Can prednisone cause constipation?

Can Prednisone Cause Constipation?

Yes, prednisone can cause constipation as a side effect, though it is not among the most commonly reported adverse effects of this medication. While gastrointestinal side effects are common with corticosteroids like prednisone, diarrhea is more frequently reported than constipation.

Evidence on Prednisone and Constipation

• Constipation is listed as a potential side effect of prednisone, though it occurs less frequently than other gastrointestinal effects 1
• In patients receiving CHOP or CHOP-like chemotherapy regimens that include prednisone, constipation has been observed, requiring prophylactic laxative management in some cases 2
• A case report documented constipation as part of a symptom complex in a patient with sarcoidosis who was subsequently treated with prednisone 3

Common Gastrointestinal Side Effects of Prednisone

• Approximately 50% of patients experience short-term corticosteroid-related adverse events, with gastrointestinal effects including dyspepsia being common 1
• Other more frequently reported gastrointestinal side effects include:
  • Nausea 1
  • Vomiting 1
  • Abdominal pain 1

Risk Factors for Constipation with Prednisone

• Concomitant use of other medications may increase the risk of constipation:
  • Anti-ulcer agents (proton pump inhibitors, H2 receptor antagonists) are often prescribed with prednisone and may interact with laxatives like magnesium oxide 2
  • Patients receiving both prednisone and other constipation-inducing medications may have compounded risk 4

Management of Prednisone-Associated Constipation

• If constipation occurs while taking prednisone:
  • Increase fluid and fiber intake 5
  • Encourage physical activity if appropriate 5
  • Consider over-the-counter laxatives or stool softeners 5
  • For persistent constipation, magnesium oxide at doses higher than 2000 mg/day may be effective 2

Clinical Considerations

• When prescribing prednisone, particularly for long-term use, monitoring for gastrointestinal side effects including constipation is recommended 6
• Low-dose prednisone (less than 5 mg/day) appears to have fewer adverse effects overall, but gastrointestinal monitoring is still warranted 6
• Patients should be advised about possible constipation and other gastrointestinal side effects when starting prednisone therapy 1

Important Caveats

• Individual patient response to prednisone varies significantly 6
• The risk of constipation may be higher in patients with certain underlying conditions or those taking multiple medications 4
• Severe constipation requiring medical intervention is uncommon with prednisone alone but should be addressed promptly if it occurs 5