Short-Term Side Effects of Prednisone
Prednisone commonly causes numerous short-term side effects including fluid retention, mood changes, sleep disturbances, increased appetite, and hyperglycemia, which can occur within days to weeks of starting therapy. 1
Common Short-Term Side Effects
Metabolic Effects
- Weight gain and fluid retention (bloating) are among the most common side effects, often occurring within the first few weeks of therapy 2
- Hyperglycemia and worsening of diabetes can occur rapidly, requiring blood glucose monitoring 3, 1
- Increased appetite leading to weight gain 2, 1
- Sodium retention resulting in edema 1
- Hypokalemia (potassium loss) 1
Neuropsychiatric Effects
- Mood disturbances ranging from euphoria and hypomania to depression, with manic symptoms being more common during short-term use 3, 4
- Insomnia and sleep disturbances are among the most frequent early side effects 3, 5
- Emotional instability, irritability, and anxiety 1, 6
- Cognitive changes including memory impairment 6, 7
- Restlessness and nervousness 3, 1
Gastrointestinal Effects
- Gastric irritation and increased risk of peptic ulcer formation 2, 1
- Nausea and vomiting 1
- Increased risk of opportunistic infections like oral candidiasis 1
Dermatologic Effects
- Facial rounding (moon face) can begin to develop even during short-term use 2, 1
- Acne and skin changes 1
- Increased sweating 1
Cardiovascular Effects
- Hypertension can develop or worsen quickly 2, 1
- Fluid retention that may exacerbate heart failure in susceptible patients 1
Musculoskeletal Effects
- Muscle weakness can occur even with short-term use 1
- Early changes in bone metabolism that eventually lead to osteoporosis with longer use 1
Risk Factors for Side Effects
- Higher doses increase the risk and severity of side effects 3, 2
- Duration of treatment longer than 6 weeks significantly increases risk of adverse effects 2
- Pre-existing conditions like diabetes, hypertension, or psychiatric disorders may be exacerbated 3, 1
- Children are at higher risk for growth suppression 2, 3
Monitoring Recommendations
- Regular monitoring of blood pressure and blood glucose is recommended, even during short courses 3, 2
- Assessment of mental health status and sleep patterns during therapy 2, 4
- Weight monitoring to detect rapid fluid retention 2, 1
- Electrolyte monitoring, particularly potassium levels 1
Important Considerations
- The American Society of Hematology strongly recommends against prolonged courses (>6 weeks) of prednisone due to increased risk of side effects 2
- Most side effects are dose-dependent, with doses >20 mg/day for more than 18 months leading to severe adverse effects in about 15% of patients 2
- Patient compliance with high-dose oral prednisone is generally good despite multiple pills and side effects 8
- Most short-term side effects are reversible upon dose reduction or discontinuation 6, 7
Common Pitfalls to Avoid
- Abrupt discontinuation can lead to adrenal insufficiency and should be avoided; tapering is necessary 1
- Failure to monitor blood glucose in patients with or at risk for diabetes 3, 1
- Overlooking early psychiatric symptoms, which can range from mild mood changes to severe mania or depression 4, 6
- Not providing prophylaxis against gastric irritation in high-risk patients 1
- Underestimating the impact of sleep disturbances and mood changes on quality of life 2, 3