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
- Category: In the first column, find the medical category of the prednisone side effect.
- Side Effect: In the second column, find the scientific name of the side effect as listed in the databases.
- Common Name: I translated these scientific names into common names in the third column.
- Source: The fourth column shows which drug databases listed that specific side effect (see the sources below the list).
- Frequency: The fifth column shows how common the side effect, if a drug reference included a description such as “rare” or “common.”
- 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
|Category||Side Effect||Common Name||Source||Frequency||Dose|
|Fluid and Electrolyte Disturbances||hypernatremia, sodium retention||retain salt||1, 2, 3|
|Fluid and Electrolyte Disturbances||fluid retention; increased plasma volume; leg edema||retain water||1, 2, 3, 4, 5||common||high|
|Fluid and Electrolyte Disturbances||hypokalemia: potassium excretion at distal renal tubule||potassium loss||1, 2, 3, 4, 5|
|Fluid and Electrolyte Disturbances||hypokalemic metabolic alkalosis||electrolyte imbalance||1, 2, 3, 5|
|Fluid and Electrolyte Disturbances||hydrogen excretion at distal renal tubule||kidney electrolyte loss||2|
|Fluid and Electrolyte Disturbances||anemia||low blood count||2|
|Fluid and Electrolyte Disturbances||folic acid loss, glossitis||low B vitamin||2, 3|
|Fluid and Electrolyte Disturbances||decrease serum concentration of vitamin C||low vitamin C||2, 3|
|Fluid and Electrolyte Disturbances||decrease serum concentration of vitamin A||low vitamin A||2|
|Fluid and Electrolyte Disturbances||pyridoxine increased dietary requirement||low vitamin B6||3|
|Fluid and Electrolyte Disturbances||phosphorus increased dietary requirement||low phosphorus||3|
|Cardiovascular||hypertension||high blood pressure||1, 2, 3, 4, 5||common, >30%||high, long-term|
|Cardiovascular||congestive heart failure, cardiac failure||heart failure||1, 2, 3, 5||medium <7.5mg7.5mg|
|Cardiovascular||hypercholesterolemia, atherosclerosis/ arteriosclerosis, premature atherosclerotic disease||high cholesterol||2, 5||irreversible||over 7.5 mg|
|Cardiovascular||fat (lipid) embolism, vasculitis, necrotizing angiitis||heart complications||2, 5||rare|
|Cardiovascular||palpitations, arrhythmia, sinus tachycardia, bradycardia||heart rhythm changes||2, 5||rare||high|
|Cardiovascular||atrial fibrillation, atrial flutter||A fib, heart beating too fast||5||3.6 x risk|
|Cardiovascular||cardiovascular 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 mortality||heart problems||2, 4, 5||rare||high|
|Cardiovascular||thrombosis, venous thromboembolism (VTE), thrombo-phlebitis||blood clot||2, 3, 4, 5|
|Cardiovascular||myocardial infarction, cardiac arrest||heart attack||2, 4, 5||rare|
|Cardiovascular||epistaxis||nose bleed||5||>5 mg|
|Neurological||emotional lability||mood swings||1, 2, 3, 4, 5||common|
|Neurological||psychiatric disturbance||emotional changes||1, 2, 3, 5||over 20 mg|
|Neurological||insomnia, sleep disturbance||can't sleep||1, 2, 3, 5|
|Neurological||euphoria||feeling unnaturally well, lots of energy||1, 2, 3, 5||early|
|Neurological||personality changes||personality altered||1, 2, 3|
|Neurological||severe depression||bad depression||1, 2, 3, 5||10% at high doses||long-term|
|Neurological||psychotic disorder, psychosis, schizophrenic reactions, mania, hypomania, hallucinations, delirium||feel crazy||1, 2, 3, 4, 5||30% at >75 mg||over 20 mg|
|Neurological||withdrawn behavior||avoid being social||2|
|Neurological||amnesia, steroid dementia, memory impairment||forgetful||2, 5||0.01||high, long-term|
|Neurological||confusion, disorientation||confused, lost||5|
|Neurological||impaired cognition||brain fog||2|
|Neurological||increased intracranial pressure with papilledema, pseudotumor cerebri||pressure around brain increases||1, 2, 3, 4, 5||rare|
|Neurological||seizure; EEG changes||convulsions||1, 2, 3, 4|
|Neurological||vertigo||dizziness||1, 2, 3|
|Neurological||headache||head pain||1, 2, 3|
|Neurological||paralytic syndrome||loss of muscle function||4|
|Neurological||ischemic peripheral neuropathy||tingling nerve pain||2|
|Neurological||paresthesias||burning or prickling sensation||2|
|Neurological||motor activity increase||more movement||2|
|Neurological||malaise||feeling of unease||2|
|Musculoskeletal||steroid myopathy, myasthenia||muscle weakness||1, 2, 3, 4, 5||infrequent||high|
|Musculoskeletal||muscle wasting, amyotrophy||loss of muscle mass||1, 2, 3|
|Musculoskeletal||quadriparesis||weakness in all 4 limbs||2|
|Musculoskeletal||osteopenia: bone mineral density accelerated reduction||bone thinning||2, 5||irreversible|
|Musculoskeletal||osteoporosis, bone matrix atrophy||bone loss||1, 2, 3, 4, 5||common||all doses|
|Musculoskeletal||tendon rupture||Achilles tendon breaks||1, 2, 3, 4|
|Musculoskeletal||vertebral compression fractures||bones in spine squish together||1, 2, 3, 4, 5|
|Musculoskeletal||aseptic/avascular necrosis, osteonecrosis of femoral and humeral heads||bone death||1, 2, 3, 4, 5||rare|
|Musculoskeletal||pathologic fracture of long bones||break bones||1, 2, 3, 5|
|Gastrointestinal||peptic ulcer with possible perforation and hemorrhage, GI bleed; perforated sigmoid diverticular abscess||ulcers, holes in bowels||1, 2, 3, 5||with NSAIDs|
|Gastrointestinal||pancreatitis||pancreas inflamed||1, 2, 3, 4||rare|
|Gastrointestinal||abdominal pain and/or distention||belly swollen||1, 2, 3|
|Gastrointestinal||ulcerative esophagitis||hole in esophagus||1, 2, 3, 5|
|Gastrointestinal||diarrhea, constipation||change in bowel movements||2|
|Gastrointestinal||gastritis, gastrointestinal perforation, visceral perforation, irritation||hole in bowels||2, 4, 5|
|Gastrointestinal||abrupt cessation: nausea, vomiting, anorexia, weight loss||if stop taking suddenly, will feel sick to stomach||2|
|Hepatic||elevated hepatic enzymes: increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphatase||liver enzymes go up||2, 3|
|Hepatic||steatohepatitis, cirrhosis||fatty liver||1, 3, 5|
|Dermatologic||impaired wound healing||wounds don't heal as well||1, 2, 3, 4||not low|
|Dermatologic||skin atrophy, parchment-like skin, skin thinning||thin fragile skin||1, 2, 3, 5||"most common," 46%||low|
|Dermatologic||petechiae and ecchymoses||red dots & painless bruises||1, 2, 3, 5||low|
|Dermatologic||facial erythema||red face||1, 2, 3, 5||low|
|Dermatologic||diaphoresis||increased sweating||1, 2, 3|
|Dermatologic||acne vulgaris, acneiform rash||zits||2, 5||long-term, medium to high|
|Dermatologic||hirsutism||male-pattern hair growth||2, 5||long-term, medium to high|
|Dermatologic||alopecia||balding, hair loss||2||long-term, medium to high|
|Dermatologic||striae||stretch marks||2, 5||low|
|Dermatologic||purpura||purple-colored spot on skin||2, 5|
|Dermatologic||lupus-like symptoms||feel like Lupus||2|
|Dermatologic||perineal pain & irritation||pain around genitals||2|
|Dermatologic||suppressed reactions to skin tests||skin tests not work well||1|
|Metabolic||negative nitrogen balance due to protein catabolism; generalized protein depletion||protein breakdown||1, 2, 3|
|Endocrine||menstrual irregularities: dysmenorrhea, amenorrhea, postmenopausal bleeding||changes in women's period||1, 2, 3|
|Endocrine||decrease or increase in motility and # of spermatozoa||sperm count||2|
|Endocrine||hypercorticism; Cushingoid state & appearance||signs of high cortisol such as weight gain||1, 2, 3, 4, 5||low|
|Endocrine||fat abnormalities; lipodystrophy, redistribution of body fat: truncal obesity, buffalo hump, moon face||fat moves to face, belly and back of neck||2, 5||>30%||Dose-dependent, within 2 months|
|Endocrine||hypothalamic-pituitary-adrenal (HPA) axis suppression; less endogenous corticosteroids and androgens; adrenocortical atrophy||stress response system blocked||1, 2, 3, 5||>30%|
|Endocrine||secondary adrenocortical insufficiency and pituitary unresponsiveness during stress: surgery, trauma, illness||body can't handle stress as well||1, 2, 5|
|Endocrine||withdrawal: acute adrenal insufficiency, death||can't stop taking it suddenly or could die||1, 2, 3, 5|
|Endocrine||withdrawal syndrome: anorexia, lethargy, nausea/vomiting, headache, fever, arthralgia, myalgia, exfoliative dermatitis, weight loss, hypotension||feel awful when stop taking too quickly, without tapering||2|
|Endocrine||growth suppression in children||children don't grow as much||1, 2, 3, 4, 5|
|Endocrine||glycosuria||sugar in urine||2|
|Endocrine||appetite stimulation||feel hungrier||2, 4, 5||common|
|Endocrine||weight gain, metabolic syndrome||gain weight||2, 4, 5||most common, >30%||low: 4-8% body weight|
|Endocrine||decreased carbohydrate tolerance; carbohydrate intolerance||body can't handle too much sugar||1, 3, 4||common|
|Endocrine||hyperglycemia: fasting glucose levels, postprandial||high blood sugar||2, 5||10 x risk at >30 mg||high|
|Endocrine||latent diabetes mellitus||diabetes appears||1, 2, 3, 5|
|Endocrine||increased need for insulin or oral hypoglycemic agents in diabetics||need more diabetes medicines||1, 2, 5|
|Endocrine||nonketotic hyperosmolar state, diabetic ketoacidosis||diabetes emergency||1, 2, 3||rare|
|Endocrine||hypocalcemia: decreased osteoblasts, malabsorption Ca in nephron and gut, reduce sex [hormone]; increased dietary requirement||low calcium||1, 2, 3, 4, 5|
|Endocrine||vitamin D depletion; increased dietary requirement||low vitamin D||3, 5, 6|
|Endocrine||hypocortisolism secondary to another disorder||low cortisol||4|
|Endocrine||hyperthyroidism or hypothyroidism||thyroid gland changes||1, 2, 3|
|Ophthalmic||posterior subcapsular cataracts||eye lens clouding||1, 2, 3, 4, 5||common, irreversible||long-term, even low dose|
|Ophthalmic||increased intraocular pressure; ocular hypertension||more pressure in eyes||1, 2, 3, 5|
|Ophthalmic||glaucoma||eye damage from high pressure||1, 2, 3, 4, 5||long-term|
|Ophthalmic||exophthalmos||eyes bulging||1, 2, 3, 5||rare|
|Ophthalmic||lid swelling||puffy eyelid||5||rare|
|Ophthalmic||visual impairment||blurry vision, blindness||2|
|Ophthalmic||corneal perforation||damage eye lens||1, 2|
|Ophthalmic||central serous chorioretinopathy, retinopathy||fluid build-up in eye||2, 4, 5||rare|
|Ophthalmic||optic neuritis; ocular nerve damage||temporary vision loss||2|
|Immunologic||neutropenia, febrile neutropenia||low white blood cells||2|
|Immunologic||leukocytosis||high white blood cells||5||often|
|Immunologic||angioedema||swelling skin||2, 4|
|Immunologic||immunosuppresion||weakened immune system||2||common||high|
|Immunologic||urticaria||itching||1, 2, 3|
|Immunologic||anaphylaxis, hypersensitivity reactions, allergic dermatitis, shock||allergic to prednisone||1, 2, 3, 4|
|Immunologic||infection: mask symptoms||can get sick easier||1, 2, 3, 5||high|
|Immunologic||oropharyngeal candidiasis, mycosis||thrush, fungus||2, 5|
|Immunologic||sepsis||extreme response to infection||5|
|Immunologic||Kaposi's sarcoma, pulmonary tuberculosis, Pneumocystis jirovecii pneumonia||rare infections||1, 2, 3, 4, 5||rare||high|
|Respiratory||shortness of breath||trouble breathing||5|
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.
- Clinical Pharmacology
- Natural Medicines Database
- Endotext: Glucocorticoid Therapy
- 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.
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:
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:
- Fluid retention
- Aseptic necrosis of the femoral and humeral heads
- Posterior subcapsular cataracts
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
- Fluid retention
- Aseptic necrosis of the femoral and humeral heads
- Posterior subcapsular cataracts
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
- Moon face (round face shaped like a moon)
- Fluid retention (swelling and water weight)
- Osteoporosis (thinning bones)
- Insomnia (can’t sleep)
- Emotional lability (unable to control emotions, rollercoasters, high to anxious, depressed)
- Carbohydrate intolerance (crave but cannot use sugars, leading to high blood sugar)
- Appetite stimulation (hungry all the time!)
- Weight gain (no kidding, after all that ravenous hunger)
Common Long-Term Prednisone Side Effects:
- Hypertension (high blood pressure)
- Myopathy (muscle wasting or pain)
- Vertebral compression fractures (osteoporosis leads to broken bones in the spine)
- Ulcers (hole in the gut)
- Cataracts (eye condition)
- Glaucoma (eye condition)
- Impaired wound healing
- 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:
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
- Adverse Effects of Prednisone – What’s Going to Happen to Me?
- Irreversible Prednisone Side Effects
- Short-Term Prednisone Side Effects – Do They Exist?
- Long-Term Prednisone Side Effects
- Common Side Effects of Prednisone & How to Cope
- Prednisone Side Effects in Men
- Prednisone Side Effects in Women
- What I Wish My Family Knew About Prednisone Side Effects
- Prednisone Weight Gain
- Prednisone 20 mg Side Effects & What You Can Do About It
- How to Counteract Prednisone Side Effects
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