What are the effects of a prednisone (corticosteroid) overdose?

From the Guidelines

Prednisone overdose requires immediate medical attention, and treatment typically involves supportive care to manage symptoms while the medication clears from the body, with no specific antidote available. If you suspect a prednisone overdose, call poison control (1-800-222-1222) or go to the emergency room immediately. Symptoms of overdose may include increased blood pressure, elevated blood sugar, fluid retention, mood changes, insomnia, stomach irritation, and in severe cases, seizures or psychosis 1. The severity of overdose effects depends on the amount taken, how long the person has been on prednisone, and individual factors. Prednisone is a corticosteroid that affects multiple body systems by suppressing inflammation and immune responses, which is why overdose can cause widespread effects.

Key Considerations

• Prolonged use of prednisone is associated with numerous side effects, including increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease 1.
• There is evidence of increased mortality in patients on long-term steroids, with a study showing that prolonged steroid use carries greater mortality compared to patients starting anti-TNF therapy 1.
• After medical stabilization, patients may need a carefully managed tapering schedule if they were previously on long-term prednisone therapy, as sudden discontinuation can cause withdrawal symptoms 1.

Management and Treatment

• Healthcare providers will monitor vital signs, electrolyte levels, and organ function while providing appropriate interventions for any complications.
• The treatment approach may involve a combination of supportive care and careful management of the patient's underlying condition.
• In some cases, patients may require a tapering schedule to gradually reduce the dose of prednisone and minimize the risk of withdrawal symptoms.

Important Recommendations

• Patients who have taken an overdose of prednisone should seek immediate medical attention.
• Healthcare providers should carefully monitor patients who are taking prednisone, especially those who are on long-term therapy, to minimize the risk of adverse effects.
• Patients who are taking prednisone should be aware of the potential risks and benefits of the medication and should follow their healthcare provider's instructions carefully.

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

The effects of a prednisone overdose are not directly stated in the provided drug labels. However, based on the listed adverse reactions, it can be inferred that an overdose may lead to severe manifestations of these reactions, including:

• Cardiovascular complications such as cardiac arrest, congestive heart failure, and hypertension
• Allergic reactions like anaphylaxis and angioedema
• Electrolyte disturbances including hypokalemia and hyperglycemia
• Increased risk of infection due to immunosuppression 2
• Various other systemic effects, including endocrine, metabolic, and musculoskeletal complications 2

It is essential to note that these are potential effects based on reported adverse reactions and may not be directly related to an overdose. The actual effects of a prednisone overdose may vary depending on several factors, including the dose and duration of exposure.

From the Research

Effects of Prednisone Overdose

• Adrenal insufficiency is a potential effect of prednisone overdose, as seen in patients with polymyalgia rheumatica or giant cell arteritis treated with prednisolone 3
• The prevalence of adrenal insufficiency in patients treated with low-dose prednisolone for rheumatoid arthritis is high, with 48% of patients showing an insufficient adrenal response to the Synacthen test 4
• Adrenal insufficiency can occur even at low doses of prednisolone, and the risk is not correlated with the duration of treatment 4

Clinical Presentation

• Adrenal insufficiency can cause symptoms such as fatigue, weight loss, and hypotension, which can be similar to those of the underlying disease being treated 3
• Patients with adrenal insufficiency may require individualized glucocorticoid replacement therapy to prevent adverse effects such as Cushing-like symptoms or adrenal crisis 5, 6
• High-dose glucocorticoid replacement therapy may delay the resolution of nonsevere diabetic ketoacidosis and prolong ICU and hospital stays in patients with stable Addison's disease 7

Management

• The management of adrenal insufficiency due to prednisone overdose requires careful evaluation of adrenal function and individualized glucocorticoid replacement therapy 3, 4, 5
• Clinicians should be aware of the potential for development of adrenal insufficiency or symptoms of glucocorticoid excess in patients receiving prednisone, and modify glucocorticoid dosing accordingly 5