The Top 10 Prednisone Side Effects (#1 Might Surprise You)

I surveyed over 150 people taking prednisone and asked them to describe their worst side effects. The #1 answer isn’t what doctors usually warn you about—but it’s what patients struggle with most.

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I recently had the opportunity to attend a Harvard Medical Conference focused on polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). In preparation, I surveyed my audience—over 150 people taking prednisone, mostly for PMR and GCA—and asked them a simple question:

What are your worst prednisone side effects?

The responses were heartbreaking, validating, and incredibly revealing. I analyzed every answer, ranked them by frequency, and discovered that the side effect patients struggle with most is rarely the first thing doctors mention.

In this article, I’m counting down from #10 to #1, sharing exactly what patients said (in their own words), why each side effect is so devastating, and what’s happening in your body to cause it.

If you’re on prednisone right now and feeling alone in this struggle, I want you to know: You’re not imagining these side effects. They’re real, they’re documented, and you’re not alone.

#10: Blood Sugar Changes and Pre-Diabetes

What Patients Said:

“I’ve gained 55 pounds now, have high cholesterol, and I’m pre-diabetic.”

“I’ve been battling both those conditions from taking prednisone so long.”

“My A1C jumped to the pre-diabetic range.”

“I never had blood sugar issues before prednisone.”

Why This Is Devastating:

You’re essentially adding another chronic condition on top of the one you already have. Now you’re managing your original autoimmune or inflammatory disease plus diabetes or pre-diabetes.

This comes with dietary restrictions, possibly more medications (with their own side effects), and long-term complications affecting your vision, kidneys, nerves, fingers, and toes.

Why This Happens:

Prednisone is a glucocorticoid—”gluco” literally means glucose or sugar. It fundamentally changes how your body metabolizes sugar, proteins, and fats.

Specifically, prednisone causes:

• Insulin resistance (your cells stop responding to insulin properly)
• Increased glucose production by your liver
• Depletion of chromium, which is vital for glucose regulation

The higher your dose and the longer you take it, the greater your diabetes risk.

#9: Muscle Weakness and Muscle Loss

What Patients Said:

“I used to be strong. Now I struggle with simple things.”

“My legs feel like noodles.”

“I can’t lift things I used to be able to carry easily.”

“I have muscle cramps.”

Why This Is Devastating:

This side effect robs you of independence. You need help with basic tasks. You feel weak and vulnerable. You’re afraid of falling. You can’t do activities you used to enjoy.

Why This Happens:

What you’re experiencing is called proximal muscle weakness—difficulty going from standing to sitting, climbing stairs, or lifting your arms over your head.

There’s actual muscle atrophy happening. This happened to me when I was on prednisone. My arms and legs were visibly shrinking while my belly got bigger and my face got rounder. It’s the stereotypical “watermelon on toothpicks” appearance.

Prednisone is what’s called a catabolic steroid. It breaks down muscle protein and converts it into glucose. At the same time, it’s depleting potassium and other nutrients your muscles need to function properly, and it’s interfering with your body’s ability to build new protein.

#8: Insomnia (The 2 AM Torture)

This was my personal #1 side effect.

What Patients Said:

“Sleeplessness. Either I can’t go to sleep or I sleep till 2 to 3 AM and then wide awake.”

“I haven’t slept more than two to three hours a night in months.”

“I’m wide awake at 2 AM again Googling ‘prednisone insomnia help.'”

“The insomnia was terrible.”

Why This Is Devastating:

This isn’t just “I can’t sleep.” This is specific, cruel, predictable insomnia that happens every night for months or years.

For me and many others, you fall asleep okay—but then at 2 or 3 AM, you’re wide awake. Your mind is racing. You’re absolutely certain the world is falling apart, or you’re obsessing over problems that feel insurmountable in the dark.

Sleep deprivation is literal torture. After weeks of this, you’re functionally impaired. Studies show you’re worse than a drunk driver. It’s impossible to maintain a happy, healthy mood. You go through emotional roller coasters and anxiety spikes. You can’t think clearly. Your family is upset because you’re cranky all the time.

Why This Happens:

Prednisone mimics cortisol, which is our “wake up” hormone. Cortisol naturally follows a cycle similar to the sun—it rises first thing in the morning, then slowly decreases throughout the day until it’s nearly gone by sunset.

Prednisone replaces that natural rhythm with way higher amounts of cortisol than your body could ever naturally produce. This turns off your melatonin-producing system.

Melatonin is your “sleep hormone”—what makes you feel calm, restful, and able to fall asleep and stay asleep. Your brain thinks it’s 7 AM at 2 AM.

This was the worst side effect for me personally, which is exactly why I felt driven to create Nutranize Zone. It has a morning and a bedtime bottle to support you while you’re on prednisone. The bedtime bottle specifically contains melatonin to replenish what prednisone steals, plus other ingredients to help you feel calm and rested at night.

It’s the #1 reason people love Nutranize. So many tell me, “I finally can sleep again. I’m sleeping better than I have in years.”

The morning bottle helps with other side effects too—it contains chromium to support healthy blood sugar and help prevent ongoing muscle loss.

Try Nutranize Zone for $25 off →

#7: Brain Fog and Memory Loss

What Patients Said:

“I’m not myself mentally.”

“I feel like I’m in a fog all the time.”

“I’m feeling lightheaded, foggy, off in a cloud.”

“I can’t think straight. I used to be sharp and now I feel dull.”

Why This Is Devastating:

Your brain feels like it’s wading through mud. You can’t think clearly, process information properly, or remember things that used to be easy.

You doubt yourself. Your work suffers. Your relationships suffer because you can’t engage in conversations the way you used to.

Why This Happens:

Prednisone affects the memory center of your brain called the hippocampus. At the same time, it’s disrupting your sleep (which is crucial for memory consolidation), and it’s depleting B vitamins that you need for proper nerve function.

#6: Skin Issues (Fragile and Visible)

What Patients Said:

“I have purple spots.”

“My skin tears if I bump into something.”

“I bruise if someone just touches me.”

“I look older. My skin looks terrible.”

Why This Is Devastating:

Other things you might notice: easy bruising, skin tearing, thinning skin where you can see your veins easily with a crepe-paper texture, poor wound healing (cuts can take months to heal), stretch marks from rapid weight gain, adult acne breakouts, and a red flushed face (which I also experienced).

The sad news: The skin thinning is often permanent. The stretch marks from rapid weight gain and collagen destruction can be permanent. The bruising eventually goes away, but the damage to your skin’s structure may not fully reverse.

Why This Happens:

Prednisone causes collagen breakdown, which thins the dermis layer of your skin, weakens your capillaries, and impairs wound healing. The loss of vitamin C caused by prednisone accelerates all of these changes.

#5: Bone Loss Concerns (The Silent Emergency)

What Patients Said:

“My bone density dropped 18% in one year.”

“Already been diagnosed with osteoporosis, and I’m only on year two.”

“She has moon face and is very worried about bone loss.”

“I’ve been battling osteoporosis from taking prednisone so long.”

Why This Is Devastating:

This one is called the “silent emergency” because you can’t feel your bones weakening until they’re so compromised that they break. The fear of invisible damage and permanent complications is constant.

This is such a predictable side effect that the doctors who prescribe prednisone most—rheumatologists—actually have an entire guideline about it: the Glucocorticoid-Induced Osteoporosis Guideline by the American College of Rheumatology.

But here’s the problem: Even though there’s a guideline, that doesn’t mean doctors are actually following it.

Doctors should be recommending calcium and vitamin D, ordering a DEXA scan to check your bone density, and preparing you for this risk. But surveys show that less than half of doctors who prescribe prednisone ever follow up about osteoporosis.

Comment below if your doctor mentioned osteoporosis when they prescribed prednisone—was it the first appointment, years later, or never?

This is another reason I created Nutranize Zone. It contains calcium, vitamin D, magnesium, and vitamin K2—all designed to support your bones while on prednisone to meet that guideline, especially if your doctor hasn’t been helping you with it.

#4: Personality Changes and Mood Swings (Personality Theft)

What Patients Said:

Jack’s entire survey response was just three words: “It changed me.”

Peggy said: “The rage. Either yelling, swearing, or crying. I find myself hiding away so I don’t bring on a stroke.”

Jill said: “I snap at my family and have an incredibly short fuse. I have a lot of difficulty finding joy. I prefer being alone. I feel like I’m missing out on the joys of life and family, which makes me profoundly sad.”

Another patient: “My husband says I’m not myself anymore. I hate who I’ve become. I’m hiding from my family because of the rage.”

Why This Is Devastating:

You become someone you don’t recognize emotionally. Your family says you’re not yourself. You feel hijacked.

I can’t tell you the number of people who’ve called me in crisis—their spouse is divorcing them, they’re losing custody of their children, they’ve lost their jobs, they’re facing legal consequences—all because of what prednisone did to their personality and mood.

Why This Happens:

This is not you being difficult. This is actual brain chemistry disruption.

Prednisone affects neurotransmitters—serotonin, dopamine, GABA—that regulate mood, impulse control, and emotional stability. You can’t just “control your attitude” through willpower alone. This is biological.

The Top 3: The Most Common Prednisone Side Effects

We’re now down to the top three most commonly reported side effects from the survey. These are the ones patients struggle with most.

#3: Fatigue and Unpredictable Energy Crashes

What Patients Said:

Deborah: “Exhaustion is awful and each day is different. I can’t plan anything as I don’t know how I’ll feel.”

“I’m exhausted all day, and then I can’t sleep at night.”

“I’ve had to cancel so many plans.”

“I used to be active. Now I can barely make it through the day.”

Why This Is Devastating:

This isn’t normal tiredness. This is bone-deep, unpredictable exhaustion that makes planning life feel impossible.

So many people tell me: “I used to do Ironmans. I used to run marathons. I used to train other people. I was the most fit person I knew. Now I can’t do anything and I’m exhausted all the time.”

Why This Happens:

I think this is a combination of prednisone side effects and the disease itself. People with PMR and GCA in particular seem to experience dramatic, disease-related exhaustion.

But there’s also likely an element of what’s coming next at #2—which compounds the fatigue significantly.

#2: The Taper Trap

What Patients Said:

“I cannot taper down past 5 milligrams. I have been doing this for many years.”

“I can’t get below 4 milligrams doing the dead slow taper. How can I get off this horrid medication? I’ve passed the three-year mark of being on prednisone.”

“I’m unable to reduce below 6 milligrams. Feeling lightheaded, foggy, off in a cloud.”

A wife wrote: “Each time he has tried to wean off any further, even by as little as 1 milligram, he has crashed and burned and had to go back up to 10 milligrams.”

“I’m desperate to come off it completely.”

And this one sums it up: “I’m more scared of getting off prednisone than being on it.”

Why This Is Devastating:

The taper trap is this: You take prednisone for a long time, then slowly try to taper down—from 20 to 17 to 15 to 12 to 10 to 9 to 8 to 7 to 6 to 5 to 4… but then your disease flares, and you have to go back up. It’s a roller coaster.

I personally dealt with this. I’d start at 60 mg and taper down over four to six weeks. But usually around week four, my disease would flare, and I’d have to start all over again.

The taper trap reminds me of what someone struggling with infertility might feel every month—that cycle of hope (“It’s going to work this time!”) followed by crushing disappointment (“It didn’t work. I have to start all over.”).

That’s exactly how tapering prednisone feels. You’re tapering down, getting closer to freedom, thinking “This time it’s going to work”—and then your disease flares. The hope is lost. The frustration is unbearable.

The only way I got through it was switching to a biologic medication called Rituximab. That’s one of my key recommendations: Ask your doctor if there are alternatives to help you get through this.

Why This Happens:

After weeks on prednisone, your adrenal glands (which sit on top of your kidneys) stop making cortisol on their own. They’re part of the HPA axis—the hypothalamic-pituitary-adrenal axis—and the whole system essentially shuts down because you have so much prednisone replacing natural cortisol.

Your body basically says, “Oh, I don’t have to do my job anymore. You’ve got this.”

But when you want that system to start working again, your adrenal glands need time to wake up. And everybody’s body is different in how long that takes.

You’re dealing with withdrawal symptoms: fatigue, dizziness, body aches, nausea. And it’s really hard to distinguish between a disease flare, withdrawal symptoms, or another illness (like the flu).

There’s no perfect, scientifically clear way to taper prednisone that works for everyone. It’s as much an art as a science—listening to your body, paying attention to symptoms, going back up when you have to, and asking for alternatives when possible.

You feel trapped. Your doctor might have promised it would be 4-6 weeks. Maybe they said 12-18 months. But it becomes 3 to 5 to 10 years of treatment. You get stuck at 5 mg (a very common sticking point), and you can’t seem to get lower.

#1: Weight Gain (Where and How Fast You Gain It)

And here we are—the #1 most commonly reported prednisone side effect.

What Patients Said:

“I don’t recognize myself in the mirror. I’ve gained 55 pounds now. I have high cholesterol and I’m pre-diabetic.”

“Will my face ever be less round? I have moon face and I’m very worried about bone loss.”

“I’ve gained 40 pounds in four months. Nothing works to lose it. I avoid mirrors because I don’t recognize my face.”

Why This Is Devastating:

This isn’t vanity. This is identity theft.

It’s not just that you gain weight—it’s where you gain it and how fast. Prednisone redistributes fat in the most unflattering way possible, making you feel unrecognizable even to yourself.

You lose yourself visually. Family members do double takes. One guy told me he ran into an acquaintance who said, “Hey, I know your brother!” He had to explain, “No, that’s actually me.”

You avoid photos. You might become socially isolated because you’re embarrassed about your new appearance.

Why This Happens:

Prednisone causes:

• Moon face: Redistribution of fat onto your face, making it puffy and round
• Buffalo hump: Fatty deposit between your shoulders and neck
• Central obesity: Most people gain belly fat rapidly
• Thin arms and legs: Fat redistributes away from limbs to your trunk and face

For me, I had just finished losing my pregnancy weight—and then suddenly I had a belly again without a baby inside.

It’s rapid onset despite diet and exercise. While it doesn’t happen to everyone, this was the #1 side effect patients complained about in the survey.

Why is this happening?

Prednisone:

• Increases your appetite by manipulating hunger hormones (turning off the “I’m full” hormone and turning on the “I’m still hungry” hormone)
• Changes fat storage patterns
• Causes fluid retention (so it’s not just fat—it’s also water weight)
• Slows your metabolism

Diet and exercise do help, but they don’t fully counteract these hormonal changes. This is not about willpower alone.

5 Bonus Side Effects That Didn’t Make the Top 10

Before I wrap this up, here are five additional side effects that patients mentioned frequently:

#11: Dizziness and Balance Issues – This one surprised me with how common it was.

#12: Vision and Eye Problems – Glaucoma and cataracts can develop from prednisone use.

#13: Excessive Sweating – Night sweats, hot flashes, and profuse sweating. I experienced this one myself, and I hear about it constantly.

#14: Digestive Issues – Interestingly, I rarely hear about digestive problems, so it was surprising this made the list.

#15: Immune System Concerns – Prednisone increases your risk for pneumonia, sepsis, and other infections. It’s a powerful immunosuppressant (which is why I took it—to turn down my overactive immune system). But that means you’re more vulnerable to infections and wound healing is slower.

How These Side Effects Compound Each Other

Here’s what’s crucial to understand: These aren’t isolated side effects.

You might have noticed in the patient quotes that the same people were mentioned multiple times, describing multiple side effects. That’s because they’re all interconnected:

• Insomnia worsens your mood
• Mood swings lead to brain fog and fatigue
• Fatigue lowers your tolerance and willpower, so you eat more and gain weight
• Exhaustion means you can’t exercise, which worsens weight gain, muscle loss, and bone loss
• Weight gain worsens your mood, increases diabetes risk, and strains your joints
• Mood changes damage relationships, increasing isolation and worsening mental health
• Brain fog affects your work, increasing stress and worsening all symptoms
• Fear of bone loss creates constant underlying anxiety, worsening sleep and mood
• And when you can’t taper successfully, you’re stuck with all of these side effects indefinitely

It’s cumulative. You’re not dealing with one side effect at a time. You’re managing 5 to 8 or more significant issues simultaneously while trying to function in daily life, maintain relationships, work, and not lose hope.

You’re Not Alone. You’re Not Imagining This.

If you’re experiencing these side effects, I need you to hear this clearly:

You are not alone. You’re not imagining it. And there are ways to support your body through this.

Not all side effects can be prevented, but many happen or worsen because you don’t know what you don’t know. There are specific things you should probably be avoiding while on prednisone, but no one mentioned them because they never took the time to explain.

In fact, my most popular video on YouTube is “7+ Things to Avoid While Taking Prednisone.” You should watch that next so you know exactly what to avoid and what you can do to minimize these side effects so you can feel as well as possible.

Watch: 7+ Things to Avoid While Taking Prednisone →

Download: The Free Prednisone Checklist →

You deserve to understand what’s happening to your body. You deserve support. And you deserve to know that what you’re experiencing is real, documented, and shared by thousands of others.

Keep fighting, Prednisone Warriors. I’m here with you.