9+ Worst Side Effects of Prednisone

Prednisone, a commonly prescribed corticosteroid, is known for its effectiveness in treating a variety of conditions, from autoimmune diseases to severe allergies. However, its use is not without significant side effects. With personal experience, I compiled a list of the nine worst side effects of prednisone, ranked from least to worst based on patient perceptions and clinical impact.

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9th Worst Side Effect

Sleep Disturbance (Insomnia)

Ranked as the ninth worst side effect, sleep disturbance is a common issue for those on prednisone. Patients often report difficulty falling asleep or staying asleep, which can lead to fatigue and decreased quality of life.

8th Worst Side Effect

Skin Thinning and Easy Bruising

Prednisone can cause the skin to become thin and fragile, making it more susceptible to bruising. This side effect, while not life-threatening, can be distressing and impact daily activities.

7th Worst Side Effect

Infection

The seventh worst side effect is an increased risk of infection. Prednisone suppresses the immune system, making it harder for the body to fight off infections. Patients need to be vigilant about hygiene and avoid exposure to contagious illnesses.

6th Worst Side Effect

Cardiovascular Disease

Ranked sixth, cardiovascular disease is a serious concern for long-term prednisone users. The medication can lead to high blood pressure, increased cholesterol levels, and other heart-related issues.

5th Worst Side Effect

Hyperglycemia (Diabetes)

Prednisone can cause elevated blood sugar levels, or hyperglycemia, which is particularly concerning for patients with diabetes. Monitoring blood sugar levels and adjusting medications as needed is crucial.

4th Worst Side Effect

Bone Loss

Bone loss, leading to osteoporosis and fractures, is the fourth worst side effect. Long-term use of prednisone can weaken bones, making them more prone to breaks and fractures. Patients are often advised to take calcium and vitamin D supplements to mitigate this risk.

Top Three Worst Side Effects According to Patients

3rd Worst Side Effect

Mood Changes

Mood changes, including anxiety, depression, and irritability, are the third worst side effect. These psychological effects can be challenging to manage and significantly impact a patient’s mental health and relationships.

2nd Worst Side Effect

Weight Gain

Weight gain is the second most common complaint among prednisone users. The medication can increase appetite and cause fluid retention, leading to noticeable weight gain.

1st (Top) Worst Side Effect

Fat Redistribution (Moon Face)

The most perceived worst side effect is fat redistribution, commonly known as “moon face.” This condition causes fat to accumulate around the face, leading to a rounded appearance. Moon face can severely affect a patient’s self-image and confidence.

This article emphasizes the importance of managing these side effects to improve the quality of life for prednisone users. You can download the Prednisone checklist to help patients avoid common mistakes and mitigate side effects.

References:

Black RJ, Goodman SM, Ruediger C, Lester S, Mackie SL, Hill CL. A Survey of Glucocorticoid Adverse Effects and Benefits in Rheumatic Diseases: The Patient Perspective. J Clin Rheumatol. 2017 Dec;23(8):416-420. doi: 10.1097/RHU.0000000000000585. PMID: 28926469.
Yardimci GK, Pagnoux C, Stewart J. A Canadian vasculitis patient-driven survey to highlight which prednisone-related side effects matter the most. Clin Exp Rheumatol. 2023 Apr;41(4):943-947. doi: 10.55563/clinexprheumatol/ef9nda. Epub 2023 Mar 27. PMID: 36995315.
Strehl C, Bijlsma JW, de Wit M, Boers M, Caeyers N, Cutolo M, Dasgupta B, Dixon WG, Geenen R, Huizinga TW, Kent A, de Thurah AL, Listing J, Mariette X, Ray DW, Scherer HU, Seror R, Spies CM, Tarp S, Wiek D, Winthrop KL, Buttgereit F. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis. 2016 Jun;75(6):952-7. doi: 10.1136/annrheumdis-2015-208916. Epub 2016 Mar 1. PMID: 26933146.