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Side effects of predniso(lo)ne (and other glucocorticoids) mostly occur at high doses, and as a rule severe side effects only occur when prednisolone is taken for a long period. At lower doses (10 mg daily or less) side effects can occur too.
The most frequent side effect is weight gain. In the first few weeks this is mainly caused by fluid retention and increased hungriness and appetite. The fluid effect usually only lasts a few weeks, but it is important right from the beginning to stay on the same food intake and not give in to the ‘false’ hunger signal. Finally, we know active rheumatoid arthritis costs a lot of energy. Many patients  have lost weight since the disease started. Any powerful treatment that works well will counteract the disease, causing people to gain weight again. So this is an intended effect!
In the first weeks of COBRA therapie, when the dose is still high, you may experience an ‘excess’ of energy, and problems getting to sleep. This is temporary. Also, with higher doses we sometimes see menstrual disturbances. More rarely we see skin problems such as thinning, swelling of the face, slow wound healing and bruising. Bone loss can occur, increasing the risk of fracture over time. Fluid retention can cause ankle swelling (edema) and hypertension. Sometimes prednisolone causes muscle weakness, cataract, increased eye pressure and increased blood sugar. Abdominal pain and nausea can also occur. The use of prednisolone together with NSAIDs increases the likelihood of a stomach ulcer or bleed. This manifests itself by the vomiting of blood or by tarry stools. The likelihood of infections such as flu, bronchitis, pulmonary and urinary infections and herpes zoster increases when using prednisolone.

Contact your rheumatologist in case of:
- Tarry stools
- Vomiting of blood
- Fever, flu and other signs of infection if they do not improve in 1 week
- Abnormal thirst (especially at night) and increased discharge/volume of urine

The effect on fertility, pregnancy and breastfeeding

As far as is known, prednisolone has no influence on fertility of men or women. The use of prednisolone during pregnancy is also considered as relatively safe for the unborn child. This means that during pregnancy, you can continue to use prednisolone, but always consult your rheumatologist.  It is better not to use prednisolone during breastfeeding, because the drug appears in breast milk.


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