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 <7.5mg
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	syncope	fainting	2, 4
Cardiovascular	epistaxis	nose bleed	5		>5 mg
Neurological	emotional lability	mood swings	1, 2, 3, 4, 5	common
Neurological	irritability	cranky	2	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	anxiety	worried	2, 5
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	neuritis	nerve inflamed	2
Neurological	paresthesias	burning or prickling sensation	2
Neurological	akathisia	restlessness	2, 5
Neurological	motor activity increase	more movement	2
Neurological	malaise	feeling of unease	2
Neurological	suicide	kill self	5	rare
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	myalgia	muscle pain	2
Musculoskeletal	quadriparesis	weakness in all 4 limbs	2
Musculoskeletal	arthralgia	joint pain	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	hiccups	hiccup	2
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
Hepatic	hepatomegaly	liver expands	2
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	telangiectasia	spider veins	2
Dermatologic	striae	stretch marks	2, 5		low
Dermatologic	xerosis	dry skin	2
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	rash	skin irritation	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	neutrophilia	high neutrophils	5
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.

DailyMed
Clinical Pharmacology
Lexicomp
Micromedex
UpToDate
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.

prednisone side effects in drug databases

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:

Osteoporosis
Fluid retention
Hypertension
Aseptic necrosis of the femoral and humeral heads
Posterior subcapsular cataracts
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

Osteoporosis
Fluid retention
Hypertension
Aseptic necrosis of the femoral and humeral heads
Posterior subcapsular cataracts
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

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)
Prolonged high blood pressure
Headache
Chest pain
Stomach Irritation
Low energy
Irritable
Heat flashes
Rash
Muscle pain
Sweating
Irregular heart rhythm
Dizziness
Slow wound healing

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.