From the Guidelines
Prednisone can cause numerous side effects, including increased appetite, weight gain, fluid retention, mood changes, insomnia, elevated blood sugar, and increased susceptibility to infections, with more serious effects like high blood pressure, osteoporosis, and adrenal suppression developing with longer use 1.
Common Side Effects
- Increased appetite and weight gain
- Fluid retention and mood changes (including irritability, anxiety, and euphoria)
- Insomnia and elevated blood sugar
- Increased susceptibility to infections
Serious Side Effects
- High blood pressure and osteoporosis
- Cataracts and glaucoma
- Muscle weakness, thinning skin, and easy bruising
- Adrenal suppression and facial swelling (moon face)
- Fat redistribution creating a buffalo hump and increased body hair
Management of Side Effects
- Regular monitoring of blood pressure, blood sugar, and bone density during extended treatment
- Gradual tapering of the dose when stopping prednisone to avoid abrupt withdrawal
- Reporting concerning side effects to the healthcare provider and adjusting treatment as needed
- Considering alternative treatment options if side effects are severe or persistent 1.
From the FDA Drug Label
ADVERSE REACTIONS (listed alphabetically, under each subsection) The following adverse reactions have been reported with prednisone or other corticosteroids: Allergic Reactions anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema Cardiovascular System bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, ECG changes caused by potassium deficiency, edema, fat embolism, hypertension or aggravation of hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, necrotizing angiitis, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis Dermatologic acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema, angioneurotic edema, atrophy and thinning of skin, dry scaly skin, ecchymoses and petechiae (bruising), erythema, facial edema, hirsutism, impaired wound healing, increased sweating, Karposi’s sarcoma, lupus erythematosus-like lesions, perineal irritation, purpura, rash, striae, subcutaneous fat atrophy, suppression of reactions to skin tests, striae, telangiectasis, thin fragile skin, thinning scalp hair, urticaria ...
The side effects of prednisone include:
- Allergic reactions: anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema
- Cardiovascular issues: bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure
- Dermatologic problems: acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema
- Other issues: abdominal distention, abdominal pain, anorexia, constipation, diarrhea, elevation in serum liver enzyme levels, gastric irritation, hepatomegaly, increased appetite and weight gain, nausea, oropharyngeal candidiasis, pancreatitis, peptic ulcer with possible perforation and hemorrhage, vomiting 2
From the Research
Side Effects of Prednisone
- The study 3 mentions that changes in clinical efficacy and appearance of side effects have been related to altered prednisolone clearance, which is a metabolite of prednisone.
- Common clinical use of prednisone and prednisolone can lead to frequency of adverse effects, according to the study 3.
- Drug interactions between prednisolone and anticonvulsants are common, as stated in the study 3, which may contribute to side effects.
- The study 3 also notes that liver and kidney disease have only limited effects on prednisolone disposition, but does not provide direct information on side effects of prednisone.
- There is no direct information on side effects of prednisone in the studies 4 and 5, as they focus on ambulatory blood pressure monitoring and its application in diagnosing and managing hypertension.