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Adverse Effects of Prednisone – What’s Going to Happen to Me?

Adverse Effects of Prednisone – What’s Going to Happen to Me?

Adverse effects, also known as side effects, are the negative consequences of taking a drug. In this article we will outline the common side effects of taking prednisone.

What is an Adverse Effect?

The term adverse effect is simply the medical term for what is commonly called a side effect. Pharmacology textbooks and medical references will refer to the harms caused by a drug as an Adverse Effect, or an Adverse Drug Event, which is often abbreviated as ADE. Another term is Adverse Reaction, or Adverse Drug Reaction, which may be abbreviated ADR. If you have a notable or terrible side effect to a drug in the U.S.A., you should report it to FDA MedWatch. This is the place where the government monitors whether a drug is causing a surprising side effect that might cause the FDA to take an action such as removing the drug from the market. This happened to Vioxx when it was discovered that many people were suffering heart attacks, strokes, and death after taking Vioxx.

What are the Adverse Effects of Prednisone?

This is a tricky question. There are over 150 side effects to prednisone reported in the medical references, and a list of all 150 is overwhelming. What you really want to know is, what’s going to happen to me if I take prednisone? Right?

Most people who take prednisone experience at least one side effect. There are many other drugs where most people experience zero side effects, such as acetaminophen (Tylenol). Chances are if you take prednisone you will have several side effects. Read below to find out more details:

  • Common Adverse Effects of Prednisone
  • Common Side Effects of Prednisone from Patient Surveys
  • Long-Term Side Effects of Prednisone
  • Worst Side Effects of Prednisone
Here are Dr. Megan’s Side Effects for a quick visual of what you might experience!
Dr. Megan’s side effects to prednisone over her whole body.

Common Adverse Effects of Prednisone

Emotional Side Effects

When first starting prednisone, you may feel euphoria and a lot of energy, “like drinking 3 cups of coffee.” This may go away after taking it for several days. Prednisone may cause emotional roller coasters from easy frustration and rage down to depression. People describe these personality changes as “‘Roid Rage” and you should warn your family, friends, and co-workers that you may not be yourself for a while, and to please be more forgiving than usual.

Find peace knowing it’s not you, it’s the drug, in this article about Psychiatric Side Effects of Prednisone.

Appetite

Many people notice an increased appetite, with unprecedented cravings. People who take prednisone describe it as “you won’t even be hungry but you just want to eat.” This increased appetite can cause weight gain. One study showed an average of 10%. This depends on your dose, as the higher the dose, the more the appetite stimulation. The increased food and sugar eaten can also increase the blood sugar, which can then lead to diabetes. Be careful to use the appetite to eat extra vegetables instead of cookies!

Check out these articles about Prednisone Weight Gain for how it happens and what you can do about it!

Bones

Prednisone is the drug most likely to cause osteoporosis, or thinning of bones, which can lead to broken bones. This tricky side effect cannot be felt like the ‘Roid Rage. Bone loss is silent and undetectable except with medical tests like a DEXA scan or MRI/CT scans of the spine and joints, and even then, it’s hard to detect. According to the doctors who prescribe prednisone the most, rheumatologists, everyone taking prednisone should take calcium and vitamin D to supplement the nutrients being leached from the bones by prednisone. Read more in this article.

Check out my Prednisone Side Effects Make You Feel Old post for more details.

Insomnia

Prednisone is well-known for causing insomnia. Unless the prednisone dose is taken late in the day, it’s less likely to be unable to fall asleep, as to be able to stay asleep. Many people suffering from insomnia from prednisone tell of feeling fully awake after only a few hours of sleep and feel unable to fall back asleep. Prednisone can also cause strange dreams and nightmares.

Check out my 9+ Healthy Sleep Habits post for tips on how to cope.

Heart

Prednisone can affect many aspects of heart health. High blood pressure, or hypertension, is a common side effect of prednisone that can lead to other heart problems. Heart palpitations, arrhythmias, or rhythm changes, can be harmless like a racing heart and trembling hands, or can be more dangerous and rare.

Watch Dr. Megan explain in more detail:

My Adverse Effects to Prednisone

The rest of this article describes in more detail how I created the lists of Adverse Effects of Prednisone.

  • First, I share my personal experience. I took prednisone and you’ll see how it made me feel.
  • Next, I’ll try to show you a complete list. It’s a struggle to find an accurate list of adverse effects.
  • I’ll show you where to find more help and how to find answers to your questions.

My Personal Experience on Prednisone

prednisone side effects illustration by Dr. Megan
Dr. Megan’s side effects to prednisone over her whole body.

This is me. Can you tell? Doesn’t it look just like me, all that crazy curly hair? Oh, those big strong muscles. Just kidding.

This cartoon image is what I felt like while I was on prednisone. We’ll go through each of the side effects to prednisone that I personally experienced, starting at the top.

  • Emotional Roller Coaster: I felt like an emotional roller coaster. I didn’t feel like I was in control of my mood at all. I’d go from happy to sad, really fast. And it felt like it was uncontrollable. Then I’d get really angry, really fast.
  • Blurry Vision: I had blurry eyes. Especially when I woke up in the morning and I’d wonder, “Oh, do I need a new prescription for my glasses?”
  • Muscle Loss: I could see my legs and arms getting skinnier, but it’s not because I was losing fat. I was losing muscle. Prednisone was breaking down all the muscles and I was losing protein.
  • Insatiable Appetite: I felt hungry all the time. If there was a cake, I didn’t want just one slice. I wanted the entire cake. That led to weight gain! And a lot of things led to fat redistribution to my belly. So I had these skinny arms and legs and a big fat belly.

prednisone side effects

 

  • Retain Water Increased Urine: Then I would retain water. Urine was there–like lots all at once. Not a lot for a couple of days. And then–bam!–lots of urine.
  • Bruises that didn’t hurt: They just showed up on my legs and I’d wonder, “Oh, wow there’s a bruise. Where’d that come from?” Is it wasn’t even really a bruise. It just looked like a bruise.
  • Swelling Knees: My knees felt swollen. I know some people’s fingers swell or their feet swell. It was my knees.
  • Impaired Wound Healing: it felt like if I got a cut or if I had to have a procedure or anything, I took forever to heal.
  • Bone Loss: I couldn’t actually feel this, but I knew it was happening because the calcium was being depleted. That’s the number one side effect–it’s osteoporosis.

Long-Term Prednisone Side Effect

Blood Changes on Prednisone

I was taking prednisone for a bleeding disorder. I had to get my blood checked every week, if not more often than that. Those blood tests showed me that my blood sugar was high. My neutrophils, which are my white blood cells, were high. And if you want to hear more about the blood tests, and all the different ways that it was messing with my labs, I have a video you can check out below:

Hand Tremor from Prednisone: Then I had this weird hand tremor, like, like when you’re hungry or something, it was there. It was, it was weird. Like all shaky, a weird jittery feeling from prednisone. I could feel my heart beating extra hard sometimes or in a weird rhythm, little heart palpitations.

Moon Face: my round face. You can see my face right now (after taking prednisone and and being off it for a year): I have a nice defined chin. I didn’t have a defined chin while I was on prednisone. You couldn’t see my cheekbones at all. And my friend said that my face looked puffy. She told me in her broken English, “Tell you doctor, you face looks puffy.” Ha! I thought. All right. I will do that.

Prednisone Moon Face before and after

Felt Old on Prednisone

Then I felt old. Prednisone side effects make you feel old.

Hot Flashes: I would have hot flashes and I’m not old enough to have hot flashes! I’d get night sweats, day sweats, and just break out into sweats. And I don’t normally do that. You can see my beautiful red flushed cheeks there too.

Insomnia: Finally, the prednisone adverse effect of insomnia. Oh, insomnia. Just my mind was racing all the time. I couldn’t turn it off, especially at two o’clock in the morning.

Hair Loss: I lost about 1/3 of my hair after getting off prednisone.

So that was my personal experience with prednisone adverse effects. There are probably more that I can’t even remember at this time, but that’s what I can remember.

The Adverse Effects of Prednisone – What can I really expect?

When I first started taking prednisone, I wanted to know: what can I really expect? I’d studied prednisone in pharmacy school, but all I could really remember was a few things like osteoporosis and weight gain, and insomnia. Oh, and some weird stuff that we had to memorize that I was afraid that might happen to me.

But what’s it like really? Is that what I’m going to experience?  So I looked up a whole bunch of drug references. What are the side effects of prednisone?

You can see this little funnel I made. Those balls represent different online drug databases, Lexicomp, Clinical Pharmacology, and Micromedex. And I looked up prednisone in each of those. There’s always the default source of information; the package insert that comes with every pill bottle, and theoretically, every prescription. I looked at the “adverse drug events” or “adverse event” or “adverse drug reaction” section of each database for prednisone.

Consolidating Prednisone Side Effect Lists

I took all of the information on there and found there are over 142 adverse effects of prednisone. I’ve actually found even more than that. There are over 150 grouped different terms and you can see on the right terms like fat redistribution like the list below. This is how I grouped the term fat abnormalities:

  • Fat redistribution (moving the fat from my arms to my belly)
  • Truncal obesity (that means fat in your belly your trunk)
  • Buffalo hump (that nice little fat pad on the back of your neck)
  • Moon face (that round face & cheeks)

I grouped of those all as fat abnormalities.

95 Grouped Prednisone Side Effects

So when you take all of these separate terms and then grouped them all, there are still 95 different things that are possible to expect.  There are 95, almost a hundred adverse effects that could happen to me while on prednisone! I wanted to know:

What’s really going to happen to me?

The Truth

I wanted to know what I was going to experience while on prednisone. So I was surprised to find when I did that, this pattern, you would think that all of those different drug references would have the exact same list!

prednisone side effects in drug databases

I thought if you took all of the drug side effects that are from Clinical Pharmacology and UpToDate and Micromedex that it would just be one circle and they would have the exact same list basically. But that’s not what I found. What’s crazy is they had different things listed. Clinical Pharmacology listed tons of prednisone adverse effects. It had 31 that nobody else even bothered to put on their list. The circle is instead a Venn Diagram!

There were only 8 adverse effects that all four of these drug databases listed. Are those 8 the ones that we’re all going to experience? No, they’re not!

Searching for Common Adverse Effects

Then I looked at these lists and I thought, “Where’s a list of common side effects?” Most drugs these days go through a testing process and the drug companies have to find out what percent of people experience a side effect.

So a brand new drug monograph says, for example,

“We tested this drug on 5,000 people who have diabetes and of those 5,000 people, 50 experience heart palpitations, and 100 of them experience sweating, 500 of those people experienced insomnia.”

So then the new drug company can say 1% heart palpitations, 2% sweating, and 10% insomnia. They’d report a percentage for each adverse effect.

But there were no tests for the percent of people who experienced certain adverse effects for prednisone!

And the reason why is because the drug is so old; prednisone was approved in the 1950s before the United States Food and Drug Administration (FDA) required that kind of thorough testing.

“Since the testing has never been done, no one really knows what the actual prednisone adverse effects are!”

I was shocked to figure that out. I thought, for sure it must be there somewhere, but no. It’s not there. You must be also cautious when looking this up online since there are a lot side effects mentioned but the terms they are using are not right and some aren’t accurate.

Prednisone was “grandfathered in.” It was approved by the FDA the same year my grandfather started our family’s pharmacy! (See below the three generations of pharmacists: me, my dad, and grandfather, 15 years ago when he was still alive).

Watch this video to find out where to get the information online instead:

What are the side effects of Prednisone?

I had to find a way to make a list for you and me of what we really are going to expect. So this is not based on that kind of rigorous study that they do for new drugs. This is based on surveys and analysis of lots of different scientific literature, but it’s the best we’ve got.

Check out my searchable Ultimate List of Prednisone Side Effects!

Common Side Effects of Prednisone in Patient Surveys

Insomnia while on Prednisone

If you have been on prednisone a while or you have a friend who’s been prescribed prednisone, you can send them this list. This is what you’re actually most likely to experience. So the most common side effects are:

  1. Moon face
    – That little puffy roundness to your face
  2. Fluid Retention
    – excess fluid builds up in the body
  3. Swelling
    – enlargement of the skin or other body parts
  4. Weight Gain
    – And a lot of people are surprised to find out that prednisone causes weight gain, but it does!
  5. Osteoporosis
    -the very common and it’s the bone loss and potential breaking and wearing away of joints
  6. Insomnia
    – it’s the most tweeted side effect
  7. Emotional Lability
    -just up and down and all over with your emotions in a roller coaster
  8. Carbohydrate Intolerance
    – that basically means that when you’re on prednisone, you can’t deal with carbs as well. Sugars, especially refined sugars, are what we need to avoid on prednisone.
  9. Appetite Stimulation
    – just feeling hungry all the time

Long-Term Side Effects of Prednisone

prednisonee side effects

So then these are some things if you’re on prednisone a long time, that you’re more likely to experience, but not necessarily people who are on it for just a few days are likely to experience these long-term side effects:

  1. Hypertension
    – that means high blood pressure.
  2. Myopathy
    – that’s the muscle wasting when my arms and legs got skinny and it was just shrinking.
  3. Vertebral Compression Fractures
    – that’s a big word! That means your spine collapses. The little tiny breaks are just crushing your spine! It’s osteoporosis progressing to bone breaking.
  4. Ulcers
    – In your gut where you have lots of pain and nausea and can’t swallow and the gut lining can get so thin that it gets holes.
  5. Growth Suppression
    – this commonly happens to young children who have to take prednisone.
  6. Cataracts
    – those are the clouding of the lens of your eyes
  7. Glaucoma
    – #1 cause of blindness of the eyes due to eye pressure that damages the optic nerve.
  8. Impaired Wound Healing
    – delay of healing wounds

What are the Worst Side Effects of Prednisone?

rare symptoms caused by prednisone

These are often talked about on those side-effect lists, but they’re pretty rare. So you’re not likely to experience them.

  1. Exophthalmos
    – means bulging eyes like super bulging eyes and that’s not very common.
  2. Pancreatitis
    – that is when your pancreas gets inflamed and it’s painful and miserable.
  3. Aseptic Necrosis of Bones
    – basically, that’s bone death, where especially your joints, most commonly the hip joint, where the top of your long leg bone, where it inserts into the hip, and you have to have a hip replacement.
  4. PCP Infections
    – That’s a really super, super rare infection that usually only affects people who are affected with HIV and AIDS. And it can happen when your immune system is down. So if prednisone is shutting down your immune system it’s a possibility.
  5. Anaphylaxis
    – people actually being allergic to prednisone itself, which is also counterintuitive because prednisone is used to counteract allergic reactions, especially rashes.

The last list mentioned is really rare!

Free Prednisone Checklist

If you found this helpful and you want to know the ways to help combat those side effects. I have a free Prednisone Wellness Checklist that I created based on evidence and hope that it will help you.

Just sign up and fill out the form below!

Free Prednisone Checklist

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