Short-Term and Long-Term Side Effects of Prednisone

Prednisone is a widely used prescription corticosteroid. It is a commonly used anti-inflammatory and immunosuppressive medication. It may be used in the treatment of conditions such as rheumatoid arthritis, severe allergic reactions, lupus, and multiple sclerosis, among other conditions.¹

The medication is taken by mouth, either as a tablet or oral solution,¹ and it is available in both immediate-release or delayed-release formulations.^2,3

What Are the Side Effects of Prednisone?

Though it’s a valuable pharmacotherapeutic used in a number of medical situations, prednisone has several significant side effects—especially if used in large amounts or for sustained periods of time. Side effects can range from mild to severe, and they may worsen over time, especially with higher doses of the medication.⁴

Side effects may include:^1,5

• Personality/mood changes.
• Insomnia.
• Headache.
• Dizziness.
• Fatigue.
• Muscle weakness.
• Increased growth of hair.
• Heartburn.
• Weight gain.
• Changes in fat distribution through the body.
• Skin changes (increased thinness and fragility and/or red or purple blotches or lines under the skin).
• Sweating.
• Onset of acne.
• Slower healing of wounds.
• Irregular periods or amenorrhea in women.
• Lowered sexual interest.

Some side effects may be more serious, including:^1,5,6

• Hyperglycemia (increased blood glucose level).
• Dyslipidemia.
• Increased susceptibility to infections.
• Bone loss, osteoporosis, and increased fracture risk.
• Stunted growth (in children).
• Gastrointestinal inflammation.
• Nausea and/or vomiting.
• Stomach pain.
• Ulcers.
• Hacking cough.
• Very high blood pressure, which may lead to:
  • Severe headache.
  • Shortness of breath.
  • Confusion.
  • Arrhythmias.
  • Eye problems, including blurred vision.
• Numbness or tingling in face and extremities.
• Twitching of the muscles.
• Uncontrollable shaking of the hands.
• Seizures.
• Depression.
• Psychotic symptoms/loss of touch with reality.

How Does Prednisone Interact with Other Drugs?

Prednisone may negatively interact with other medications, both over-the-counter and prescription. Because prednisone is associated with a risk of gastrointestinal ulceration, patients are advised to avoid taking it in combination with aspirin or other NSAIDs.^4,6 Other drug interactions include the following:

• Because prednisone may increase blood sugar, individuals taking diabetic agents may require a dose adjustment of the antidiabetic medication.⁴
• Patients taking both cyclosporine, an immunosuppressant, and prednisone have been reported to suffer convulsions.⁴
• Prednisone can inhibit the body’s response to anticoagulants, such as warfarin.⁴
• Oral birth control may increase the effects of prednisone.⁴

Prednisone may also interfere with the body’s normal response to vaccines, making them less effective. ⁴ Your doctor can evaluate the potential impact of these drug combinations to make a recommendation for your specific treatment plan needs.

What Risks Are Associated with Use?

There may be some negative risks associated with even short-term use of corticosteroids like prednisone. One study noted that over a 3-year period, approximately 1 in 5 Americans used an oral corticosteroid for less than 30 days. This short-term use of corticosteroids increased the risk of sepsis, venous thromboembolism, and bone fractures even at low doses.⁷

Another concern with the use of prednisone is that some of the conditions that the drug treats are long-term chronic conditions, such as rheumatoid arthritis or asthma, but long-term use of prednisone continues to increase the risk of negative side effects. This puts many patients and doctors in a difficult position, as they need the medication to manage the symptoms of chronic conditions, but they may end up with other problems due to long-term use of the drug.⁷

Corticosteroid therapy is the first line of treatment for several inflammatory conditions and, in some cases, may be the only appropriate treatment option. Your doctor can discuss the risks and benefits of prednisone with you.

References:

1. U.S. National Library of Medicine. (2015). Prednisone.
2. (n.d.). Prednisone (Rx).
3. Alten R, Grahn A, Holt RJ, et al. Delayed-release prednisone improves fatigue and health-related quality of life: findings from the CAPRA-2 double-blind randomised study in rheumatoid arthritis. RMD Open 2015(1), e000134.
4. Horizon Pharma. (2012). Rayos (prednisone), Highlights of Prescribing Information.
5. Puckett Y, Bokhari AA. Prednisone. [Updated 2019 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
6. University of Maryland Medical Center. (n.d.). Taking Prednisone.
7. Waljee Akbar K, Rogers Mary A M, Lin Paul, Singal Amit G, Stein Joshua D, Marks Rory M et al. (2017). Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ, 357:j1415.