 months in patients treated with <5 mg/day versus ≥5 mg/day prednisone, maintained for >8 years 4
• The mean initial prednisone dose in clinical practice declined from 10.3 mg/day in 1980-1984 to 3.6 mg/day in 2000-2004, reflecting recognition that lower doses can be effective 5

Critical Monitoring and Prevention

All patients on prednisone 5 mg daily require specific monitoring and preventive measures. 6, 2

• Calcium and vitamin D supplementation should be provided to all patients receiving corticosteroids to prevent osteoporosis 2
• Regular monitoring should include blood pressure, blood glucose, and consideration of bone density testing 2
• The American College of Cardiology recommends baseline blood pressure assessment before initiating therapy and frequent monitoring during dose changes 6

Important Caveats

The evidence shows that while 5 mg prednisone is considered "low dose," it is not without physiologic effects. The distinction between "low dose" (typically defined as ≤7.5 mg/day) and "very low dose" (<5 mg/day) is clinically meaningful, as adverse event rates increase substantially above 5 mg/day 7. Patients and providers should not assume that 5 mg daily is entirely benign, particularly with prolonged use exceeding 18 months 2.