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Prednisone Side Effects

Common prednisone side effects include nausea, weight gain and headaches. More serious side effects include fetal toxicity, allergic reactions and high blood pressure. Prednisone side effects are more likely to occur with larger doses or long-term therapy.

Last Modified: September 15, 2022
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Common Prednisone Side Effects

Common side effects of prednisone tend to be mild, especially with lower doses and short-term use. They may last a few days to a few weeks. If side effects persist or worsen, talk to your doctor or pharmacist.

Women are more likely to experience prednisone side effects, which can vary in severity and type, depending on a person’s overall health, age and other medications they take.

Common prednisone side effects include:
  • Acne
  • Blurred vision
  • Changes in behavior or mood
  • Dizziness
  • Elevated blood pressure levels
  • Elevated blood sugar levels
  • Fluid retention
  • Headache
  • Increased appetite
  • Insomnia or fatigue
  • Nausea
  • Restlessness and inability to stay still (akathisia)
  • Sleep problems
  • Swelling
  • Thinning skin
  • Vomiting
  • Weight gain

Many people take prednisone with only minor side effects — or none — but each method of taking corticosteroids can present its own unique side effects. In its liquid form, prednisone can cause a sore mouth, sore throat and stomach pain.

Other corticosteroids come as inhalers, as topical creams or as IV fluids. Fluticasone in asthma medications, such as Advair, comes in an inhaler. Hydrocortisone often comes as a cream. Methylprednisolone comes in tablet form, but medical providers can also deliver it intravenously for multiple sclerosis patients.

Serious Prednisone Side Effects

The most serious prednisone side effects usually include allergic reactions, infections, gastrointestinal issues and elevated blood sugar. These may occur when people take larger doses or take the medication for long-term treatment.

Some side effects and what to expect from them include:
Allergic Reactions:
The most prevalent reactions are hives, skin rashes, itching, difficulty breathing, and swelling of the lips, tongue or face. If you experience any of these symptoms, contact an urgent-care provider or your local emergency room.
Bone Loss:
One study showed that up to 40% on a long-term treatment of prednisone have enough bone loss to lead to a fracture. People can also experience osteonecrosis, which is death of bone tissue because of reduced blood flow to the joints. This often manifests as hip and knee pain, but it can become severe and may require surgery. Most people lose bone mass within the first six to 12 months of prednisone therapy.
Cardiovascular Issues:
Prednisone can cause irregularities in potassium, calcium and phosphate levels, potentially leading to high blood pressure and heartbeat irregularities. People who take medium-high doses may develop premature atherosclerosis, a buildup of cholesterol in the arteries.
Cushing Syndrome:
Too much cortisol can trigger Cushing syndrome, which redistributes fat within the body. Signs of Cushing syndrome include the distribution of fatty tissue around the midsection, between the shoulder blades and in the face. Children with Cushing syndrome have experienced impaired growth.
Gastrointestinal Problems:
People who take prednisone increase their risk of developing gastric ulcer formation, gastritis and GI bleeding. The risk is four times higher when someone takes prednisone and an NSAID (such as ibuprofen) together. Other side effects include fatty liver and pancreatitis.
High Blood Sugar:
Anyone who takes prednisone should get their blood sugar tested and monitored while taking it. The drug can cause an increase in fasting blood sugar, a side effect especially serious for people with Type 2 diabetes. Blood sugar metabolism usually returns to normal after the medication is stopped.
Infection Risk:
Taking prednisone can increase the chances of developing mild, serious or life-threatening infections. Larger doses increase the risk, especially doses for immunosuppression. Older age and taking other medications that also suppress the immune system increases the risks. Doses of 10 mg or lower pose the least risk.
Muscle Weakness:
Prednisone and other corticosteroids can cause muscle weakness in the legs and arms. Severe cases may require hospitalization. Stopping treatment and performing exercises usually reverses this side effect.
Skin Problems:
Even at low doses, prednisone can cause skin issues. These include skin thinning, acne, excess hair growth (hirsutism), hair thinning, face redness, stripe-like marks on the skin (stria) and impaired wound healing.
Vision Changes:
Blurry vision is the most common eye problem associated with prednisone, but it’s usually not serious. However, the risk of cataracts in both eyes increases for people who take more than 10 mg of prednisone daily for longer than a year. The drug also increases eye pressure, potentially leading to glaucoma or even permanent damage to the optic nerve.

Fetal toxicity is a valid concern for pregnant women who have a medical reason for taking prednisone. Autoimmune diseases, including lupus, rheumatoid arthritis and inflammatory bowel disease, are potentially more damaging to unborn babies than prednisone.

Researchers hint at a small increased risk of babies being born with a cleft lip or without a cleft palate when their mothers took corticosteroids in the first trimester of pregnancy. But medical providers need much more hard research to document fetal toxicity and other issues, such as a link to gestational diabetes, related to prednisone.

Adrenal Insufficiency

Increased cortisol from prednisone (and other corticosteroids) can cause adrenal glands to shut down, leading to adrenal atrophy (wasting away) and adrenal insufficiency. Adrenal insufficiency is when the adrenal glands don’t produce enough hormones.

The condition leads to Addison’s disease, a life-threatening episode characterized by low blood pressure, low levels of blood sugar and high levels of potassium.

Symptoms of adrenal insufficiency include:
  • Abdominal pain
  • Anorexia or weight loss
  • Body pains
  • Diarrhea
  • Fatigue
  • Fever
  • Headache in the morning
  • Nausea
  • Poor growth and weight gain in children
  • Psychiatric symptoms

Addison’s disease presents when damaged adrenal glands produce insufficient amounts of cortisol or aldosterone.

Mental Health Side Effects

Early in treatment (within several days), prednisone may increase feelings of well-being, anxiety, hypomania or mild euphoria. With long-term therapy, however, people may develop depression. Psychosis, referred to as corticosteroid-induced psychosis, can occur at doses of 20 mg or more per day with long-term use.

Mental health issues start within 3 to 4 days after starting prednisone therapy, but they can occur at any time. Some people continue to have symptoms, including depression, even after therapy stops.

Children who get prednisone for acute lymphoblastic leukemia (ALL), may develop mood fluctuations, depression, manic behavior or euphoria. For most, symptoms go away when therapy concludes.



Prednisone Side Effects in Women and Men

Because corticosteroids, such as prednisone, impact hormones, they can affect men and women differently. Women are more likely to develop osteoporosis, a serious side effect from prednisone use. And women who are pregnant, who want to get pregnant or who are breastfeeding should not take prednisone.

For men, prednisone can cause erectile dysfunction and change testosterone levels. Some men reported reduced sperm counts and infertility.

Men and women experience similar side effects, including depression, mood swings and stomach pain. But overall, doctors need more research to understand the specific role of gender in reactions to corticosteroids.

How to Reduce Your Risk of Prednisone Side Effects

The best thing you can do to minimize side effects from taking prednisone is to maintain a healthy lifestyle. That means eating smart, exercising regularly and getting plenty of sleep.

While taking prednisone, you should avoid smoking and drinking alcohol, and add supplements to your diet.

Once you start on a course of prednisone, pay attention to signals your body sends. Weight gain, fluid retention, nausea, mood swings, sleeplessness and overall weakness are signs to watch. This is especially true for someone on a long-term treatment plan. Exercise helps with fluid retention, depression and high blood sugar.

Tips to help you manage, mitigate and reduce the risk of side effects include:
Fluid retention:
While it might seem counterintuitive, drinking more water helps maintain a proper fluid balance and reduce water retention. But if you notice ankle swelling, speak with your doctor.
Gastrointestinal symptoms:
Take your doses of prednisone with some food in your stomach. If the drugs irritate your stomach, mix in antacids for help.
Infection:
Prednisone and other corticosteroids suppress the immune system, which may need a boost. Stay updated on your vaccines, including an annual flu shot and for long-term vaccines and boosters for shingles, tetanus, pneumonia and COVID-19.
Insomnia:
Before relying on sleeping pills, develop a bedtime routine that includes relaxation techniques, such as guided meditation or deep breathing.
Osteoporosis:
Anyone who takes prednisone should increase their sources of calcium from supplements and food groups to offset bone loss. Peas, beans, lentils, almonds, sesame seeds, amaranth, dark leafy greens (such as collard greens and spinach), broccoli and Brussels sprouts are quality sources of calcium.
Weight gain:
Gaining weight while taking prednisone is a genuine concern, especially because one side effect from the medication is increased appetite. Monitor your food intake and develop a regular exercise routine.

Make time for other things you enjoy: reading, writing, fishing, hiking, dancing, crafting, painting, yoga, Pilates and tai chi can help people find balance. Community centers often have free or inexpensive classes several times a week.

How Prednisone Dosage Impacts Side Effects

Dosage and duration are two aspects of your prednisone prescription that affect the likelihood and severity of side effects.

The higher your dose of prednisone, the more likely you are to notice side effects. The same is true if you must take the medication for longer than 30 days. In fact, most side effects stem from long-term use.

Even if you experience negative side effects, don’t stop taking your prednisone. It is a strong medication, and doctors recommend a gradual step-down approach to end the prescription cycle.

Please seek the advice of a medical professional before making health care decisions.
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