From the Guidelines
Prednisone can cause numerous side effects, including cosmetic, systemic, and quality of life issues, and patients should be closely monitored for these effects, especially with prolonged use 1.
Common Side Effects of Prednisone
The side effects of prednisone can be categorized into short-term and long-term effects. Short-term side effects include:
- Increased appetite
- Weight gain
- Fluid retention
- Mood changes (including irritability, anxiety, and euphoria)
- Insomnia
- Elevated blood sugar
- Increased susceptibility to infections
Serious Side Effects with Prolonged Use
With prolonged use, more serious side effects may develop, including:
- Osteoporosis
- Muscle weakness
- Thinning skin
- Easy bruising
- Cataracts
- Glaucoma
- High blood pressure
- Diabetes
- Adrenal suppression
- Increased risk of peptic ulcers
Management of Side Effects
To minimize side effects, prednisone is typically prescribed at the lowest effective dose for the shortest duration possible 1. Patients should never stop taking prednisone abruptly as this can cause adrenal crisis, a potentially life-threatening condition. Instead, the medication should be tapered gradually under medical supervision. Taking the medication with food can help reduce stomach irritation, and supplementing with calcium and vitamin D may help protect bone health during longer treatment courses 1. Patients should report any concerning side effects to their healthcare provider promptly.
Monitoring for Side Effects
The treating physician should ensure that the patient is adequately monitored for potential corticosteroid side effects, regardless of the duration or type of corticosteroid selected 1. This includes close monitoring for hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis. Given the potential impact of corticosteroids on mental health, the treating physician should conduct an assessment of health-related quality of life (HRQoL) while patients are receiving corticosteroids.
Patient Concerns
Patients' concerns about weight gain and other side effects should be addressed, and they should be informed about the potential risks and benefits of prednisone treatment 1. Patients should be encouraged to report any concerns or side effects to their healthcare provider promptly.
From the FDA Drug Label
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, angioneurotic edema, atrophy and thinning of skin
- Other issues: gastrointestinal, hematologic, metabolic, musculoskeletal, neurologic, ophthalmic problems 2
From the Research
Common Side Effects of Prednisone
- Fluid retention or bloating, which can be minimized by reducing the dosage in most instances 3
- Insomnia, particularly in patients receiving short-term treatment (less than two weeks) 3
- Suppression of bone formation, which may lead to reduced bone repair or renewal and adverse effects on bone mass and/or bone strength 4
- Decreased indices of bone resorption in postmenopausal women 4
Less Common Side Effects of Prednisone
- Bruising and skin-thinning, particularly in patients taking low-dose prednisone (<5 mg/day) 5
- Hypertension, diabetes, and cataracts, although these were reported at low levels 5
- Osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations, associated with long-term corticosteroid use 6
- Psychosis, a significant side effect that has been encountered in some patients 6
Factors That Increase the Risk of Side Effects
- Smoking, excessive alcohol consumption, amenorrhoea, relative immobilisation, chronic obstructive pulmonary disease, inflammatory bowel disease, hypogonadism in men, and organ transplantation, which may increase the risk of corticosteroid-induced osteoporosis 7
- High doses of chronic glucocorticoids, which can cause premature or exaggerated osteoporosis 4, 7
Management of Side Effects
- Using the lowest effective dose of prednisone, with topical corticosteroids used whenever possible 7
- Maintaining an adequate daily intake of calcium and cholecalciferol (vitamin D) 7
- Stopping smoking and avoiding excessive alcohol intake 7
- Detecting and treating hypogonadism in men, and replacing gonadal hormones in postmenopausal women or amenorrhoeic premenopausal women 7