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

What is an Adverse Effect?

Adverse effects, also known as side effects, refer to the harms caused by a drug. These can be described as an Adverse Drug Event (ADE) or Adverse Drug Reaction (ADR).

If you experience significant side effects from a drug in the U.S.A., you should report them to FDA MedWatch. This is where the government monitors whether a drug is causing a surprising side effect that might cause the FDA to take 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?

There are over 150 side effects to prednisone reported in medical references which may sound overwhelming. But I’m here to clarify what will happen if you take prednisone.

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

Here are Dr. Megan’s Side Effects for a quick visual of what you might experience!

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% increase in weight. 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 share their experiences of feeling fully awake after only a few hours of sleep and struggling 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.

Prednisone Heart Pounding

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. Prednisone heart palpitations, arrhythmias, or rhythm changes, can be harmless like a racing heart and trembling hands, or can be more dangerous and rare.

Watch now!

Why Does Prednisone Make Your Heart Race?

Taking prednisone can disrupt electrolytes balance, including potassium, due to sodium retention. Imbalances in electrolytes can impact heart’s electrical signaling, potentially resulting in palpitations. This usually occurs with large doses or prolonged use of prednisone.

Can Prednisone Increase Heart Rate Permanently?

Luckily, the increased heart rate caused by prednisone is generally a temporary side effect. Once the medication is gradually reduced or stopped, the cardiovascular effects usually diminish. However, it’s important to consult your healthcare provider before altering your medication schedule.

How to Stop Heart Palpitations from Prednisone

1. Communication With Healthcare Professionals

If you have persistent or severe heart palpitations while taking prednisone, it’s important to tell your healthcare provider. They can evaluate your overall health, adjust your medication if needed, or explore other treatment options.

2. Lifestyle Modifications

Certain lifestyle changes can help manage prednisone heart rate and heart palpitations. These include cutting back on caffeine, practicing stress reduction techniques like deep breathing or meditation, and staying hydrated.

3. Gradual Tapering

Suddenly discontinuing prednisone can result in withdrawal symptoms, which may worsen the side effects. Gradually tapering the medication with the guidance of your healthcare provider allows your body to adjust in a more gradual manner.

My Personal Adverse Side Effects of Prednisone

This is me, Dr. Megan, while I was taking prednisone. 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 common 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.

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?” 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.

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.

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 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 & Heart Palpitations from Prednisone

Then I had this weird hand tremor, like when you’re hungry or something, it was 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

You can see my face right now (after taking prednisone and and being off it for a year). 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 , “Tell your doctor, your face looks puffy.” Ha! I thought. All right. I will do that.

Watch now!

Feeling Old on Prednisone 

Then I felt old, which is a common side effect of prednisone.

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. M y 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.

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 . 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. 

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

Despite my prior knowledge about potential side effects like osteoporosis, I felt the need to dive deeper into the real experiences.

I scoured various drug references, including Lexicomp, Clinical Pharmacology, and Micromedex, creating a funnel of information. Examining adverse drug events sections for prednisone in each database and the package insert, I discovered a staggering over 142 adverse effects.

Grouping related terms, like various fat redistributions, brought the count to 95 distinct potential side effects. It dawned on me that navigating prednisone involves navigating through a vast landscape of potential outcomes, making open communication with healthcare providers crucial for personalized understanding and management.

The Truth

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:

Common Side Effects of Prednisone in Patient Surveys

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!

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

If you’re on prednisone a long time, you’re more likely to experience these side effects:

1. Hypertension – that means high blood pressure.
2. Myopathy – muscle weakness.
3. Vertebral Compression Fractures – This is when 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?

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 – bulging eyes.
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.

Once again, the last list mentioned is really rare! 

Your Ultimate Guide to Adverse Side Effects of Prednisone

When it comes to prednisone side effects, there’s a whole range you might not have heard of. It’s important to have accurate information and many resources out there don’t give the full picture. I’m here to offer you reliable and precise insights, all in one place. Take control of your health journey and empower yourself with knowledge.

Discover more about prednisone side effects here.

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!