From the Guidelines
Prednisone can cause significant weight gain, particularly with long-term therapy and at daily dose-equivalent exposures of >5 mg prednisolone. This is due to its impact on body composition, resulting in central deposition of adipose tissue, increased appetite, insulin resistance, and catabolic effects on bone and muscle 1. The risk of weight gain is a major concern for patients, often influencing their decision to accept or decline glucocorticoid therapy, despite the potential benefits 1.
Common Side Effects
Some common short-term side effects of prednisone include:
- Increased appetite
- Weight gain
- Fluid retention
- Mood changes, such as irritability, anxiety, and euphoria
- Insomnia
- Elevated blood sugar
- Increased susceptibility to infections
Serious Side Effects
With prolonged use, prednisone may cause more serious effects, including:
- Osteoporosis
- Adrenal suppression
- Muscle weakness
- Thinning skin
- Easy bruising
- Cataracts
- Glaucoma
- High blood pressure
- Diabetes
- Cushingoid features, such as round face, buffalo hump, and central obesity
- Slow wound healing
Monitoring and Management
It is essential for the treating physician to monitor patients for potential corticosteroid side effects, including hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis 1. An assessment of health-related quality of life (HRQoL) should also be conducted to evaluate the impact of corticosteroids on mental health, including depression, fatigue, and mental status 1. Patients should never stop taking prednisone abruptly, as this can cause adrenal crisis, and should instead follow a tapering schedule as directed by their healthcare provider.
From the FDA Drug Label
Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection 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 Prednisone can cause
- Infections
- Allergic reactions
- Cardiovascular problems
- Dermatologic issues
- Other adverse reactions, including endocrine, metabolic, and musculoskeletal problems 2, 2
From the Research
Potential Side Effects of Prednisone
- Osteoporosis: Prednisone can cause osteoporosis, particularly with long-term use 3, 4.
- Bone Mineral Density (BMD) Changes: Studies have shown that prednisone can lead to significant changes in BMD, particularly in the femoral neck, trochanter, and total hip 3.
- Increased Risk of Fracture: The overproduction of cortisol, such as in Cushing's disease, can lead to a dramatic reduction in bone density and an increased risk of fracture 5.
- Effects on Bone Metabolism: Glucocorticoids, such as prednisone, can have powerful effects on bone metabolism, including changes in bone growth and development 5.
- Adrenal Androgen Effects: Adrenal androgens, which can be affected by prednisone use, can also have significant effects on bone health, particularly in women 6, 5.