Can prednisone (corticosteroid) cause tingling sensations in the hands?

Can Prednisone Cause Tingling in the Hands?

Yes, prednisone can cause tingling sensations in the hands as a neurologic adverse effect, though this is not among the most commonly reported side effects. 1

Evidence from FDA Drug Labeling

The FDA-approved prescribing information for prednisone explicitly lists paresthesia (abnormal sensations including tingling) and neuropathy among the neurologic adverse reactions associated with corticosteroid therapy. 1 Other neurologic effects documented include:

• Neuritis (nerve inflammation) 1
• Ischemic neuropathy 1
• Peripheral neuropathy 1
• Vertigo and dizziness 1

Clinical Context and Mechanism

While tingling is a recognized adverse effect, it's important to understand the broader context:

• Electrolyte disturbances caused by prednisone—particularly hypokalemia (low potassium)—can manifest as paresthesias and tingling sensations 1
• Fluid retention and edema, which occur commonly with corticosteroids, may cause nerve compression leading to tingling 1
• Direct neurotoxic effects on peripheral nerves have been documented 1

Differential Diagnosis Considerations

Before attributing tingling solely to prednisone, consider the underlying condition being treated:

• If prednisone is being used for inflammatory neuropathy (such as chronic inflammatory demyelinating polyradiculoneuropathy), the tingling may represent the underlying disease rather than a drug side effect 2, 3
• Inflammatory conditions affecting nerves may cause paresthesias that improve with corticosteroid treatment 2

Frequency and Risk Factors

• Hypersensitivity reactions to corticosteroids, which can include neurologic symptoms, occur in approximately 0.3-0.5% of patients 4
• Long-term corticosteroid use is associated with more serious neurologic sequelae compared to short-term use 5
• Higher doses and prolonged duration of therapy increase the risk of adverse neurologic effects 5

Management Approach

If a patient on prednisone develops new tingling in the hands:

• Check serum electrolytes, particularly potassium, to rule out hypokalemia 1
• Assess for fluid retention and edema that might cause nerve compression 1
• Evaluate whether symptoms represent progression of the underlying disease versus a drug effect 2
• Consider whether the patient is experiencing other corticosteroid-related neurologic effects (dizziness, weakness, cognitive changes) 1
• Monitor for signs of more serious neurologic complications if symptoms persist or worsen 1

Common Pitfalls

• Assuming all new symptoms during prednisone therapy are drug-related when they may represent inadequately treated underlying disease 2
• Failing to check electrolytes when paresthesias develop, as hypokalemia is a correctable cause 1
• Not recognizing that neurologic side effects may be dose-dependent and potentially reversible with dose reduction 5