What Are Prednisone Side Effects?

Low cost and rapid relief are two key benefits of Prednisone, a corticosteroid used to treat asthma, inflammatory bowel disease (IBD), and several other conditions. But the list of Prednisone side effects is long, and it's important to be aware of them before and while taking the drug.

Prednisone side effects are common and can include insomnia, abnormal hair growth, fatigue, thinning of the skin, constipation, and more. While some are manageable, others can be intolerable or even permanent. And some that can develop after months or years of use, like swallowing difficulties and irregular heartbeat, can be quite serious.

Because the potential for side effects is high and increases the longer you use the drug, prednisone should only be used on a short-term basis.

This article lists the common and severe side effects of prednisone. It also explains why abruptly stopping prednisone is unsafe.

Common Side Effects of Prednisone

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
• 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

Gastrointestinal Side Effects of Prednisone

Prednisone and other corticosteroids can cause the following gastrointestinal side effects:

• Abdominal distention
• Abdominal pain
• Anorexia which may result in weight loss
• Constipation
• Diarrhea
• Elevation in serum liver enzyme levels (usually reversible upon discontinuation)
• Gastric irritation
• Hepatomegaly
• Increased appetite and weight gain
• Nausea
• Oropharyngeal candidiasis
• Pancreatitis
• Peptic ulcer with possible perforation and hemorrhage
• Perforation of the small and large intestine (particularly in people with IBD)
• Ulcerative esophagitis
• Vomiting
  

Prednisone Side Effects From Long-Term Use

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

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.

These may be infections you acquire from others or the reactivation of infections that your body was 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

You can stop taking prednisone if you are not able to tolerate these side effects, but this should never be done suddenly or without a healthcare provider's guidance.

Prednisone is a man-made version of a hormone called cortisol that is naturally secreted by the adrenal glands. Taking the drug effectively renders these glands "off duty," since it provides the body an ample supply of the hormone.

Abruptly stopping prednisone can lead to a serious condition known as an adrenal crisis. Without prednisone to act as a cortisol substitute, the body may not have enough of the hormone 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.

Tapering Prednisone

To avoid adrenal crisis, a prednisone dose should be decreased gradually over a period of time under the guidance of a healthcare provider.

The tapering schedule for prednisone can vary depending on the dose you were prescribed and how long you were on treatment.

People on long-term therapy often need months to get off the drug completely.

Never alter the prescribed dose or duration of prednisone therapy without your healthcare provider's OK.

Prednisone can be a very effective drug if used appropriately. If your healthcare provider prescribes prednisone, take the drug as directed.

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.