What Are Prednisone Side Effects?

Prednisone is an inexpensive and effective corticosteroid drug that is frequently used to treat acute flare-ups of inflammatory bowel disease (IBD). While prednisone provides rapid relief, side effects are common and can occasionally be intolerable. These include insomnia, mood changes, abnormal hair growth, fatigue, thinning of the skin, and acne.

What Is Prednisone?

Prednisone is a man-made version of a hormone called cortisol that is naturally secreted by the adrenal glands. By mimicking cortisol (a hormone that helps regulate the immune response), prednisone can temper inflammation associated with many conditions, including IBD.

Prednisone is a type of immunosuppressant. While the drug can be beneficial to people with autoimmune or immune-mediated diseases by blunting the exaggerated immune response, doing so can leave a person vulnerable to other infections.

Prednisone is associated with a long list of potential side effects. Many are manageable, particularly during the early stages of treatment. However, more serious side effects can develop after months or years of use.

Common Side Effects

Because prednisone can alter the balance of hormones in the body, metabolic side effects can develop that affect everything from your skin texture to your brain and digestive function. Many of these side effects are reversible once the treatment is stopped; some (like the thinning of the skin) may not be.

Some of the more common side effects associated with prednisone use include:

• Acne
• Headache
• Dizziness
• Insomnia
• Heartburn
• Increased sweating (hyperhidrosis)
• Irregular periods or no periods (amenorrhea)
• Chronic fatigue
• Bulging eyes (proptosis)
• Facial puffiness ("moon face")
• Thinning of skin (skin atrophy)
• Spider veins (telangiectasia)
• Easy bruising
• Impaired healing
• Abnormal hair growth (hirsutism)
• Muscle weakness
• Irregular or missed periods (amenorrhea)
• Reduced sex drive (low libido)
• Weight gain and obesity
• Worsening of diabetes
• Increased risk of infection

Severe Side Effects

The risk of severe side effects tends to increase the longer you take prednisone. The prolonged use (or overuse) of prednisone is associated with an increased risk of the following side effects:

• Painful burning or tingling sensations in the hands or feet (peripheral neuropathy)
• Severe depression
• Changes in behavior
• Uncontrollable muscle twitching or stiffening
• Changes in body fat distribution (lipodystrophy)
• Uncontrollable hand tremors
• Vision problems (including glaucoma and cataracts)
• Stunting of growth in children
• Irregular heartbeat (arrhythmia)
• Difficulty swallowing (dysphagia)
• Stomach ulcers
• Seizures

Risk of Infection

Because of prednisone's immunosuppressant properties, people taking the drug are at increased risk of certain infections. These may be infections you acquire from others or the reactivation of infections that you were previously able to control.

The risk of infection increases with the dose or duration of therapy and may include:

• Bacterial skin infections
• Pneumonia, both bacterial and fungal
• Shingles (herpes zoster virus)
• Surgical site infection
• Tuberculosis

The risk of other types of infection may also increase, particularly if there is underlying immunosuppression.

Discontinuing Treatment

Prednisone should not be stopped suddenly as doing so can lead to a serious condition known as an adrenal crisis. Because the adrenal glands have been effectively "off duty" due to ample supplies of the cortisol substitute, stopping suddenly can leave your body without enough to function properly.

Symptoms of an acute adrenal crisis include:

• Headache
• Fatigue
• Nausea or vomiting
• Dizziness or fainting
• Severe stomach pain
• Weakness
• Confusion

Severe cases can lead to hypovolemic shock, coma, and even death. To avoid this, the prednisone dose should be decreased gradually over a period of time.

A Word From Verywell

Prednisone can be a very effective drug if used appropriately. If your healthcare provider prescribes prednisone, take the drug as directed, neither altering the dose or duration of therapy.

If you experience any side effects or have signs of infection, let your healthcare provider know without delay. Never stop treatment or reduce the dose because it "makes you feel better." Doing so may not only undermine the aims of treatment but trigger a potentially serious adrenal crisis.