Prednisone Side Effects
Prednisone side effects range from milder adverse events such as nausea, weight gain and headache to more serious complications such as fetal toxicity, allergic reactions and high blood pressure. Prednisone side effects are more likely to occur with larger doses or long-term therapy.
Medical providers have been prescribing corticosteroid drugs such as prednisone since the late 1950s to treat a variety of ailments caused by inflammation and over-active immune systems. Because prednisone works by altering many different processes in the body, including the immune system, it causes a wide variety of side effects. Some of these side effects are unavoidable.
There have been 87,545 reports of adverse events reported to the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) from 1968 to 2020 for Rayos (brand name, delayed release prednisone), Prednisone Intensol (oral liquid) and generic prednisone.
Of those reports, 77,738 were serious, including 14,121 deaths. In 2019 alone, there were 17,068 reported side effects. FAERS reports are voluntary and not gathered during a clinical trial, so there is no way for the FDA to verify that prednisone caused the effects.
The side effects and how serious they are vary depending on a person’s age, how healthy they are and other medications they are taking. Women are also more likely to experience prednisone side effects than men.
Despite the long list of side effects associated with prednisone and other corticosteroids, many people take them and have minor or no side effects, according to Dr. Theodore R. Fields of the Hospital for Special Surgery. There are also precautions people can take to manage or reduce side effects.
Common Side Effects
Common side effects of prednisone tend to be milder, especially with lower doses and short-term use. They may last a few days to a few weeks. This isn’t a complete list of side effects. If side effects last for a long time or get worse, patients should talk to their pharmacist or medical provider.
People with acute conditions such as asthma flare ups, allergic reactions or a flare up of chronic obstructive pulmonary disease (COPD) may take prednisone short-term.
- Blurred vision
- Changes in behavior or mood
- Elevated blood pressure levels
- Elevated blood sugar levels
- Fluid retention
- Restlessness and inability to stay still (akathisia)
- Sleep problems
- Thinning skin
- Weight gain
Serious Side Effects
More serious side effects can occur with larger prednisone doses and long-term treatment. People who have chronic inflammatory conditions such as rheumatoid arthritis, asthma, COPD, inflammatory bowel disease or osteoarthritis are more likely to receive prednisone long-term — for several months or years. People who need to suppress the immune system for a long period of time, such as after a transplant, may also receive prednisone long-term.
In addition to allergic reactions such as hives or trouble breathing, prednisone can affect the bones, muscles, adrenal glands, cardiovascular system, skin, eyes, gastrointestinal system and even mental health.
In some cases, people may be able to counteract prednisone side effects by adjusting diet, taking supplements or exercising.
An allergic reaction to prednisone can be serious. If you have any of these symptoms, contact your medical provider or emergency room right away.
- Skin rash
- Swelling of the face, lips or tongue
- Difficulty breathing
Bone and Muscle Problems
Up to 40 percent of people taking long-term prednisone experience bone loss that leads to a fracture, according to an article by Dr. Muhammad Yasir and colleagues in the U.S. Library of Medicine. Most people lose bone mass within the first six to 12 months of therapy.
To counteract this side effect, medical providers may recommend a calcium supplement, vitamin D supplement, weight bearing exercise or bone-saving medications such as Fosamax or Binosto (alendronate), Boniva (ibandronate) or Actonel or Atelvia (risedronate).
In addition, patients may experience osteonecrosis — death of bone tissue that happens when there is reduced blood flow to the joints. This often manifests as hip and knee pain, but it can become severe and may require surgery.
Prednisone also affects the muscles and can cause muscle weakness in the legs and arms. In severe cases, patients may be hospitalized. Stopping treatment and performing exercises usually reverses this side effect.
High Blood Sugar and Shifting Body Fat
Taking prednisone can cause an increase in fasting blood sugar. This can be especially serious in people with Type 2 diabetes. Patients should make sure they get their blood sugar tested and monitored while taking prednisone. After stopping treatment, blood sugar metabolism usually returns to normal.
Prednisone and other corticosteroids are the main cause of redistribution of body fat called Cushing syndrome. This can develop early in the dosing regimen and manifests as a buffalo hump behind the neck, a round “moon face” and gathering of fat in the abdomen. Children also have skin changes and hypertension.
Prednisone can affect several hormones, including cortisol. Prolonged hormone suppression can cause adrenal gland atrophy (wasting away) which leads to adrenal insufficiency.
- Abdominal pain
- Anorexia or weight loss
- Body pains
- Headache in the morning
- Poor growth and weight gain in children
- Psychiatric symptoms
Increased Risk of Infection
Taking prednisone can increase a person’s chance of getting mild to serious, life-threatening infections. Larger doses increase the risk, especially doses for immunosuppression. Older age and taking other drugs that also suppress the immune system increase the risk. Doses of 10 mg or lower pose the least risk.
Prednisone can cause irregularities in potassium, calcium and phosphate levels. This may lead to high blood pressure, heart-beat irregularities, edema (swelling) and weight gain.
People on medium-high doses of prednisone may suffer premature atherosclerosis — buildup of cholesterol in the arteries. Over time, this can obstruct blow flow or lead to blood clots.
Medical providers may recommend a low salt diet or diuretics (water pills) to help combat fluid accumulation and control blood pressure. Eating a low cholesterol diet and getting exercise may also help with atherosclerosis.
Even at low doses, prednisone can cause skin problems. These include skin thinning, acne, hirsutism (excess hair growth), hair thinning, face redness, stripe-like marks on the skin (stria) and impaired wound healing.
Blurred vision is the most common eye problem with prednisone use, and it’s not typically a serious issue. But the risk of cataracts in both eyes is high in patients who take more than 10 mg of prednisone daily for longer than a year.
The drug increases pressure in the eye that might lead to glaucoma. The pressure may subside after stopping treatment, but the damage to the optic nerve may be permanent.
People who start having vision changes should see an ophthalmologist to see what treatments may help counteract vision side effects.
Gastrointestinal Side Effects
People using prednisone have an increased risk of gastric ulcer formation, gastritis and GI bleeding. The risk is four times greater when prednisone and an NSAID, such as ibuprofen, are used together.
Other gastrointestinal side effects include fatty liver and pancreatitis.
Mental Health Side Effects
Early on in treatment (within several days), prednisone may increase feelings of well-being, anxiety, hypomania or mild euphoria. With long-term therapy, however, patients 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.
About 1.3 percent of psychosis cases occurred in patients taking 40 mg or lower, while 18.4 percent occurred in patients taking 80 mg daily. Patients with a history of mental health issues and female gender are at greater risk.
Mental health symptoms start within three to four days after starting therapy, but they can occur at any time. Some people have symptoms, including depression, after stopping therapy.
In children receiving prednisone for acute lymphoblastic leukemia (ALL), prednisone may cause behavioral symptoms including aggression, insomnia, mood fluctuations, depression, manic behavior and euphoria. Most children no longer experience these symptoms after they stop therapy.
Side Effects in Women vs. Men
Overall, women are at greater risk of side effects from prednisone than men. They are more likely to resist increases in dosages because of side effects. Women also reported more intolerable side effects than men.
- Weight gain
- Increased appetite
- Changed appearance
- Moon face
- Prominent scar
- Increased hair loss
- Gingival hyperplasia (gum swelling)
- Mood swing
- Poor concentration
Warnings and Precautions
Tell your doctor or pharmacist if you’re allergic to prednisone or have other types of medication allergies. Also be sure to tell your doctor about all medications, vitamins and herbal supplements you take because prednisone could interact with them.
- Congestive heart failure or heart failure
- Glaucoma or cataracts
- High blood pressure that is not well controlled
- History or mental illness
- Osteoporosis or low bone density
- Peptic ulcer disease
- Type 2 diabetes
Prednisone and Vaccines
Do not get live or attenuated live vaccines if you are on high doses of prednisone that suppress the immune system. Prednisone may cause organisms in the vaccines to replicate (grow) and this may cause infections.
People taking prednisone have weakened immune systems and should also be careful around people with diseases including smallpox, chicken pox or measles.
Seniors, Children and Pregnant Women
Seniors are at greater risk for prednisone-induced side effects and this is usually dose related. The lowest effective dose should always be used.
In seniors, bone loss and osteoporosis are the most frequently reported side effects. Bone loss is more likely to occur at the beginning of treatment and may recover after stopping treatment. Taking medications such as Fosamax or Binosto (alendronate), Boniva (ibandronate) or Actonel or Atelvia (risedronate) may slow bone loss.
Children experience the same side effects as adults, but prednisone may stunt their growth even with low doses.
Pregnant women should use prednisone with caution. The risk of birth defects and low birth weight increases when pregnant women take the drug during the third trimester. Prednisone may pass to an infant though breast milk and may harm the baby.
Prednisone and COVID-19
A recent editorial in the Journal of Clinical Endocrinology & Metabolism by Dr. Paul M. Stewart and colleagues found that patients who take prednisone or other glucocorticoid drugs are at high risk for developing complications if infected with COVID-19.
Because prednisone decreases a person’s ability to fight off infections, the body is unable to mount an adequate response to the virus, according to researchers.
Please seek the advice of a medical professional before making health care decisions.