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Prednisone Side Effects – The Ultimate List

Prednisone Side Effects – The Ultimate List

Prednisone Side Effects List

Which prednisone side effects did your doctor or pharmacist warn you about? How many adverse effects of prednisone did the list include?

It probably didn’t include all of them. In fact, it likely did not, since all the current lists are incomplete. Read on, below, to find out how I compiled the most complete, thorough, and useful list of prednisone side effects. At the end, find out what to actually expect when prescribed prednisone.

This interactive chart below includes all prednisone side effects in the top drug databases, medical references, scientific articles, and textbooks.

How to Use It

You can search it for specific adverse effect words, like try typing “osteoporosis.” Or using the arrows at the top, sort it by frequency or dose. Change the number of side effects that show using the drop-down.

What it Includes

  1. Category: In the first column, find the medical category of the prednisone side effect.
  2. Side Effect: In the second column, find the scientific name of the side effect as listed in the databases.
  3. Common Name: I translated these scientific names into common names in the third column.
  4. Source: The fourth column shows which drug databases listed that specific side effect (see the sources below the list).
  5. Frequency: The fifth column shows how common the side effect, if a drug reference included a description such as “rare” or “common.”
  6. Dose: The last column includes details about which dose, from low to high, when you might expect this side effect.

The Ultimate List of Prednisone Side Effects

CategorySide EffectCommon NameSourceFrequencyDose
Fluid and Electrolyte Disturbanceshypernatremia, sodium retentionretain salt1, 2, 3
Fluid and Electrolyte Disturbancesfluid retention; increased plasma volume; leg edemaretain water1, 2, 3, 4, 5commonhigh
Fluid and Electrolyte Disturbanceshypokalemia: potassium excretion at distal renal tubulepotassium loss1, 2, 3, 4, 5
Fluid and Electrolyte Disturbanceshypokalemic metabolic alkalosiselectrolyte imbalance1, 2, 3, 5
Fluid and Electrolyte Disturbanceshydrogen excretion at distal renal tubulekidney electrolyte loss2
Fluid and Electrolyte Disturbancesanemialow blood count2
Fluid and Electrolyte Disturbancesfolic acid loss, glossitislow B vitamin2, 3
Fluid and Electrolyte Disturbancesdecrease serum concentration of vitamin Clow vitamin C2, 3
Fluid and Electrolyte Disturbancesdecrease serum concentration of vitamin Alow vitamin A2
Fluid and Electrolyte Disturbancespyridoxine increased dietary requirementlow vitamin B63
Fluid and Electrolyte Disturbancesphosphorus increased dietary requirementlow phosphorus3
Cardiovascularhypertensionhigh blood pressure1, 2, 3, 4, 5common, >30%high, long-term
Cardiovascularcongestive heart failure, cardiac failureheart failure1, 2, 3, 5medium <7.5mg
Cardiovascularhypercholesterolemia, atherosclerosis/ arteriosclerosis, premature atherosclerotic diseasehigh cholesterol2, 5irreversibleover 7.5 mg
Cardiovascularfat (lipid) embolism, vasculitis, necrotizing angiitisheart complications2, 5rare
Cardiovascularpalpitations, arrhythmia, sinus tachycardia, bradycardiaheart rhythm changes2, 5rarehigh
Cardiovascularatrial fibrillation, atrial flutterA fib, heart beating too fast53.6 x risk
Cardiovascularcardiovascular events: left ventricular rupture, angina, angioplasty, coronary revascularization, stroke, transient ischemic attack, cardiomegaly, arrhythmia exacerbation, ECG changes, hypertrophic myopathy, pulmonary edema, cardiovascular death, all-cause mortalityheart problems2, 4, 5rarehigh
Cardiovascularthrombosis, venous thromboembolism (VTE), thrombo-phlebitisblood clot2, 3, 4, 5
Cardiovascularmyocardial infarction, cardiac arrestheart attack2, 4, 5rare
Cardiovascularsyncopefainting2, 4
Cardiovascularepistaxisnose bleed5>5 mg
Neurologicalemotional labilitymood swings1, 2, 3, 4, 5common
Neurologicalirritabilitycranky2common
Neurologicalpsychiatric disturbanceemotional changes1, 2, 3, 5over 20 mg
Neurologicalinsomnia, sleep disturbancecan't sleep1, 2, 3, 5
Neurologicaleuphoriafeeling unnaturally well, lots of energy1, 2, 3, 5early
Neurologicalpersonality changespersonality altered1, 2, 3
Neurologicalsevere depressionbad depression1, 2, 3, 510% at high doseslong-term
Neurologicalanxietyworried2, 5
Neurologicalpsychotic disorder, psychosis, schizophrenic reactions, mania, hypomania, hallucinations, deliriumfeel crazy1, 2, 3, 4, 530% at >75 mgover 20 mg
Neurologicalwithdrawn behavioravoid being social2
Neurologicalamnesia, steroid dementia, memory impairmentforgetful2, 50.01high, long-term
Neurologicalconfusion, disorientationconfused, lost5
Neurologicalimpaired cognitionbrain fog2
Neurologicalincreased intracranial pressure with papilledema, pseudotumor cerebripressure around brain increases1, 2, 3, 4, 5rare
Neurologicalseizure; EEG changesconvulsions1, 2, 3, 4
Neurologicalvertigodizziness1, 2, 3
Neurologicalheadachehead pain1, 2, 3
Neurologicalparalytic syndromeloss of muscle function4
Neurologicalischemic peripheral neuropathytingling nerve pain2
Neurologicalneuritisnerve inflamed2
Neurologicalparesthesiasburning or prickling sensation2
Neurologicalakathisiarestlessness2, 5
Neurologicalmotor activity increasemore movement2
Neurologicalmalaisefeeling of unease2
Neurologicalsuicidekill self5rare
Musculoskeletalsteroid myopathy, myastheniamuscle weakness1, 2, 3, 4, 5infrequenthigh
Musculoskeletalmuscle wasting, amyotrophyloss of muscle mass1, 2, 3
Musculoskeletalmyalgiamuscle pain2
Musculoskeletalquadriparesisweakness in all 4 limbs2
Musculoskeletalarthralgiajoint pain2
Musculoskeletalosteopenia: bone mineral density accelerated reductionbone thinning2, 5irreversible
Musculoskeletalosteoporosis, bone matrix atrophybone loss1, 2, 3, 4, 5commonall doses
Musculoskeletaltendon ruptureAchilles tendon breaks1, 2, 3, 4
Musculoskeletalvertebral compression fracturesbones in spine squish together1, 2, 3, 4, 5
Musculoskeletalaseptic/avascular necrosis, osteonecrosis of femoral and humeral headsbone death1, 2, 3, 4, 5rare
Musculoskeletalpathologic fracture of long bonesbreak bones1, 2, 3, 5
Gastrointestinalpeptic ulcer with possible perforation and hemorrhage, GI bleed; perforated sigmoid diverticular abscessulcers, holes in bowels1, 2, 3, 5with NSAIDs
Gastrointestinalpancreatitispancreas inflamed1, 2, 3, 4rare
Gastrointestinalabdominal pain and/or distentionbelly swollen1, 2, 3
Gastrointestinalhiccupshiccup2
Gastrointestinalulcerative esophagitishole in esophagus1, 2, 3, 5
Gastrointestinaldiarrhea, constipationchange in bowel movements2
Gastrointestinalgastritis, gastrointestinal perforation, visceral perforation, irritationhole in bowels2, 4, 5
Gastrointestinalabrupt cessation: nausea, vomiting, anorexia, weight lossif stop taking suddenly, will feel sick to stomach2
Hepaticelevated hepatic enzymes: increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphataseliver enzymes go up2, 3
Hepaticsteatohepatitis, cirrhosisfatty liver1, 3, 5
Hepatichepatomegalyliver expands2
Dermatologicimpaired wound healingwounds don't heal as well 1, 2, 3, 4not low
Dermatologicskin atrophy, parchment-like skin, skin thinningthin fragile skin1, 2, 3, 5"most common," 46%low
Dermatologicpetechiae and ecchymosesred dots & painless bruises1, 2, 3, 5low
Dermatologicfacial erythemared face1, 2, 3, 5low
Dermatologicdiaphoresisincreased sweating1, 2, 3
Dermatologicacne vulgaris, acneiform rashzits2, 5long-term, medium to high
Dermatologichirsutismmale-pattern hair growth2, 5long-term, medium to high
Dermatologicalopeciabalding, hair loss2long-term, medium to high
Dermatologictelangiectasiaspider veins2
Dermatologicstriaestretch marks2, 5low
Dermatologicxerosisdry skin2
Dermatologicpurpurapurple-colored spot on skin2, 5
Dermatologiclupus-like symptomsfeel like Lupus2
Dermatologicperineal pain & irritationpain around genitals2
Dermatologicrashskin irritation2
Dermatologicsuppressed reactions to skin testsskin tests not work well1
Metabolicnegative nitrogen balance due to protein catabolism; generalized protein depletionprotein breakdown1, 2, 3
Endocrinemenstrual irregularities: dysmenorrhea, amenorrhea, postmenopausal bleedingchanges in women's period1, 2, 3
Endocrinedecrease or increase in motility and # of spermatozoasperm count2
Endocrinehypercorticism; Cushingoid state & appearancesigns of high cortisol such as weight gain1, 2, 3, 4, 5low
Endocrinefat abnormalities; lipodystrophy, redistribution of body fat: truncal obesity, buffalo hump, moon facefat moves to face, belly and back of neck2, 5>30%Dose-dependent, within 2 months
Endocrinehypothalamic-pituitary-adrenal (HPA) axis suppression; less endogenous corticosteroids and androgens; adrenocortical atrophystress response system blocked1, 2, 3, 5>30%
Endocrinesecondary adrenocortical insufficiency and pituitary unresponsiveness during stress: surgery, trauma, illnessbody can't handle stress as well1, 2, 5
Endocrinewithdrawal: acute adrenal insufficiency, deathcan't stop taking it suddenly or could die1, 2, 3, 5
Endocrinewithdrawal syndrome: anorexia, lethargy, nausea/vomiting, headache, fever, arthralgia, myalgia, exfoliative dermatitis, weight loss, hypotensionfeel awful when stop taking too quickly, without tapering2
Endocrinegrowth suppression in childrenchildren don't grow as much1, 2, 3, 4, 5
Endocrineglycosuriasugar in urine2
Endocrineappetite stimulationfeel hungrier2, 4, 5common
Endocrineweight gain, metabolic syndromegain weight2, 4, 5most common, >30%low: 4-8% body weight
Endocrinedecreased carbohydrate tolerance; carbohydrate intolerancebody can't handle too much sugar1, 3, 4common
Endocrinehyperglycemia: fasting glucose levels, postprandialhigh blood sugar2, 510 x risk at >30 mghigh
Endocrinelatent diabetes mellitusdiabetes appears1, 2, 3, 5
Endocrineincreased need for insulin or oral hypoglycemic agents in diabeticsneed more diabetes medicines1, 2, 5
Endocrinenonketotic hyperosmolar state, diabetic ketoacidosisdiabetes emergency1, 2, 3rare
Endocrinehypocalcemia: decreased osteoblasts, malabsorption Ca in nephron and gut, reduce sex [hormone]; increased dietary requirementlow calcium1, 2, 3, 4, 5
Endocrinevitamin D depletion; increased dietary requirementlow vitamin D3, 5, 6
Endocrinehypocortisolism secondary to another disorderlow cortisol4
Endocrinehyperthyroidism or hypothyroidismthyroid gland changes1, 2, 3
Ophthalmicposterior subcapsular cataractseye lens clouding1, 2, 3, 4, 5common, irreversiblelong-term, even low dose
Ophthalmicincreased intraocular pressure; ocular hypertensionmore pressure in eyes1, 2, 3, 5
Ophthalmicglaucomaeye damage from high pressure1, 2, 3, 4, 5long-term
Ophthalmicexophthalmoseyes bulging1, 2, 3, 5rare
Ophthalmiclid swellingpuffy eyelid5rare
Ophthalmicvisual impairmentblurry vision, blindness2
Ophthalmiccorneal perforationdamage eye lens1, 2
Ophthalmiccentral serous chorioretinopathy, retinopathyfluid build-up in eye2, 4, 5rare
Ophthalmicoptic neuritis; ocular nerve damagetemporary vision loss2
Immunologicneutropenia, febrile neutropenialow white blood cells2
Immunologicneutrophiliahigh neutrophils5
Immunologicleukocytosishigh white blood cells5often
Immunologicangioedemaswelling skin2, 4
Immunologicimmunosuppresionweakened immune system2commonhigh
Immunologicurticariaitching1, 2, 3
Immunologicanaphylaxis, hypersensitivity reactions, allergic dermatitis, shockallergic to prednisone1, 2, 3, 4
Immunologicinfection: mask symptomscan get sick easier1, 2, 3, 5high
Immunologicoropharyngeal candidiasis, mycosisthrush, fungus2, 5
Immunologicsepsisextreme response to infection5
ImmunologicKaposi's sarcoma, pulmonary tuberculosis, Pneumocystis jirovecii pneumoniarare infections1, 2, 3, 4, 5rarehigh
Respiratoryshortness of breathtrouble breathing5

Sources of Prednisone Side Effect Data

In the table above, the fourth column includes numbers. The numbers correspond to the sources below. The first six sources made up the first three columns. Columns 5-6 include information from all of the sources below.

  1. DailyMed
  2. Clinical Pharmacology
  3. Lexicomp
  4. Micromedex
  5. UpToDate
  6. Natural Medicines Database
  7. Endotext: Glucocorticoid Therapy
  8. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. [Link]
Watch a Video of Dr. Megan explaining the entire list of Prednisone Side Effects

How I Created the Ultimate List of Prednisone Side Effects

Background: Is it a side effect or symptom?

When first diagnosed with a disease, a patient wonders about the symptoms of the disease. Patients seek information from the doctor, online databases, and fellow sufferers of that disease. Then when the doctor prescribes a drug, the same process starts over. The patient searches for information in many places about how it feels to take the drug. Sometimes it is hard to distinguish between a symptom of the disease and a side effect of the drug. For patients taking prednisone, the task to decipher whether their experience is a side effect or symptom is complicated even further, because until now, there is no widely accepted or complete list of prednisone side effects.

There is no complete list of prednisone side effects.

No Complete List

“How can this be?” you ask. Prednisone has been around forever, has been used by hundreds of millions of patients, so how do we not know what the side effects are?

The clue is that prednisone has been around forever. Prednisone entered the list of the U.S. Food and Drug Administration (FDA) approved drugs in 1955. At that time, drugs did not have to undergo strict testing like new drugs do.

New drugs undergo testing in thousands of patients to determine the frequency of side effects, or how often a patient will experience an adverse effect. For example, a chart like this will accompany every bottle of a new drug:

New Drug Example Shows %:

Prednisone is an old drug

But prednisone was approved before the rigorous tests were required. The prednisone patent, which gave one company exclusive rights to market a new drug, expired before testing was required. By the time side effect frequency testing was required by the FDA, the prednisone patent expired, and many different companies were marketing prednisone as a generic. No company was motivated or had a budget to do this research.

Therefore, no one actually knows what the side effects of prednisone are.

My Prednisone Story

When I was diagnosed with ITP and prescribed prednisone, I tried to find a complete list of what to expect. As a pharmacist, I have access to many high-quality drug references, the best-known information on this topic. I was surprised to find the different databases showed lists of side effects that seemed completely inconsistent.

For example, here is a screen shot of a free online drug database. Check out the list and find which #1 side effect is missing:

Side effects missing

This free database did not mention the #1 side effect, or the #2 or #3 side effects either! Weight gain, “moon face” and insomnia, the important side effects for a patient to expect, are missing.

Patients taking prednisone need to know about the possibility of weight gain and insomnia since these will impact their quality of life and potentially their ability to heal from the disease for which they are taking prednisone in the first place. But this drug reference does not even mention those side effects.

The real #1 side effect, weight gain, is NOT listed.

Side effects listed versus experienced

Another curious finding is that the most commonly listed side effects are not the most commonly experienced side effects. Nearly every drug reference lists “pancreatitis,” but this is an extremely uncommon, though nasty, side effect of prednisone.

There’s actually debate about whether it is even a legitimate side effect, since it usually only happens in patients with conditions that might also cause it. So it’s more likely that the patient has a diagnosis like Systemic Lupus Erythematosus (SLE), which can cause pancreatitis itself, and they also take prednisone.

Prednisone gets blamed, but it’s probably more likely to be the lupus.

Most patients taking prednisone will never have pancreatitis, yet all receive this warning. Most patients taking prednisone will have to deal with weight gain, yet not all are warned about it.

Prednisone Side Effect Research

Watch me explain how I performed the Prednisone Side Effect Research:

First, I searched the three best pharmacy databases—Lexicomp, Clinical Pharmacology, and Micromedex—to find prednisone’s side effects. I expected each would kick out a list of side effects identical to the others, but I was wrong. Also, I expected each database to call the same side effect the same thing. (That’s what would have happened with any new drug.) Again, I was wrong.

Side Effect Grouping

Between these three references, I found 142 separate side effect terms, which I grouped together into 95 side effects. For example, I grouped together all the different terms for raising cholesterol. I took the terms “dyslipidemia,” “hyperlipidemia,” “hypercholesterolemia,” “atherosclerosis,” and “arteriosclerosis” and called all of these “high cholesterol.” This process yielded 95 separate miserable experiences patients taking prednisone might expect.

prednisone side effect grouping

But which of these 95 side effects will I experience?

My research continued…

Simply knowing every possible side effect is not helpful to know what I should actually expect. How likely am I to experience any one of the 95 side effects?

Rank them by # of times?

First, I thought if I ranked them by the number of different drug references that list a single side effect, then I would know which are the most common. If this was true, then the image below would not be a Venn diagram with circles that do not overlap.

Each reference, if listing the same information, would all overlap completely and there would be one circle of information “truth.” Frustrated, I checked one more reliable source, UpToDate, the best medical reference. Surprisingly, the circles continued to spread:

prednisone side effects in drug databases

Expanding the Search

Including the four references above, adding a well-respected pharmacology textbook and the prednisone package insert, there are only six side effects listed by all six of these! The most frequently listed side effects, by all 6 references, include:

  1. Osteoporosis
  2. Fluid retention
  3. Hypertension
  4. Aseptic necrosis of the femoral and humeral heads
  5. Posterior subcapsular cataracts
  6. Glaucoma
How many of these did you experience?

If you answered zero, that’s possible. Guess how many of these are common? Only the first three of these side effects listed by every drug reference commonly afflict prednisone patients. The other three less common, and in the case of aseptic necrosis, extremely rare.

Common (bold) vs. Rare Side Effects on Lists

  1. Osteoporosis
  2. Fluid retention
  3. Hypertension
  4. Aseptic necrosis of the femoral and humeral heads
  5. Posterior subcapsular cataracts
  6. Glaucoma

Yet these six make up the entire most commonly listed side effects. How many patients have even heard of aseptic necrosis before prednisone? Now suddenly it’s on their radar to watch out for, even though it is so rare. Why is the data so skewed? What can an actual prednisone patient realistically expect?

Next, my search led me to patient surveys. According to these surveys, the most common side effects for patients who start taking prednisone include:

Common Short-Term Prednisone Side Effects

  1. Moon face (round face shaped like a moon)
  2. Fluid retention (swelling and water weight)
  3. Osteoporosis (thinning bones)
  4. Insomnia (can’t sleep)
  5. Emotional lability (unable to control emotions, rollercoasters, high to anxious, depressed)
  6. Carbohydrate intolerance (crave but cannot use sugars, leading to high blood sugar)
  7. Appetite stimulation (hungry all the time!)
  8. Weight gain (no kidding, after all that ravenous hunger)

Common Long-Term Prednisone Side Effects:

  1. Hypertension (high blood pressure)
  2. Myopathy (muscle wasting or pain)
  3. Vertebral compression fractures (osteoporosis leads to broken bones in the spine)
  4. Ulcers (hole in the gut)
  5. Cataracts (eye condition)
  6. Glaucoma (eye condition)
  7. Impaired wound healing
  8. Growth suppression in children

What can you expect to actually experience when you take prednisone?

At first, you might feel full of lots of energy, ravenously hungry and feel so buzzed at the end of the day that you can’t fall asleep. Or maybe you can fall asleep but can’t stay asleep because your mind is racing. If anyone triggers your emotions, you might explode at them in an uncharacteristically harsh or unkind way.

Remember, it’s not you, it’s the drug.

These are the Side Effects to Prednisone I Experienced:

prednisone side effect cartoon

Benefits and Risks

Prednisone will help you heal, but it will do so at a price: these side effects. Now that you know what prednisone side effects to expect, you can make better judgment about whether or not taking prednisone will be worth it for you.

What You Can Do About Prednisone Side Effects

Many of the side effects of prednisone 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.

Prednisone Side Effect Articles for Further Reading

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