The Steroid Curse: Prednisone Vs. Methylprednisolone

I have always had a love-hate relationship with prednisone.

I don't like to be on it.   I was miserable when I was on it all the time, but not being on it, my pain significantly increased.

I was really stubborn, though, and when I was on prednisone on an "as needed" basis, I probably only took it once a month.

The last time I was at my rheumatologist's, he suggested going back on steroids full time, but rather than putting me back on prednisone, he suggested that I try methylprednisolone.

He told me that while prednisone is the go-to, default steroid in the United States, methylprednisolone is the default in Europe.

You might think a steroid is a steroid, because that is sort of what I thought, too, but my experience suggests otherwise.

A cursory search of PubMed, using the search term "prednisone" reveals 43,591 results and using the search term "methylprednisolone" reveals 20,165 results.   This is particularly telling, I think, that there is almost twice as much information about prednisone as there is about methylprednisolone.

We are all familiar with the weightless feeling that prednisone gives - like I feel like the weight of the whole world is on my shoulders and then I take prednisone and I don't feel that anymore.   But what I have felt and experienced is constant hunger, paranoia, weight gain, the tell-tale moon face - you name it.

The only side effect I have really noticed from the methylprednisolone is that I sweat like a 400-pound man, almost constantly, even when I am sitting down and doing nothing.

Some people may be more familiar with IV Medrol or Solu-Medrol, which is basically the same thing as methylprednisolone, only given by IV instead of orally.   I had three days of Solu-Medrol infusions when I first got sick, and I felt great for a month.   Granted, when my parents couldn't find the car when we were leaving the hospital, I sat down in the middle of the parking lot and couldn't stop laughing like a hyena, but at least I wasn't feeling any pain.

Unfortunately, I can't find much information to explain why prednisone is the go-to steroid in America and methylprednisolone is the go-to steroid in other countries.

But what I can say is that my experience with methylprednisolone has been better than the experience I have had with prednisone.   I can only speak to my own experience, but if you have had issues with the side-effects of prednisone, it may be worth talking to your doctor to see if you can be put on another type of steroid.

If you have to be on prednisone, I highly recommend that book, "Coping with Prednisone," which made me feel less crazy about the side effects I was having when I first started taking steroids.