What are the acute and chronic side effects of prednisone. How does prednisone affect mood, weight, and sleep. Can prednisone cause high blood pressure and diabetes. What are the long-term risks of prednisone use on bone health and heart disease.

Acute Prednisone Side Effects: What to Expect in the Short Term

Prednisone, a commonly prescribed corticosteroid, can cause a range of side effects that may occur within days or weeks of starting treatment. These acute side effects are often dose-dependent, meaning they are more likely to occur with higher doses and longer durations of use.

Energy and Sleep Disturbances

One of the most noticeable acute effects of prednisone is its impact on energy levels. Many patients report feeling more energetic and experiencing less pain when taking moderate to high doses. However, this increased energy can sometimes lead to sleep disturbances.

• Insomnia or difficulty falling asleep
• Restlessness and hyperactivity
• Disrupted sleep patterns

To mitigate sleep-related issues, doctors often recommend taking prednisone earlier in the day. This timing adjustment can help reduce the medication’s stimulating effects during nighttime hours.

Appetite Changes and Weight Gain

Prednisone is known to increase appetite, which can lead to weight gain. This side effect is often compounded by the medication’s tendency to cause water retention.

• Increased hunger and frequent snacking
• Water retention and bloating
• Initial weight gain, particularly in the face and midsection

Patients taking prednisone should be aware of these potential changes and work with their healthcare providers to develop strategies for managing weight gain and maintaining a healthy diet.

Digestive System Effects

Prednisone can have significant impacts on the digestive system, particularly in terms of acid production and reflux.

• Increased risk of heartburn and acid reflux
• Potential for stomach ulcers
• Changes in bowel habits

To address these issues, doctors may prescribe acid-suppressing medications or recommend dietary changes to help manage digestive symptoms.

Mood and Mental Health Changes

Prednisone can have a profound impact on mood and mental health. While some patients may experience an elevated mood or increased sense of well-being, others may experience more severe mood disturbances.

• Mood swings or irritability
• Anxiety or agitation
• In rare cases, mania or psychosis

It’s crucial for patients and their loved ones to monitor for any significant mood changes and report them to their healthcare provider immediately. Those with a history of mood disorders may be at higher risk for these side effects.

Prednisone’s Impact on Blood Pressure and Blood Sugar

Prednisone can have significant effects on both blood pressure and blood sugar levels, even in patients without pre-existing conditions.

Hypertension and Prednisone Use

Prednisone can cause or exacerbate high blood pressure (hypertension). This effect can occur rapidly after starting treatment, even in individuals with no prior history of hypertension.

• Regular blood pressure monitoring is essential
• Lifestyle modifications may be necessary
• Antihypertensive medications might be required

Can prednisone cause a sudden spike in blood pressure. Yes, prednisone can lead to a rapid increase in blood pressure, sometimes within days of starting treatment. This is why close monitoring is crucial, especially in the early stages of therapy.

Blood Sugar Control and Diabetes Risk

Prednisone can significantly impact blood sugar levels, potentially leading to the development or worsening of diabetes.

• Increased insulin resistance
• Elevated blood glucose levels
• Potential for new-onset diabetes or difficulty controlling existing diabetes

Is blood sugar monitoring necessary for all patients on prednisone. While not all patients will require intensive monitoring, those with risk factors for diabetes or pre-existing diabetes should have their blood sugar levels closely monitored. In some cases, temporary or long-term diabetes management may be necessary.

Long-Term Prednisone Use: Chronic Side Effects and Risks

While acute side effects of prednisone are often the most noticeable, long-term use of this medication can lead to a range of chronic health issues that may not become apparent for months or even years.

Skin Changes and Increased Bruising

Prolonged prednisone use can lead to significant changes in the skin’s structure and appearance.

• Thinning of the skin, particularly on the arms and hands
• Increased susceptibility to bruising
• Slower wound healing
• Possible development of stretch marks

How can patients minimize skin-related side effects of long-term prednisone use. While some skin changes may be unavoidable, patients can take steps to protect their skin by using sunscreen, avoiding trauma, and moisturizing regularly. In some cases, topical treatments may be prescribed to help manage skin thinning.

Ocular Complications: Cataracts and Glaucoma

Long-term prednisone use is associated with an increased risk of eye problems, particularly cataracts and glaucoma.

• Higher incidence of cataracts, especially posterior subcapsular cataracts
• Increased intraocular pressure, potentially leading to glaucoma
• Greater risk when using both oral prednisone and steroid eye drops

How often should patients on long-term prednisone have eye examinations. Regular eye exams are crucial for patients on long-term prednisone therapy. Most eye care professionals recommend annual comprehensive eye exams, but more frequent monitoring may be necessary depending on individual risk factors and dosage.

Bone Health and Osteoporosis Risk with Prednisone Use

One of the most significant long-term risks associated with prednisone use is its impact on bone health, particularly the increased risk of osteoporosis.

Mechanisms of Prednisone-Induced Bone Loss

Prednisone affects bone health through several mechanisms:

• Decreased calcium absorption from the gut
• Increased calcium excretion through the kidneys
• Inhibition of bone formation
• Increased bone resorption

How quickly can prednisone affect bone density. Bone loss can begin within the first few months of prednisone therapy, with the most rapid loss occurring in the first 6-12 months of treatment. However, the risk continues to increase with prolonged use.

Preventing and Managing Prednisone-Induced Osteoporosis

To mitigate the risk of osteoporosis, several preventive measures and treatments are available:

• Calcium and Vitamin D supplementation
• Weight-bearing and resistance exercises
• Bone density scans to monitor bone health
• Prescription medications to prevent bone loss (bisphosphonates, etc.)

When should bone density screening be initiated for patients on prednisone. For patients expected to be on prednisone for three months or longer, baseline bone density testing is often recommended. Follow-up scans may be performed every 1-2 years, depending on individual risk factors and initial results.

Cardiovascular Risks Associated with Long-Term Prednisone Use

The long-term use of prednisone can have significant impacts on cardiovascular health, increasing the risk of heart disease and stroke.

Prednisone and Atherosclerosis

Prolonged prednisone use may accelerate the development of atherosclerosis, the buildup of plaque in the arteries.

• Increased inflammation in blood vessel walls
• Alterations in lipid metabolism
• Higher risk of plaque formation and instability

How does prednisone contribute to heart disease risk. Prednisone can indirectly increase heart disease risk by elevating blood pressure, raising blood sugar levels, and altering lipid profiles. Additionally, it may have direct effects on blood vessel walls, promoting inflammation and atherosclerosis.

Mitigating Cardiovascular Risks

Patients on long-term prednisone therapy should work closely with their healthcare providers to manage cardiovascular risk factors:

• Regular monitoring of blood pressure, lipids, and blood sugar
• Lifestyle modifications (diet, exercise, smoking cessation)
• Use of medications to control hypertension, diabetes, and hyperlipidemia when necessary
• Consideration of aspirin therapy for appropriate patients

Is cardiovascular risk assessment necessary for all patients on long-term prednisone. Yes, all patients on long-term prednisone therapy should undergo regular cardiovascular risk assessments. The frequency and extent of these assessments may vary based on individual risk factors and prednisone dosage.

Prednisone and Infection Risk: Balancing Immunosuppression

One of the most significant concerns with prednisone use is its impact on the immune system and the subsequent increased risk of infections.

Mechanisms of Immune Suppression

Prednisone affects the immune system in several ways:

• Suppression of inflammatory responses
• Reduction in the production and function of various immune cells
• Alteration of cytokine production and signaling

How does prednisone increase infection risk. Prednisone suppresses various components of the immune system, making it more difficult for the body to fight off infections. This can lead to an increased susceptibility to bacterial, viral, and fungal infections, as well as the reactivation of latent infections.

Managing Infection Risk in Patients on Prednisone

To minimize infection risk, several strategies can be employed:

• Regular screening for latent infections (e.g., tuberculosis) before starting therapy
• Vaccination against common pathogens when appropriate
• Prophylactic antibiotics in certain high-risk situations
• Patient education on recognizing signs of infection
• Prompt medical attention for suspected infections

Should patients on prednisone avoid crowds or sick individuals. While complete isolation is not necessary, patients on high-dose or long-term prednisone therapy should take precautions to minimize exposure to infectious agents. This may include avoiding close contact with sick individuals, practicing good hand hygiene, and being cautious in crowded public spaces during peak illness seasons.

Balancing Benefits and Risks: When is Prednisone the Right Choice?

Despite its numerous potential side effects, prednisone remains a valuable and sometimes life-saving medication for many conditions. The decision to use prednisone should always involve a careful consideration of its benefits and risks.

Conditions Commonly Treated with Prednisone

Prednisone is used to treat a wide range of inflammatory and autoimmune conditions, including:

• Rheumatoid arthritis and other rheumatologic disorders
• Asthma and COPD exacerbations
• Inflammatory bowel diseases
• Severe allergic reactions
• Certain types of cancer
• Organ transplant rejection prevention

How do doctors determine if prednisone is the right treatment option. The decision to use prednisone is based on several factors, including the severity of the condition, the potential benefits of treatment, the risks of side effects, and the availability of alternative therapies. Doctors weigh these factors against the patient’s individual health status and preferences.

Strategies for Minimizing Prednisone Side Effects

When prednisone is deemed necessary, several strategies can be employed to minimize side effects:

• Using the lowest effective dose for the shortest duration possible
• Employing alternate-day dosing when appropriate
• Gradually tapering the dose to allow the body to adjust
• Combining prednisone with steroid-sparing agents to reduce the required dose
• Implementing preventive measures for known side effects (e.g., bone health protection)

Can the side effects of prednisone be completely avoided. While it’s not possible to completely eliminate the risk of side effects, careful management and monitoring can significantly reduce their occurrence and severity. Open communication between patients and healthcare providers is crucial for optimizing prednisone therapy while minimizing risks.

In conclusion, prednisone remains a crucial medication in the treatment of many inflammatory and autoimmune conditions. While its potential side effects are numerous and sometimes serious, understanding these risks allows for better management and monitoring. By working closely with healthcare providers, patients can maximize the benefits of prednisone therapy while minimizing its potential drawbacks. As medical research continues, new strategies for mitigating prednisone’s side effects may emerge, further improving its safety profile and therapeutic utility.

Know the Prednisone Side Effects • Connected Rheumatology •

Let me be clear – I wouldn’t want to be on prednisone either. In fact, when suffering from a wicked case of vertigo, I fought my doctor buddies who advised I take a Medrol dose pack to ease the symptoms.

“I’m going to gain weight!” “I’m going to have anxiety!”

As a Rheumatologist, I am well-versed in all the possible side effects of prednisone (and similar meds) and feared the worse.

But I also know that there is a time a place for prednisone. Not only was I currently in need of the benefits of prednisone, many of my patients are as well. But there ARE side effects that need to be considered and discussed.

How to think about prednisone side effects

When starting any new medication the first questions anyone has is “what are the potential side effects?” Most are worried about what can happen immediately. It’s certainly a fair question, but when thinking about prednisone, this is only half of what we need to consider. “What can happen to me right away and what can happen to me 5 or 10 years from now?” is a more appropriate question. The medical terminology would be acute side effects and chronic side effects. 

The risk any individual has for the following side effects rises with:

• the length of time and
• the dose of prednisone used.

For example, someone on a moderate or high dose of prednisone (40mg- 60mg/day) for 6 months will have a higher risk than someone on a low dose (5mg/day) for a few weeks.

Acute prednisone side effects

When starting a moderate or high dose of corticosteroids, such as prednisone, there are key symptoms to look out for. These can occur within days to weeks of starting the medication and may be cause for adjusting or even stopping the medication (with guidance from your doctor, of course).  

Prednisone, and all the glucocorticoids, is very activating. Meaning, it can rev up your system. This is a big reason most people feel great while on moderate to high doses. People experience less pain and higher energy. But sometimes this can go overboard. Energy levels may increase so much so that sleep becomes difficult, leading to insomnia. Adjusting the time you take the medication (taking it earlier in the day) can help with this.

Along with this energy “activation” is an increased hunger. Snacking is more frequent and this, along with a propensity for water retention, can lead to initial weight gain. Along with the munching, prednisone can lead to more frequent or severe heart burn. This can be helped with an acid-suppressing medication.

Mood is also affected. Mood can be elevated but when taken too far can result in mania, anxiety or even psychosis. Thankfully, this isn’t common. But if you have a history of these conditions or if you or a loved one notices any serious mood changes, let your doctor know immediately.  

Along with any mood disorders, there a number of medical conditions that need to be considered when starting prednisone. High blood pressure (hypertension) and diabetes can both worsen with prednisone and need to be monitored closely. Even in those without a previous history of high blood pressure, this can be seen soon after starting steroids. Similarly, blood sugar levels can become elevated and difficult to control in those with or even without diabetes.

Chronic side effects

Along with the potential prednisone side effects that can occur right away, a number of issues can occur years later.

With prolonged use, the skin becomes thinner and more prone to bruising. This is especially true for the skin on the forearms and hands. Prednisone users have a higher risk of developing cataracts or glaucoma especially when using steroid eye drops. Osteoporosis is also a long term effect many do not appreciate. Osteoporosis in and of itself isn’t painful, but can lead to bone fractures, something no one wants to deal with! A healthy Vitamin D level, Calcium supplements, weight bearing exercise and (sometimes) bone building medication are used to prevent this side effect.

The risks to the heart, blood vessels and brain are rarely discussed when starting prednisone but should be considered. Taking steroids not only raises blood pressure and blood sugar, but overall raises one’s risk for heart attacks and strokes. When steroids are needed for only a few days or weeks there isn’t much concern. But when needing it longer, there should be measures taken to control all other possible risk factors. This includes controlling the blood pressure, cholesterol and blood sugar levels either through diet and lifestyle or with medications.

Prednisone & Infection

Lasting, we can’t talk about prednisone side effects without discussing the risk of infection. Within Rheumatology, we work with many potent “immune-suppressing” and “immune-mediating” medications that can elicit a lot of fear. It’s true that many immune-based therapies can increase one’s risk for infection, but it is often not appreciated how much prednisone contributes to this risk. Prednisone at low, but especially, at high doses can increase the risk for severe infection. For this reason, it is imperative someone take the day-to-day precautions we were all taught in grade school – wash our hands, keep our distance from those that are ill and when appropriate, get vaccinated. Taking prednisone doesn’t make someone more likely to catch a bug, but it impairs their ability to fight it off should they catch it.

How to get off prednisone

With all the risks, it’s legitimate to ask why you should even start it in the first place. For a more in-depth view of that, I recommend checking out this blog post. But suffice it to say, sometimes we just need some prednisone to control our condition. But just like with every medication, you need to understand the pros and the cons, the risks and the benefits, and all the potential side effects. And understand that only in a minority of cases should prednisone be considered a long-term therapy. 

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FAQ: Prednisone | Patient Education

• Why is this medication being recommended?
• What special precautions should I follow?
• What side effects can this medication cause?
• What monitoring will I need?

Why is this medication being recommended?

Prednisone is part of a class of drugs called immunosuppressants. It suppresses the body’s immune response and reduces inflammation in your lungs. Because inflammation is the precursor to fibrosis (scarring), we hope prednisone will prevent the formation of lung fibrosis and allow the inflamed lung to return to normal.

What special precautions should I follow?

Before taking prednisone:

• Tell your doctor and pharmacist if you are allergic to prednisone, other medications or any of the inactive ingredients in prednisone tablets or solutions. Ask your doctor or pharmacist for a list of the inactive ingredients.
• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins and nutritional supplements you are taking or plan to take. Be sure to mention any of the following:
  • Amiodarone (Cordarone, Pacerone)
  • Anticoagulants (‘blood thinners’) such as warfarin (Coumadin)
  • Certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) and voriconazole (Vfend)
  • Aprepitant (Emend)
  • Aspirin
  • Carbamazepine (Carbatrol, Epitol, Tegretol)
  • Cimetidine (Tagamet)
  • Clarithromycin (Biaxin, in Prevpak)
  • Cyclosporine (Neoral, Sandimmune)
  • Delavirdine (Rescriptor)
  • Diltiazem (Cardizem, Dilacor, Tiazac, others)
  • Dexamethasone (Decadron, Dexpak)
  • Diuretics (‘water pills’)
  • Efavirenz (Sustiva)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Luvox)
  • Griseofulvin (Fulvicin, Grifulvin, Gris-PEG)
  • HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase)
  • Hormonal contraceptives (birth control pills, patches, rings, implants and injections)
  • Lovastatin (Altocor, Mevacor)
  • Diabetes medications
  • Nefazodone
  • Nevirapine (Viramune)
  • Phenobarbital
  • Phenytoin (Dilantin, Phenytek)
  • Rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate)
  • Sertraline (Zoloft)
  • Troleandomycin (TAO)
  • Verapamil (Calan, Covera, Isoptin, Verelan)
  • Zafirlukast (Accolate)

  Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• Tell your doctor what herbal products you take or plan to take, especially St. John’s wort.
• Tell your doctor if you have:
  • An eye infection now or have ever had eye infections that come and go
  • Diabetes
  • Emotional problems
  • Heart disease
  • High blood pressure
  • Intestinal disease
  • Kidney disease
  • Liver disease
  • Mental illness
  • Myasthenia gravis, a condition in which the muscles become weak
  • Osteoporosis, a condition in which the bones become weak and fragile and can break easily
  • Seizures
  • Threadworms – a type of worm that can live inside the body – currently or in the past
  • Thyroid disease
  • Tuberculosis (TB)
  • Ulcers
• Tell your doctor if you are pregnant, plan to become pregnant or are breast-feeding. If you become pregnant while taking prednisone, call your doctor.
• If you are having surgery, including dental surgery, or need emergency medical treatment, tell the doctor, dentist or medical staff that you are taking or have recently stopped taking prednisone. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency.
• Prednisone may decrease your ability to fight infection and can prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles.

What side effects can this medication cause?

Prednisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Acne
• Bulging eyes
• Changes in personality
• Changes in the way fat is distributed on the body
• Decreased sexual desire
• Difficulty falling asleep or staying asleep
• Dizziness
• Extreme changes in mood
• Extreme tiredness
• Headache
• Heartburn
• Inappropriate happiness
• Increased hair growth
• Increased sweating
• Irregular or absent menstrual periods
• Red or purple blotches or lines under the skin
• Slowed healing of cuts and bruises
• Thin, fragile skin
• Weak muscles

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• Confusion
• Depression
• Difficulty breathing or swallowing
• Dry, hacking cough
• Eye pain, redness or tearing
• Hives
• Irregular heartbeat
• Itching
• Lightheadedness
• Loss of contact with reality
• Muscle twitching or tightening
• Numbness, burning, or tingling in the face, arms, legs, feet or hands
• Rash
• Seizures
• Shaking of the hands that you cannot control
• Shortness of breath, especially during the night
• Sore throat, fever, chills, cough or other signs of infection
• Swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles or lower legs
• Swelling or pain in the stomach
• Upset stomach
• Vision problems
• Vomiting

Prednisone may increase the risk that you will develop osteoporosis. Talk to your doctor about the risks of taking prednisone and about things that you can do to decrease the chance that you will develop osteoporosis.