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.
Prednisone is a type of corticosteroid that treats a variety of inflammation and overactive immune system related conditions. Because prednisone impacts the immune system, it can cause an array of side effects.
Between 1968 and 2020, 87,545 reports of adverse events were filed with the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) 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 patient-filed, making it difficult to verify prednisone was solely the cause of these side effects.
Prednisone side effects can vary in severity and type depending on a person’s overall health, age and other medications they take. Women are more likely to experience prednisone side effects.
Many patients take prednisone and have minor or no side effects. There are also precautions people can take to help manage or reduce the severity of side effects.
Common Prednisone Side Effects
Prednisone can be administered as a tablet or a liquid. Oral medications, particularly in liquid form, like prednisone can cause mouth, throat and stomach side effects.
Other types of corticosteroids can be administered via inhalers and topically. Fluticasone in asthma medications like Advair, for example, comes in an inhaler, and hydrocortisone can come in topical creams. Methylprednisolone, for example, comes in tablets, but can also be used intravenously for multiple sclerosis patients.
Each method of taking corticosteroids can present their own unique side effects. Prednisone, as an oral medication, can disrupt the balance of microorganisms in the mouth and sometimes cause side effects like thrush. It is also associated with sore throats, stomach pain and digestive issues.
- Blurred vision
- Changes in behavior or mood
- Elevated blood pressure levels
- Elevated blood sugar levels
- Fluid retention
- Increased appetite
- Insomnia or fatigue
- Restlessness and inability to stay still (akathisia)
- Sleep problems
- Thinning skin
- Weight gain
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, speak with your doctor or pharmacist.
Serious Prednisone Side Effects
More serious prednisone side effects can occur with larger prednisone doses and long-term treatment.
- Allergic reactions
- Cardiovascular problems
- Decrease in bone density
- Eye damage
- Fetal toxicity
- High blood sugar
- Increased risk of GI perforation
- Increased risk of infection
- Severe depression
- Shifting body fat
- Skin problems
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 can cause significant weight gain and increase levels of the hormone cortisol. Too much cortisol in the body can cause 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.
Increased cortisol in the body from prednisone and other corticosteroids can cause the adrenal glands that naturally produce cortisol to shut down. Adrenal suppression can lead to adrenal atrophy (wasting away) and 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.
How to Reduce Your Risk of Prednisone Side Effects
Consult your doctor if you are experiencing any side effects from prednisone. Be sure to follow dosing instructions carefully.
There are some tips patients can follow to help manage, mitigate and reduce the risk of side effects. These include:
- Fluid retention: If you notice ankle swelling, speak with your doctor. Sometimes diuretics (water pills) can be prescribed. Eating a low sodium diet can also help reduce water retention (edema). While it might seem counterintuitive, drinking more water can actually help the body maintain fluid balance and reduce water retention.
- Gastrointestinal symptoms: Be sure to take prednisone on a full stomach. Antacids can also help reduce stomach irritation.
- Infection: Because corticosteroids like prednisone suppress the body’s immune system, vaccines can be particularly helpful. Ask your doctor about an annual flu shot, as well as vaccines for pneumonia and shingles.
- Insomnia: Speak to your doctor about taking your entire daily dose in the morning as evening doses can sometimes make it difficult to fall asleep. Some people find a nightly bedtime routine that includes relaxation techniques, such as guided meditation, helpful.
- Osteoporosis: Increasing healthy sources of calcium can help. Peas, beans, lentils, almonds, sesame seeds, amaranth, dark leafy greens (such as collard greens and spinach), broccoli and brussel sprouts are all good sources of calcium. Calcium supplements may also help.
- Weight gain: Prednisone can cause significant feelings of hunger and can irritate the stomach when not taken with food. It also impacts the body’s hormones, which can contribute to weight gain. Maintaining a healthy, balanced diet and following your doctor’s recommended exercise plan can help. But, as Dr. Theodore Fields of the Hospital for Special Surgery notes, “Don't let weight gain damage your self-esteem.”
Self-care is an important way to manage side effects and overall mood. Prednisone can also impact mood swings, so this is particularly important in helping maintain a sense of wellness.
Making time for favorite activities whether it’s going for a walk, reading, crafting or yoga can help people find balance. Avoiding alcohol and smoking while on prednisone is also key to preventing serious side effects. Speak to your doctor if you are taking any other medications while on prednisone.
Prednisone Side Effects in Women and Men
While it was often thought that women are at greater risk of side effects from prednisone than men, case reviews indicate both men and women experience side effects including depression, mood swings and stomach pain, for example. But because corticosteroids like prednisone impact hormones, these medications can impact men and women differently.
Women are more likely to develop osteoporosis than men, which can be a serious side effect of prednisone. Women who are pregnant or nursing should consult their doctor about how prednisone may impact them.
Men may experience erectile dysfunction and their testosterone levels may be affected. Reduced sperm counts and infertility have also been reported.
More research is needed to fully understand the specific role gender may play in reactions to corticosteroids in different biological sexes.
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.
- Anxiety or depression
- Blood clots
- Eye diseases (such as glaucoma)
- Glaucoma or cataracts
- Heart problems such as congestive heart failure
- High blood pressure
- History or mental illness
- Infections (such as fungal, tuberculosis, herpes)
- Kidney disease
- Liver disease
- Low potassium
- Osteoporosis or low bone density
- Peptic ulcer disease
- Thyroid problems
Prednisone and Vaccines
While vaccines are recommended for those taking prednisone and other corticosteroids because steroids impact the immune system, consult your doctor before vaccination, particularly live or attenuated live vaccines if you are on high doses of prednisone.
People taking prednisone have weakened immune systems and should also be careful around anyone who is sick or experiencing symptoms of diseases such as 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.
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