What are the side effects of 20 milligrams of prednisone (corticosteroid)?

From the Guidelines

Prednisone at 20mg can cause several side effects, including cosmetic, systemic, and quality of life issues, as outlined in the 2020 study published in Hepatology 1. Common side effects include facial rounding, hirsutism, alopecia, dorsal hump, striae, weight gain, glucose intolerance/diabetes, hypertension, fatty liver, osteoporosis, vertebral compression, cataracts, glaucoma, opportunistic infections, emotional instability, psychosis, depression, and anxiety. These effects occur because prednisone is a corticosteroid that mimics cortisol, affecting multiple body systems simultaneously. The risk and severity of side effects generally increase with higher doses and longer duration of treatment. Never stop taking prednisone suddenly as this can cause withdrawal symptoms; always follow your doctor's instructions for gradually reducing the dose when discontinuing. Management options for these side effects include actively tapering to the lowest steroid dose needed for remission, eye examinations for cataract and glaucoma, lifestyle interventions for metabolic syndrome, bone density monitoring, vitamin D and calcium administration, and proactive screening and management for quality of life and mental health symptoms, as recommended in the 2020 Hepatology study 1. Additionally, a 2020 review published in Arthritis Care & Research highlights the impact of glucocorticoids on body weight, noting that weight gain is a common concern for patients and can be profound, resulting in central deposition of adipose tissue and catabolic effects on bone and muscle 1. However, the most recent and highest quality evidence is from the 2020 Hepatology study 1, which provides a comprehensive overview of the side effects associated with prednisone and their management. Key points to consider when taking prednisone at 20mg include:

• Monitoring for side effects and adjusting the dose as needed
• Gradually tapering the dose when discontinuing treatment
• Implementing management strategies for side effects, such as lifestyle interventions and proactive screening
• Being aware of the potential for weight gain and its impact on body composition. It is essential to follow the guidance provided in the 2020 Hepatology study 1 to minimize the risk of side effects and ensure the best possible outcomes for patients taking prednisone at 20mg.

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 20mg 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, atrophy and thinning of skin
• 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, ulcerative esophagitis, vomiting 2

From the Research

Side Effects of 20mg Prednisone

• Osteoporosis is a potential side effect of long-term prednisone use, as glucocorticoids are a common cause of iatrogenic osteoporosis 3
• Primary care physicians often do not routinely evaluate patients for osteoporosis secondary to glucocorticoid treatment, especially when patients do not have comorbid risk factors for osteoporosis 3
• The effect of glucocorticoid replacement therapy on bone mineral density (BMD) and osteoporosis risk may vary depending on the dose and duration of treatment, as well as individual patient factors 4
• Daily hydrocortisone doses above 25mg may be associated with a higher risk of decreased BMD in the lumbar spine 4
• Other factors, such as decreased levels of adrenal androgens and estradiol, may also contribute to an increased risk of osteoporosis in patients taking glucocorticoids 4

Related Risks and Considerations

• The use of proton pump inhibitors (PPIs) may also be a risk factor for the development of osteoporosis and osteoporotic fractures, although the direct pathogenesis is unclear 5
• Short-term use of PPIs does not appear to pose a lower risk than long-term use, and the mechanism of action is not fully understood 5
• Patients taking prednisone and PPIs should be monitored for signs of osteoporosis and osteoporotic fractures, and treatment should be tailored to individual patient needs and risk factors 3, 4, 5