Which Side Effects are Worse on Prednisone 20 mg Tablets?

If your doctor prescribed a prednisone 20 mg tablet or higher, then you’ve been given a high dose. So which prednisone side effects get worse the higher the dose? In this article, I will share the side effects to expect at higher doses of prednisone (prednisone 20 mg dosage, prednisone 40 mg, and prednisone 50 mg tablets) according to the five most comprehensive pharmacy databases.

My High Dose Prednisone Experience

First, I want to share my personal experience taking high doses of prednisone and other steroids. Because my immune system killed off so many of my blood platelets, doctors worried I could bleed to death. In the hospital they started with prednisone 60 mg, given as three prednisone 20 mg tablets. That only worked for a week to boost my platelets until they started to crash again.

Prednisone Failed

So the hematologist prescribed another steroid, dexamethasone. I took #10 of the highest strength dexamethasone tablets each day for three days. The dose of dexamethasone I took equals approximately 267 mg of prednisone. Eventually, that failed as well, so my doctor started me on a slow taper down from prednisone 60 mg.

Tapering Roller Coaster

They pricked my arm each week to check my platelet level and decide whether I could continue tapering or whether I needed to go back up to a higher dose. I rode that roller coaster of blood draws for six months before they eventually resorted to chemotherapy which cured my problem, at least for now. Then I finished tapering off prednisone after nine months of high-to-low doses of prednisone.

Research: Side Effects of Prednisone

Even though I’m a pharmacist, I wanted to know which adverse effects of prednisone to really expect. Surprisingly, this is a tough answer to find! There is no comprehensive list of adverse effects of prednisone–each one is a little different.

I made it my mission to compile all this research into a complete list of side effects to prednisone. I searched the following well-respected top 5 databases for their list of prednisone side effects:

1. The package insert published by the drug manufacturers and found at the United States National Institutes of Health’s DailyMed website.
2. Clinical Pharmacology, the most comprehensive pharmacy database available today.
3. Lexicomp
4. Micromedex
5. UpToDate, the most relied-upon medical database by doctors.

Side Effects Not Consistent

Each database listed certain side effects of prednisone and some listed more than others. Clinical Pharmacology listed the most side effects, and Micromedex listed the least. This list below includes the side effects that the databases labeled high dose but with no definition of which dose means high between them all. If prednisone were a newer drug, the tests would have shown the percentage of patients that experience that side effect. However, the U.S. FDA grandfathered in prednisone, discovered in 1955, so that kind of rigorous testing is absent.

For some of the side effects, the databases listed when it is most common, such as at high doses or when taken long-term. I included both the scientific name that they listed plus my simplified version of that term. Sometimes the databases listed similar but different terms, which I lumped together to simplify the list down to 150 total side effects. The list below includes the top 11 side effects to prednisone 20 mg tablets and higher doses, such as prednisone 40 mg and up.

High Dose Prednisone Side Effects

The Side Effects of Prednisone 20 mg, Listed by All Five Databases

1. Fluid Retention. Many patients complain of retaining water and possible swelling of legs or joints. Prednisone has mineralocorticoid effects that lead to increased plasma volume. This means the body has extra liquid in the blood for the heart to pump. Another word for this is lower extremity edema or leg edema.
2. Hypertension. Also known as high blood pressure, this common side effect of prednisone happens most at high doses and while on long-term treatment. The fluid retention can lead to high blood pressure since it makes it harder for the heart to push the extra blood.
3. Psychosis. The higher the dose, the more likely for a person to feel crazy on prednisone. Other terms listed include psychotic disorder, psychosis, schizophrenic reactions, mania, hypomania, hallucinations, or delirium. It’s not you, it’s the drug causing this.

The Side Effects of Prednisone 20 mg, Listed by Four Databases

1. Psychiatric Disturbance. Building off the last side effect, these two side effects are further mental complications from prednisone. In comparison, this is more minor than full-blown psychosis.
2. Severe Depression. At high doses, a person has a 10% risk of depression. Depression happens more often the longer a person is on prednisone, where mania is more likely at shorter time periods of prednisone.

The Side Effects of Prednisone 20 mg, Listed by Three Databases

1. Cardiovascular Disease. These common heart disease complications from prednisone range from minor to severe, even causing death (which is extremely rare). The medical terms listed include the following cardiovascular events: left ventricular rupture, angina, angioplasty, coronary revascularization, stroke, transient ischemic attack, cardiomegaly, arrhythmia exacerbation, ECG changes, hypertrophic myopathy, pulmonary edema, cardiovascular death, and all-cause mortality.

The Side Effects of Prednisone 20 mg, Listed by Two Databases

1. Heart Rhythm Changes. Also known as palpitations, arrhythmia, sinus tachycardia, bradycardia, many people on prednisone wonder whether the strange “skipped a beat” feeling or hand tremors are normal. Some heart rhythm changes are minor, but others can be life-threatening.
2. Fat Abnormalities. Prednisone causes the body to move fat around, called redistribution of body fat. Fat moves to the face, belly and back of neck, leading to the not-so-flattering terms moon face, truncal obesity, and buffalo hump, respectively. The higher the dose, the rounder the face, also known as a dose-dependent change. Moon face often happens within two months.
3. Sugar. Hyperglycemia, or a simpler term, high blood sugar, describes how prednisone messes up normal metabolism. This leads to higher fasting glucose levels, especially after meals (postprandial). At doses over 30 mg, the relative risk is 10.3, which means you have a ten times greater risk of high blood sugar while on prednisone 30 mg and greater than if you never took prednisone.
4. Brain. Prednisone causes brain fog, forgetfulness, and an overall feeling of confusion. The higher the dose, the greater risk for amnesia, dementia, and memory impairment. One one source listed as a 1% risk of permanent memory impairment

The Side Effect of Prednisone 20 mg, Listed by One Database

1. Immunosuppression. While listed as a side effect, often this is the purpose for which the doctor prescribed prednisone. To treat many autoimmune conditions, doctors prescribe prednisone to weaken the immune system’s overactive response. This is more common the higher the dose.

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Watch this Video for a Summary of the Side Effects of Prednisone 20 mg Tablets

What You Can Do About the Side Effects of Prednisone 20 mg

These side effects of prednisone 20 mg and greater dosages, listed by the drug databases can cause immense suffering to patients taking prednisone. Despite the irreversible nature of many of these side effects, many of them can be prevented. But most people don’t know what they can do to fight back.

That’s why I created the Prednisone Checklist.

Get access to this valuable list of the top 15 adverse effects of prednisone and what you can do about it.

• Discover how to avoid the top 7 mistakes prednisone patients make.
• Find my top 25 tips for coping with prednisone side effects.