From the Guidelines
Prednisone, a commonly prescribed corticosteroid, carries significant risks and side effects, including short-term effects like increased appetite, weight gain, and mood changes, and long-term effects like osteoporosis, adrenal suppression, and increased susceptibility to infections, which can be minimized by taking the lowest effective dose for the shortest time possible, as recommended by the American Association for the Study of Liver Diseases in 2020 1.
Risks and Side Effects of Prednisone
The risks and side effects of prednisone can be categorized into short-term and long-term effects. Short-term effects include:
- Increased appetite and weight gain
- Fluid retention
- Mood changes, such as irritability, anxiety, and euphoria
- Insomnia
- Elevated blood sugar
- Increased susceptibility to infections Long-term effects, typically developing after 2-3 weeks of use, include:
- Osteoporosis
- Adrenal suppression
- Muscle weakness
- Thinning skin
- Easy bruising
- Cataracts
- Glaucoma
- Hypertension
Management of Risks and Side Effects
To minimize the risks and side effects of prednisone, patients should:
- Take the lowest effective dose for the shortest time possible
- Gradually taper the dose to prevent withdrawal symptoms
- Never stop taking prednisone abruptly, as this can cause adrenal crisis, a potentially life-threatening condition
- Take prednisone with food to reduce stomach irritation
- Consider calcium and vitamin D supplements to protect bone health, as recommended by the Canadian Association of Gastroenterology in 2019 1
Patient Concerns and Education
Patients' concerns about weight gain and other side effects should be addressed by healthcare providers, as weight gain is a common side effect of importance to patients and influences patient decision-making, as highlighted in a narrative review of the evidence in 2020 1. Patients should be educated on the potential risks and side effects of prednisone and the importance of monitoring and managing these effects to minimize harm and optimize treatment outcomes, as recommended by the American Society of Hematology in 2019 1.
From the FDA Drug Label
WARNINGS General Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy Cardio-Renal Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. Immunosuppression and Increased Risk of Infection Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens 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
The risks and side effects of prednisone include:
- Immunosuppression and increased risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens 2
- Cardiovascular risks, such as elevation of blood pressure, salt and water retention, and increased excretion of potassium 2
- Allergic reactions, including anaphylactoid or hypersensitivity reactions, anaphylaxis, and angioedema 2 2
- Cardiovascular system effects, such as bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, and congestive heart failure 2
- Other adverse reactions, including acne, acneiform eruptions, alopecia, and impaired wound healing 2 The use of prednisone should be carefully considered, especially in patients with a history of tuberculosis, varicella, or measles, as well as those with hepatitis B or fungal infections 2.
From the Research
Risks and Side Effects of Prednisone
The use of prednisone, a corticosteroid, is associated with various risks and side effects. Some of the common side effects include:
- Cutaneous effects
- Electrolyte abnormalities
- Hypertension
- Hyperglycemia
- Pancreatitis
- Hematologic, immunologic, and neuropsychologic effects 3
- Osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations with long-term use 3
Short-term and Long-term Effects
Short-term use of prednisone is associated with generally mild side effects, although occasionally, clinically significant side effects may occur 3. Long-term use, on the other hand, may lead to more serious sequelae, including osteoporosis and adrenal insufficiency 3, 4.
Specific Risks
Some specific risks associated with prednisone use include:
- Toxicity to articular cartilage 5
- Reduction in immune function 5
- Increased risk of infections 5
- Uveitis, a form of eye inflammation, which may require treatment with corticosteroids or immunosuppressive agents 6
Importance of Awareness
It is essential for practitioners to be aware of the potential side effects of prednisone and to monitor patients closely, especially those on long-term therapy 7, 4. This includes evaluating patients for osteoporosis secondary to glucocorticoid treatment and providing appropriate therapy to prevent or treat bone loss 4.