What are the most common side effects of prednisone. How does prednisone affect the body long-term. Can prednisone cause serious health complications. What should patients know about prednisone’s impact on children.

Understanding Prednisone: Uses and Mechanism of Action

Prednisone is a widely prescribed corticosteroid medication used to treat various conditions, including autoimmune disorders, inflammatory diseases, and allergic reactions. As a synthetic form of cortisol, prednisone works by suppressing the immune system and reducing inflammation throughout the body. This powerful drug can be highly effective in managing symptoms of numerous ailments, but it also comes with a range of potential side effects that patients and healthcare providers must carefully consider.

Common Conditions Treated with Prednisone

• Rheumatoid arthritis
• Lupus
• Multiple sclerosis
• Asthma
• Allergic reactions
• Skin conditions (e.g., Stevens-Johnson syndrome)
• Eye disorders (e.g., optic neuritis)
• Blood disorders (e.g., thrombocytopenia)
• Certain types of cancer (e.g., leukemia and lymphoma)
• Ulcerative colitis

The versatility of prednisone in treating such a wide array of conditions underscores its importance in modern medicine. However, this same potency also contributes to its potential for causing side effects, which can range from mild to severe.

Common Side Effects of Prednisone: What Patients Can Expect

While prednisone can be highly effective in treating various conditions, it’s important for patients to be aware of the common side effects they may experience. These side effects often occur as the body adjusts to the medication and may be more pronounced with higher doses or long-term use.

Frequently Reported Side Effects

• Edema (swelling due to excess fluid)
• Muscle weakness
• Bloating
• Thinning of the skin
• Increased sweating
• Changes in menstrual bleeding
• Mood changes (e.g., excitement, restlessness)
• Nausea or vomiting
• Acne
• Weight gain
• Headaches
• Sleep disturbances

Are these side effects permanent? In many cases, these side effects are temporary and may subside as the body adapts to the medication or when the dosage is reduced. However, some patients may experience persistent effects, particularly with long-term use. It’s crucial for patients to communicate any ongoing or bothersome side effects to their healthcare provider.

Serious Side Effects: Recognizing and Responding to Complications

While most patients tolerate prednisone well, some may experience more severe side effects that require immediate medical attention. Recognizing these serious complications is crucial for patient safety and long-term health outcomes.

Potential Serious Complications

1. Heart problems (e.g., congestive heart failure)
2. Mood disorders (e.g., depression)
3. Electrolyte imbalances (e.g., low potassium levels)
4. Hypertension
5. Increased susceptibility to infections
6. Osteoporosis and bone fractures
7. Gastrointestinal issues (e.g., stomach ulcers)
8. Pancreatitis
9. Endocrine disorders (e.g., diabetes)
10. Eye problems (e.g., cataracts, glaucoma)
11. Severe allergic reactions

How quickly can serious side effects develop? The onset of serious side effects can vary widely, from days to months after starting treatment. Some complications, such as increased infection risk, may occur relatively quickly, while others, like osteoporosis, typically develop with prolonged use. Patients should be vigilant and report any concerning symptoms to their healthcare provider promptly.

Prednisone and Children: Special Considerations for Pediatric Patients

The use of prednisone in children requires careful consideration due to its potential impact on growth and development. While many side effects in children are similar to those experienced by adults, there are some unique concerns that parents and healthcare providers must be aware of.

Impact on Growth and Development

Can prednisone affect a child’s growth? Yes, one of the most significant concerns with prednisone use in children is its potential to impede growth. Long-term or high-dose prednisone therapy may result in decreased growth rates, potentially affecting a child’s final adult height. This effect is due to the drug’s influence on bone metabolism and the growth hormone axis.

How is growth monitored in children taking prednisone? Healthcare providers typically monitor children’s growth closely while they are on prednisone therapy. This may involve regular height measurements, growth velocity calculations, and in some cases, bone age assessments. The goal is to balance the need for treatment with minimizing growth-related side effects.

Strategies to Mitigate Growth Effects

• Using the lowest effective dose
• Employing alternate-day dosing when possible
• Considering growth-promoting therapies in some cases
• Ensuring adequate nutrition and calcium intake
• Encouraging regular physical activity as appropriate

By implementing these strategies and closely monitoring growth, healthcare providers aim to minimize the impact of prednisone on a child’s growth potential while still effectively treating their underlying condition.

Managing Side Effects: Strategies for Patients and Healthcare Providers

Effectively managing the side effects of prednisone is crucial for optimizing treatment outcomes and improving patient quality of life. Both patients and healthcare providers play important roles in this process, employing various strategies to mitigate adverse effects while maintaining the drug’s therapeutic benefits.

Patient-Centered Approaches

• Adhering to prescribed dosing schedules
• Maintaining a balanced diet low in sodium and high in potassium
• Engaging in regular physical activity as advised by healthcare providers
• Monitoring and reporting any new or worsening symptoms
• Keeping all follow-up appointments for regular check-ups

Healthcare Provider Interventions

• Prescribing the lowest effective dose for the shortest duration possible
• Implementing alternate-day dosing when appropriate
• Recommending calcium and vitamin D supplements to support bone health
• Monitoring blood pressure, blood sugar, and electrolyte levels regularly
• Considering prophylactic medications to prevent certain side effects (e.g., proton pump inhibitors for gastrointestinal protection)

How can patients best communicate side effects to their healthcare provider? Keeping a symptom diary can be an effective way for patients to track and report side effects. This record should include the type of symptom, its severity, duration, and any factors that seem to improve or worsen the symptom. Such detailed information can help healthcare providers make informed decisions about adjusting treatment plans.

Long-Term Use of Prednisone: Balancing Benefits and Risks

While prednisone can be a life-changing medication for many patients with chronic conditions, long-term use presents unique challenges and risks. Understanding these risks and implementing strategies to mitigate them is essential for patients who require extended corticosteroid therapy.

Potential Long-Term Complications

1. Adrenal suppression
2. Increased risk of osteoporosis and fractures
3. Metabolic changes leading to diabetes or worsening of existing diabetes
4. Increased susceptibility to infections
5. Cardiovascular complications
6. Skin thinning and easy bruising
7. Cataracts and glaucoma
8. Muscle weakness and atrophy

How can the risks of long-term prednisone use be minimized? Healthcare providers employ several strategies to reduce the risks associated with prolonged corticosteroid therapy:

• Regularly reassessing the need for continued therapy
• Gradually tapering the dose when discontinuing treatment
• Implementing steroid-sparing agents when possible
• Providing comprehensive patient education about side effects and self-management
• Conducting regular health screenings to detect complications early

Patients on long-term prednisone therapy should work closely with their healthcare team to develop a personalized monitoring plan that addresses their specific risk factors and health needs.

Prednisone Alternatives: Exploring Other Treatment Options

Given the potential for side effects with prednisone, particularly with long-term use, exploring alternative treatments can be beneficial for some patients. While prednisone remains a crucial medication for many conditions, advancements in medical research have led to the development of various alternatives that may offer similar benefits with different side effect profiles.

Potential Alternatives to Prednisone

• Other corticosteroids with different pharmacokinetic profiles
• Disease-modifying antirheumatic drugs (DMARDs) for autoimmune conditions
• Biologic therapies targeting specific inflammatory pathways
• Immunosuppressants for organ transplant recipients and certain autoimmune diseases
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for some inflammatory conditions
• Targeted therapies for specific conditions (e.g., monoclonal antibodies)

Can all patients switch from prednisone to an alternative medication? The suitability of alternative treatments depends on various factors, including the specific condition being treated, the patient’s overall health status, and individual response to different medications. Some patients may be able to transition completely to an alternative therapy, while others may benefit from a combination approach that allows for a reduction in prednisone dose.

Considerations When Exploring Alternatives

1. Efficacy in treating the specific condition
2. Potential side effects and contraindications
3. Cost and insurance coverage
4. Route of administration (oral, injectable, infusion)
5. Frequency of dosing and convenience for the patient
6. Monitoring requirements and follow-up care

Patients interested in exploring alternatives to prednisone should discuss their options with their healthcare provider. This conversation should include a thorough review of the potential benefits and risks of different treatment approaches, taking into account the patient’s individual circumstances and preferences.

Prednisone oral tablet side effects: Mild to serious

Prednisone (Rayos) is a generic prescription medication, and as with other drugs, it can cause side effects. Prednisone is used to treat certain conditions, including:

• hormone conditions, such as adrenal insufficiency
• autoimmune conditions, such as rheumatoid arthritis, lupus, and multiple sclerosis
• skin conditions, such as Stevens-Johnson syndrome
• allergic conditions, such as asthma or allergies
• eye conditions, such as optic neuritis
• breathing problems, such as pneumonitis
• blood conditions, such as thrombocytopenia
• leukemia and lymphoma
• ulcerative colitis

Your doctor may prescribe prednisone short term or long term, depending on your condition.

Prednisone comes as an oral tablet. The drug also comes as an oral solution but this article does not cover that form. (For details, talk with your doctor.)

Read on to learn about potential common, mild, and serious side effects. For a general overview of this drug, including what prednisone tablets are used for, refer to this article. Your doctor can also tell you more about prednisone.

Prednisone can cause certain side effects (also called adverse effects), some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took the brand-name version of prednisone (Rayos) in clinical trials:

• edema (swelling due to excess fluid)
• muscle weakness
• bloating (swelling due to excess fluid or gas, often in the abdomen)
• thin skin
• sweating*

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

Mild side effects can occur with prednisone. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to prednisone’s prescribing information.

Mild side effects that have been reported with prednisone include:

• edema (swelling due to excess fluid)
• muscle weakness
• bloating (swelling due to excess fluid or gas, often in the abdomen)
• thin skin
• excitement
• changes in menstrual bleeding
• confusion
• restlessness
• nausea or vomiting
• acne
• moon face*
• weight gain*
• headache*
• sweating*
• difficulty sleeping*
• mild allergic reaction*

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Prednisone and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

Prednisone may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to prednisone’s prescribing information.

If you develop serious side effects while taking prednisone, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Heart problems, such as congestive heart failure. Symptoms may include:
  • difficulty breathing
  • swelling in the legs or feet
  • rapid heart rate
• Mood changes, such as depression. Symptoms may include:
  • feeling sad or hopeless
  • insomnia or sleeping more than usual
  • loss of interest in activities that you typically enjoy
• Low blood potassium level. Symptoms may include:
  • constipation
  • fatigue
  • heart palpitations
• High blood pressure. Symptoms may include:
  • headache
  • shortness of breath
  • anxiety
• Infection. Symptoms may include:
  • fever
  • sore throat
  • cough
• Osteoporosis or bone fractures. Symptoms may include:
  • back pain
  • swelling or bruising
  • pain or numbness
• Stomach ulcers. Symptoms may include:
  • abdominal pain
  • bloating
  • nausea
• Pancreatitis (pancreas inflammation). Symptoms may include:
  • abdominal pain
  • fever
  • nausea or vomiting
• High blood sugar or diabetes. Symptoms may include:
  • feeling more thirsty than usual
  • unexplained weight loss
  • blurry vision
• Eye problems, such as cataracts or glaucoma. Symptoms may include:
  • cloudy vision
  • headache
  • blurry vision
• Severe allergic reaction.*

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

In most cases, side effects in children taking prednisone are similar to side effects in adults taking the drug.

However, prednisone may cause decreased growth in children who take the drug. This may mean that if your child is taking prednisone, especially if they take the drug for a long time, they may not grow as tall.

Due to this risk, your doctor may monitor your child’s growth while they’re taking prednisone. If you have additional concerns about side effects that may occur while your child is taking prednisone, talk with their doctor.

Prednisone may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Will stopping prednisone treatment cause withdrawal symptoms?

It’s possible that stopping prednisone treatment suddenly can cause withdrawal symptoms. These are symptoms that occur when your body becomes used to a medication and you suddenly stop taking it. Symptoms may include fatigue or changes in mood, such as depression.

To help prevent prednisone side effects of withdrawal, your doctor may taper your dosage. This means following a schedule that slowly reduces your dosage of the drug over time. The goal is to gradually help your body adjust to a lower level of prednisone, which may help reduce the risk of withdrawal symptoms.

It’s important that you do not stop taking prednisone without consulting your doctor. If you’re thinking about ending your treatment, be sure to talk with your doctor first. They can recommend the best way to stop treatment and reduce your risk of withdrawal symptoms.

I’m taking prednisone for an allergic reaction. What side effects can I expect?

If you’re taking prednisone to treat an allergic reaction, you’ll likely experience the same side effects as people taking the drug for other uses. Because treatment of allergic reactions is typically short term, you may be at a lower risk of side effects such as moon face or weight gain. (These tend to occur with long-term prednisone treatment.)

For more information on the possible side effects of prednisone, see the more common, mild, and serious side effect lists above. You can also talk with your doctor or pharmacist.

Do prednisone’s side effects vary depending on the dose I take, such as 10 mg or 20 mg?

Yes, it’s possible for the side effects of prednisone to vary based on your dose. If you take a higher dose of medication, your body is exposed to more of the drug. And when you have more prednisone in your body, side effects may be more likely to occur.

For example, the risk of side effects with a 20-milligram (mg) dose of prednisone is higher than with a 10-mg dose.

Before starting prednisone treatment, you may want to talk with your doctor about your risk of side effects and what dose is right for you.

Are there long-term side effects of prednisone?

Prednisone may cause long-term side effects. However, these weren’t common in clinical trials of the brand-name version of prednisone (Rayos). Examples of long-term side effects that may occur during your treatment with prednisone can include:

• heart problems, such as congestive heart failure
• high blood pressure
• osteoporosis or bone fractures
• stomach ulcers
• eye problems, such as cataracts or glaucoma

For symptoms, see “Prednisone: Serious side effects” above. If you’re concerned about long-term side effects with prednisone, talk with your doctor before starting treatment.

Does prednisone cause constipation?

It’s not likely that you’ll experience constipation from taking prednisone. In clinical trials, constipation was not reported as a side effect of the drug.

However, constipation may be a symptom of a side effect of prednisone: a low level of potassium in the blood.

If you become constipated during your treatment with prednisone, talk with your doctor. They can help determine the cause. This may include ordering a blood test to measure the level of potassium in your blood. If it’s low, your doctor can recommend an appropriate treatment.

Most side effects of prednisone are similar in males and females.* However, this medication may cause changes in menstrual bleeding in females. For example, taking prednisone may cause irregular periods or periods that are heavier than usual.

If you have questions about side effects that prednisone may cause in males or females, talk with your doctor.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Learn more about some of the side effects that prednisone may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for prednisone.

Moon face

Prednisone may cause a condition called moon face, in which your face becomes rounder. It can happen when excess fluid or fat makes your face look round or puffy. The condition isn’t harmful. However, some people may not like the change in their appearance.

Moon face can occur with long-term use of steroid drugs such as prednisone. Clinical trials of the medication didn’t report how often this side effect occurred.

What you can do

To help prevent moon face, your doctor may prescribe prednisone for the shortest amount of time possible to treat your condition.

If you notice that your face looks round or puffy while taking prednisone, talk with your doctor. They can suggest treatment options, such as consuming less salt to help reduce puffiness. Or they may recommend a drug other than prednisone.

Weight gain

It’s possible for prednisone to cause weight gain. In fact, weight gain was one of the most common side effects reported in people taking a brand-name version of prednisone called Rayos.

Prednisone is a generic drug that comes as an immediate-release tablet. It starts working right away. Rayos comes as a delayed-release tablet. With this form, the release of the drug is delayed for a time, so its effects occur later.

What you can do

If you gain weight during your treatment with prednisone, talk with your doctor. They can help determine the cause. Weight gain can be due to conditions such as heart problems, which are a possible side effect of prednisone. Your doctor can also recommend ways to manage your weight.

Headache

Headaches may occur with prednisone. It wasn’t reported how often this side effect happened in clinical trials of people taking prednisone.

What you can do

If you have headaches while taking prednisone, talk with your doctor. They may be able to recommend a headache treatment. An example is the over-the-counter (OTC) medication acetaminophen (Tylenol). An OTC drug is one that you can purchase without a doctor’s prescription.

Sweating

Increased sweating is a possible side effect of prednisone treatment. Clinical trials of the drug didn’t report how frequently sweating occurred.

What you can do

If you’re sweating more than usual while taking prednisone, be sure to talk with your doctor. They may be able to suggest ways to manage this side effect, such as wearing clothing that keeps moisture away from the skin. You can find other tips in this article.

Difficulty sleeping

It’s possible for prednisone to cause trouble sleeping. It wasn’t reported how often difficulty sleeping occurred in clinical trials. Difficulty sleeping may also be called insomnia. This may be trouble falling asleep or trouble staying asleep throughout the night.

What you can do

If you’re not sleeping well while taking prednisone, talk with your doctor. If you take prednisone once daily, your doctor may recommend taking your dose early in the morning. This could make it less likely that the drug will keep you awake at night. Your doctor may also recommend an OTC medication to help with insomnia, such as melatonin.

Allergic reaction

As with most drugs, prednisone can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking prednisone. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Be sure to talk with your doctor about your health history before you take prednisone. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health. These are considered to be drug-condition or drug-factor interactions. The conditions and factors to consider include:

Active infections. Before starting prednisone treatment, tell your doctor if you have an active infection (one that’s causing symptoms). This medication can weaken your immune system. If you have an untreated infection, taking prednisone may worsen it. Your doctor will likely treat your infection before prescribing prednisone.

Heart disease. If you have heart disease, tell your doctor before taking prednisone. This medication can cause certain heart problems, such as congestive heart failure. If you already have heart disease, taking prednisone may worsen it. So your doctor may monitor your heart more often than usual while you take prednisone. It’s also possible that they may recommend a different treatment option.

Kidney problems. Prednisone is removed from your body by your kidneys. If your kidneys aren’t working correctly, the drug can build up in your body. If you have a kidney problem, tell your doctor before starting prednisone treatment. Your doctor may monitor your kidneys while you take the medication.

Allergic reaction. If you’ve had an allergic reaction to prednisone or any of its ingredients, your doctor will likely not prescribe prednisone. Taking prednisone could cause you to have another allergic reaction. Ask your doctor what other medications may be better options for you.

Eye problems. Before starting prednisone treatment, tell your doctor if you have any eye conditions, such as glaucoma. This medication may increase your risk of certain eye conditions, including glaucoma and cataracts. If you already have such a condition, taking prednisone may worsen it. Because of this, your doctor may monitor your eyes more often than usual when you take prednisone. In some situations, they may recommend a different treatment.

Stomach or intestinal problems. It’s possible for prednisone to cause stomach or intestinal problems, such as ulcers. If you already have a condition that affects your stomach or intestines, tell your doctor before starting prednisone treatment. Taking the drug can worsen it. Your doctor can advise you on whether prednisone is safe for you.

Mood problems. If you have any mood conditions, such as depression, tell your doctor before taking prednisone. This medication may increase your risk of mood problems. If you already have a mood condition, taking prednisone can worsen it. Your doctor may monitor your mood more frequently than usual. In some situations, they may recommend a different treatment option.

Alcohol with prednisone

There aren’t any known interactions between alcohol and prednisone. However, it’s possible that drinking alcohol while taking prednisone could increase your risk of certain side effects. For example, both alcohol and prednisone can cause:

• nausea
• vomiting
• headache
• confusion
• pancreatitis (pancreas inflammation)

If you drink alcohol during prednisone treatment, these side effects could be more likely to occur. Your doctor can help determine whether it’s safe for you to consume alcohol while taking prednisone.

Pregnancy and breastfeeding while taking prednisone

Here’s some information about pregnancy, breastfeeding, and prednisone.

Pregnancy. Your doctor may recommend that you do not take prednisone while pregnant.

Prednisone may cause harm to a developing fetus if it’s taken during pregnancy. The drug can cause cleft palate and decreased birth weight. In addition, babies may have hormone problems, such as low levels of adrenal hormones, once they’re born. This could cause problems such as fatigue and trouble feeding. Your doctor may monitor your newborn for symptoms of low hormone levels if you took prednisone while pregnant.

If you’re pregnant or planning to become pregnant, talk with your doctor. They can help determine the right treatment option for you.

Breastfeeding. It’s unknown whether it’s safe to take prednisone while breastfeeding.

It’s not known whether prednisone (a type of steroid) passes into breast milk or what effects the drug may have on a breastfed child. However, another steroid drug called prednisolone does pass into breast milk. This means that a child who is breastfed would be exposed to the drug. Prednisolone did not cause negative effects in children.

If you’re breastfeeding or thinking about it, talk with your doctor. They can help determine whether prednisone is right for you. Your doctor can also advise you on ways to feed your child.

Prednisone may cause side effects. However, most of them are mild. It’s possible to develop serious side effects from this medication as well. If you do, be sure to talk with your doctor.

If you’d like to learn more about prednisone, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug. Referring to the following articles about prednisone can provide you with additional information:

• More information about prednisone. For details about other aspects of prednisone, refer to this article.
• Drug comparison. To learn how prednisone compares with methylprednisolone, read this article.
• Cost. If you’d like to learn about prednisone and cost, see this article.
• A look at your condition. For details about some of the conditions prednisone treats, you can see our:
  • rheumatoid arthritis hub
  • dermatology hub
  • asthma and allergies hub
  • eye health hub
  • leukemia and cancer hubs
  • inflammatory bowel disease hub for information about ulcerative colitis

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Prednisone oral tablet side effects: Mild to serious

Prednisone (Rayos) is a generic prescription medication, and as with other drugs, it can cause side effects. Prednisone is used to treat certain conditions, including:

• hormone conditions, such as adrenal insufficiency
• autoimmune conditions, such as rheumatoid arthritis, lupus, and multiple sclerosis
• skin conditions, such as Stevens-Johnson syndrome
• allergic conditions, such as asthma or allergies
• eye conditions, such as optic neuritis
• breathing problems, such as pneumonitis
• blood conditions, such as thrombocytopenia
• leukemia and lymphoma
• ulcerative colitis

Your doctor may prescribe prednisone short term or long term, depending on your condition.

Prednisone comes as an oral tablet. The drug also comes as an oral solution but this article does not cover that form. (For details, talk with your doctor.)

Read on to learn about potential common, mild, and serious side effects. For a general overview of this drug, including what prednisone tablets are used for, refer to this article. Your doctor can also tell you more about prednisone.

Prednisone can cause certain side effects (also called adverse effects), some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took the brand-name version of prednisone (Rayos) in clinical trials:

• edema (swelling due to excess fluid)
• muscle weakness
• bloating (swelling due to excess fluid or gas, often in the abdomen)
• thin skin
• sweating*

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

Mild side effects can occur with prednisone. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to prednisone’s prescribing information.

Mild side effects that have been reported with prednisone include:

• edema (swelling due to excess fluid)
• muscle weakness
• bloating (swelling due to excess fluid or gas, often in the abdomen)
• thin skin
• excitement
• changes in menstrual bleeding
• confusion
• restlessness
• nausea or vomiting
• acne
• moon face*
• weight gain*
• headache*
• sweating*
• difficulty sleeping*
• mild allergic reaction*

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Prednisone and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

Prednisone may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to prednisone’s prescribing information.

If you develop serious side effects while taking prednisone, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Heart problems, such as congestive heart failure. Symptoms may include:
  • difficulty breathing
  • swelling in the legs or feet
  • rapid heart rate
• Mood changes, such as depression. Symptoms may include:
  • feeling sad or hopeless
  • insomnia or sleeping more than usual
  • loss of interest in activities that you typically enjoy
• Low blood potassium level. Symptoms may include:
  • constipation
  • fatigue
  • heart palpitations
• High blood pressure. Symptoms may include:
  • headache
  • shortness of breath
  • anxiety
• Infection. Symptoms may include:
  • fever
  • sore throat
  • cough
• Osteoporosis or bone fractures. Symptoms may include:
  • back pain
  • swelling or bruising
  • pain or numbness
• Stomach ulcers. Symptoms may include:
  • abdominal pain
  • bloating
  • nausea
• Pancreatitis (pancreas inflammation). Symptoms may include:
  • abdominal pain
  • fever
  • nausea or vomiting
• High blood sugar or diabetes. Symptoms may include:
  • feeling more thirsty than usual
  • unexplained weight loss
  • blurry vision
• Eye problems, such as cataracts or glaucoma. Symptoms may include:
  • cloudy vision
  • headache
  • blurry vision
• Severe allergic reaction.*

* For more information about this side effect, see “Prednisone: Side effect specifics” below.

In most cases, side effects in children taking prednisone are similar to side effects in adults taking the drug.

However, prednisone may cause decreased growth in children who take the drug. This may mean that if your child is taking prednisone, especially if they take the drug for a long time, they may not grow as tall.

Due to this risk, your doctor may monitor your child’s growth while they’re taking prednisone. If you have additional concerns about side effects that may occur while your child is taking prednisone, talk with their doctor.

Prednisone may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Will stopping prednisone treatment cause withdrawal symptoms?

It’s possible that stopping prednisone treatment suddenly can cause withdrawal symptoms. These are symptoms that occur when your body becomes used to a medication and you suddenly stop taking it. Symptoms may include fatigue or changes in mood, such as depression.

To help prevent prednisone side effects of withdrawal, your doctor may taper your dosage. This means following a schedule that slowly reduces your dosage of the drug over time. The goal is to gradually help your body adjust to a lower level of prednisone, which may help reduce the risk of withdrawal symptoms.

It’s important that you do not stop taking prednisone without consulting your doctor. If you’re thinking about ending your treatment, be sure to talk with your doctor first. They can recommend the best way to stop treatment and reduce your risk of withdrawal symptoms.

I’m taking prednisone for an allergic reaction. What side effects can I expect?

If you’re taking prednisone to treat an allergic reaction, you’ll likely experience the same side effects as people taking the drug for other uses. Because treatment of allergic reactions is typically short term, you may be at a lower risk of side effects such as moon face or weight gain. (These tend to occur with long-term prednisone treatment.)

For more information on the possible side effects of prednisone, see the more common, mild, and serious side effect lists above. You can also talk with your doctor or pharmacist.

Do prednisone’s side effects vary depending on the dose I take, such as 10 mg or 20 mg?

Yes, it’s possible for the side effects of prednisone to vary based on your dose. If you take a higher dose of medication, your body is exposed to more of the drug. And when you have more prednisone in your body, side effects may be more likely to occur.

For example, the risk of side effects with a 20-milligram (mg) dose of prednisone is higher than with a 10-mg dose.

Before starting prednisone treatment, you may want to talk with your doctor about your risk of side effects and what dose is right for you.

Are there long-term side effects of prednisone?

Prednisone may cause long-term side effects. However, these weren’t common in clinical trials of the brand-name version of prednisone (Rayos). Examples of long-term side effects that may occur during your treatment with prednisone can include:

• heart problems, such as congestive heart failure
• high blood pressure
• osteoporosis or bone fractures
• stomach ulcers
• eye problems, such as cataracts or glaucoma

For symptoms, see “Prednisone: Serious side effects” above. If you’re concerned about long-term side effects with prednisone, talk with your doctor before starting treatment.

Does prednisone cause constipation?

It’s not likely that you’ll experience constipation from taking prednisone. In clinical trials, constipation was not reported as a side effect of the drug.

However, constipation may be a symptom of a side effect of prednisone: a low level of potassium in the blood.

If you become constipated during your treatment with prednisone, talk with your doctor. They can help determine the cause. This may include ordering a blood test to measure the level of potassium in your blood. If it’s low, your doctor can recommend an appropriate treatment.

Most side effects of prednisone are similar in males and females.* However, this medication may cause changes in menstrual bleeding in females. For example, taking prednisone may cause irregular periods or periods that are heavier than usual.

If you have questions about side effects that prednisone may cause in males or females, talk with your doctor.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Learn more about some of the side effects that prednisone may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for prednisone.

Moon face

Prednisone may cause a condition called moon face, in which your face becomes rounder. It can happen when excess fluid or fat makes your face look round or puffy. The condition isn’t harmful. However, some people may not like the change in their appearance.

Moon face can occur with long-term use of steroid drugs such as prednisone. Clinical trials of the medication didn’t report how often this side effect occurred.

What you can do

To help prevent moon face, your doctor may prescribe prednisone for the shortest amount of time possible to treat your condition.

If you notice that your face looks round or puffy while taking prednisone, talk with your doctor. They can suggest treatment options, such as consuming less salt to help reduce puffiness. Or they may recommend a drug other than prednisone.

Weight gain

It’s possible for prednisone to cause weight gain. In fact, weight gain was one of the most common side effects reported in people taking a brand-name version of prednisone called Rayos.

Prednisone is a generic drug that comes as an immediate-release tablet. It starts working right away. Rayos comes as a delayed-release tablet. With this form, the release of the drug is delayed for a time, so its effects occur later.

What you can do

If you gain weight during your treatment with prednisone, talk with your doctor. They can help determine the cause. Weight gain can be due to conditions such as heart problems, which are a possible side effect of prednisone. Your doctor can also recommend ways to manage your weight.

Headache

Headaches may occur with prednisone. It wasn’t reported how often this side effect happened in clinical trials of people taking prednisone.

What you can do

If you have headaches while taking prednisone, talk with your doctor. They may be able to recommend a headache treatment. An example is the over-the-counter (OTC) medication acetaminophen (Tylenol). An OTC drug is one that you can purchase without a doctor’s prescription.

Sweating

Increased sweating is a possible side effect of prednisone treatment. Clinical trials of the drug didn’t report how frequently sweating occurred.

What you can do

If you’re sweating more than usual while taking prednisone, be sure to talk with your doctor. They may be able to suggest ways to manage this side effect, such as wearing clothing that keeps moisture away from the skin. You can find other tips in this article.

Difficulty sleeping

It’s possible for prednisone to cause trouble sleeping. It wasn’t reported how often difficulty sleeping occurred in clinical trials. Difficulty sleeping may also be called insomnia. This may be trouble falling asleep or trouble staying asleep throughout the night.

What you can do

If you’re not sleeping well while taking prednisone, talk with your doctor. If you take prednisone once daily, your doctor may recommend taking your dose early in the morning. This could make it less likely that the drug will keep you awake at night. Your doctor may also recommend an OTC medication to help with insomnia, such as melatonin.

Allergic reaction

As with most drugs, prednisone can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking prednisone. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Be sure to talk with your doctor about your health history before you take prednisone. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health. These are considered to be drug-condition or drug-factor interactions. The conditions and factors to consider include:

Active infections. Before starting prednisone treatment, tell your doctor if you have an active infection (one that’s causing symptoms). This medication can weaken your immune system. If you have an untreated infection, taking prednisone may worsen it. Your doctor will likely treat your infection before prescribing prednisone.

Heart disease. If you have heart disease, tell your doctor before taking prednisone. This medication can cause certain heart problems, such as congestive heart failure. If you already have heart disease, taking prednisone may worsen it. So your doctor may monitor your heart more often than usual while you take prednisone. It’s also possible that they may recommend a different treatment option.

Kidney problems. Prednisone is removed from your body by your kidneys. If your kidneys aren’t working correctly, the drug can build up in your body. If you have a kidney problem, tell your doctor before starting prednisone treatment. Your doctor may monitor your kidneys while you take the medication.

Allergic reaction. If you’ve had an allergic reaction to prednisone or any of its ingredients, your doctor will likely not prescribe prednisone. Taking prednisone could cause you to have another allergic reaction. Ask your doctor what other medications may be better options for you.

Eye problems. Before starting prednisone treatment, tell your doctor if you have any eye conditions, such as glaucoma. This medication may increase your risk of certain eye conditions, including glaucoma and cataracts. If you already have such a condition, taking prednisone may worsen it. Because of this, your doctor may monitor your eyes more often than usual when you take prednisone. In some situations, they may recommend a different treatment.

Stomach or intestinal problems. It’s possible for prednisone to cause stomach or intestinal problems, such as ulcers. If you already have a condition that affects your stomach or intestines, tell your doctor before starting prednisone treatment. Taking the drug can worsen it. Your doctor can advise you on whether prednisone is safe for you.

Mood problems. If you have any mood conditions, such as depression, tell your doctor before taking prednisone. This medication may increase your risk of mood problems. If you already have a mood condition, taking prednisone can worsen it. Your doctor may monitor your mood more frequently than usual. In some situations, they may recommend a different treatment option.

Alcohol with prednisone

There aren’t any known interactions between alcohol and prednisone. However, it’s possible that drinking alcohol while taking prednisone could increase your risk of certain side effects. For example, both alcohol and prednisone can cause:

• nausea
• vomiting
• headache
• confusion
• pancreatitis (pancreas inflammation)

If you drink alcohol during prednisone treatment, these side effects could be more likely to occur. Your doctor can help determine whether it’s safe for you to consume alcohol while taking prednisone.

Pregnancy and breastfeeding while taking prednisone

Here’s some information about pregnancy, breastfeeding, and prednisone.

Pregnancy. Your doctor may recommend that you do not take prednisone while pregnant.

Prednisone may cause harm to a developing fetus if it’s taken during pregnancy. The drug can cause cleft palate and decreased birth weight. In addition, babies may have hormone problems, such as low levels of adrenal hormones, once they’re born. This could cause problems such as fatigue and trouble feeding. Your doctor may monitor your newborn for symptoms of low hormone levels if you took prednisone while pregnant.

If you’re pregnant or planning to become pregnant, talk with your doctor. They can help determine the right treatment option for you.

Breastfeeding. It’s unknown whether it’s safe to take prednisone while breastfeeding.

It’s not known whether prednisone (a type of steroid) passes into breast milk or what effects the drug may have on a breastfed child. However, another steroid drug called prednisolone does pass into breast milk. This means that a child who is breastfed would be exposed to the drug. Prednisolone did not cause negative effects in children.

If you’re breastfeeding or thinking about it, talk with your doctor. They can help determine whether prednisone is right for you. Your doctor can also advise you on ways to feed your child.

Prednisone may cause side effects. However, most of them are mild. It’s possible to develop serious side effects from this medication as well. If you do, be sure to talk with your doctor.

If you’d like to learn more about prednisone, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug. Referring to the following articles about prednisone can provide you with additional information:

• More information about prednisone. For details about other aspects of prednisone, refer to this article.
• Drug comparison. To learn how prednisone compares with methylprednisolone, read this article.
• Cost. If you’d like to learn about prednisone and cost, see this article.
• A look at your condition. For details about some of the conditions prednisone treats, you can see our:
  • rheumatoid arthritis hub
  • dermatology hub
  • asthma and allergies hub
  • eye health hub
  • leukemia and cancer hubs
  • inflammatory bowel disease hub for information about ulcerative colitis

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Headache in the elderly

According to epidemiological studies, the frequency of headache in people over 70 years of age varies from 14 to 53%, but most authors note a trend towards a decrease in its prevalence with age [6, 20, 25]. Approximately 11-17% of the elderly complain of regular headaches, and 20% of episodic intense pain. Chronic headache in old age occurs in approximately 4% of individuals [25, 30].

In parallel with the decrease in the prevalence of primary forms of headache in elderly patients, the frequency of secondary forms of headache is increasing, which often present significant diagnostic difficulties and may be a sign of a severe, life-threatening disease. These diseases include temporal (giant cell) arteritis, brain tumors, intracranial hemorrhages, and often difficult to diagnose subacute subdural hematomas. Other causes of symptomatic headaches, which are common in the elderly, are the side effects of drugs, metabolic disorders (including hypercalcemia and hypernatremia), anemia, hypoxia, chronic liver or kidney failure. A separate category is neuralgia and other pain syndromes in the face.

This review discusses the most clinically significant forms of headache in the elderly and practical approaches to their diagnosis and treatment.

Primary headaches

The most common primary forms of headache, including in the elderly, are migraine and tension-type headache (THT). As you know, migraine is most common in middle-aged women. With age, the prevalence of migraine decreases in both women and men, and is only 3.9 in people over 70 years of age.% [4]. ⅔ attacks are reduced in elderly patients, but ⅓ on the contrary, there may be an increase in the frequency of headaches or even a transition to a chronic form. Typical risk factors for chronic headaches in the elderly are stress and overuse of pain medications. The severity of migraine attacks can also be smoothed out with age: the frequency of vegetative symptoms decreases, the headache ceases to be throbbing, and the intensity of pain decreases [18]. At the same time, the proportion of migraine with aura increases, reaching 40% in people over 70 years of age. This is primarily due to a greater reduction in the incidence of migraine without aura than a real increase in the incidence of migraine with aura.

The course of migraine with aura also changes with age: the frequency of aura may decrease, and episodes of “headless migraine” may occur, manifested by aura without subsequent headache [16]. Only in 2-3% of cases migraine first manifests itself after 50 years. In this regard, before diagnosing migraine in an elderly patient, it is necessary to exclude secondary forms of headache, which may clinically be similar to migraine.

The prevalence of HDN in different age groups remains relatively stable, but the ratio of its forms can also change. With age, the frequency of episodic TTH decreases, while the prevalence of chronic TTH increases [17, 27]. In all likelihood, this is due to an increase in the frequency of exposure to factors that worsen the course of HDN, such as depression, anxiety, excessive use of painkillers, pathology of the masticatory apparatus, and visual impairment. At the same time, it is possible that some of these patients suffer from secondary forms of headache, clinically resembling TTH, which cannot be clarified in the framework of an epidemiological study.

Other primary forms of headache in the elderly are extremely rare. Thus, cluster headache, as a rule, manifests itself between 20 and 30 years, however, there are descriptions of a later debut – after 70 years [8, 11]. Nevertheless, even the occurrence of complaints typical of cluster headache in an elderly patient should first of all arouse the suspicion of a symptomatic headache and require the exclusion of glaucoma, uveitis, or dissection of the internal carotid artery. At the same time, in 20-30% of individuals with a long-term history of cluster headache, it becomes chronic with age.

Hypnic headache is another rare primary headache variant that occurs in people over 50 years of age, more often in women. The average age of patients with this type of headache is about 64 years. Hypnic headache occurs during sleep, has an average intensity and pressing character, lasts from 15 to 180 minutes. It often occurs at the same time, but unlike cluster headache, it is bilateral and is not accompanied by autonomic symptoms (redness of the conjunctiva, lacrimation, rhinorrhea). Patients may experience several seizures per night. Conventional analgesics are ineffective in this form of headache. For treatment, you can use verapamil, lithium, caffeine. Similar to cluster headache, this rare diagnosis can only be made after symptomatic headaches have been ruled out [13]. If a hypnic headache is suspected, symptomatic headaches associated with increased intracranial pressure, such as brain tumors, should be ruled out.

In the latter case, the headache may also appear during sleep (in the morning). After waking up and moving to an upright position, these headaches decrease, thus showing the opposite dynamics compared to headache with reduced intracranial pressure. Before making a diagnosis of hypnic headache, a CT or MRI of the brain is necessary.

Secondary headaches

Compared with younger people, secondary forms of headache are more common in older people due to a higher frequency of metabolic disorders, cerebrovascular diseases, and taking a large number of drugs. In addition, temporal (giant cell) arteritis, intracranial tumors, neuralgic syndromes, sleep apnea syndrome, hemodialysis, hypothyroidism, arterial hypertension are common causes of headache. It is impossible not to mention the exaggerated role of chronic cerebrovascular insufficiency and cervical spondylosis as possible causes of chronic headache.

In ischemic stroke and transient ischemic attacks, headaches occur in 32% of cases, while ischemia in the vertebrobasilar basin is more often accompanied by headache than ischemia in the basin of the carotid arteries. Lacunar infarctions are rarely accompanied by headache. With age, the frequency of headache in ischemic stroke decreases. With intracerebral hemorrhage, headache occurs 2 times more often than with cerebral infarction – in about 64% of patients. With small intracerebral hemorrhages, headache may be absent. On the contrary, with subarachnoid hemorrhage, intense headache is observed in almost 100% of cases. Headache often occurs ipsilateral to the side of the infarction or hemorrhage [3, 10].

In cerebral vasculitis, headache occurs in at least 60% of cases. The most common form, especially in the elderly, is temporal (giant cell) arteritis [5]. The peak incidence of temporal vasculitis occurs at the age of 70 years. The disease is significantly more common in women. With temporal arteritis, the branches of the external carotid artery, as well as the vertebral, ophthalmic and posterior ciliary arteries are most often affected. The intracranial arteries are usually not affected. Headache is the initial symptom in half of the cases, and during the course of the disease it is noted in 90% of patients [31]. It can be both unilateral and bilateral, increase over several weeks, intensify in the evening. Pain and induration in the temporal artery or other branches of the external carotid artery are characteristic, but not constant, signs, but the most specific symptom is a decrease in temporal artery pulsation. Another characteristic symptom is “intermittent claudication” of the lower jaw – pain in the chewing muscles when chewing or talking, associated with insufficient blood supply to the muscles during exercise. Temporal arteritis in half of the cases is combined with polymyalgia rheumatica, manifested by pain and tension in the muscles of the neck, back, shoulder and pelvic girdle. The most formidable manifestation of temporal arteritis is blindness due to ischemia of the optic nerve. Blindness develops suddenly, but in some cases it is preceded by episodes of transient monocular blindness ( amaurosis fugax ). Damage to the second eye often develops within a few days. In some patients, lesions of other cranial nerves, most often the oculomotor nerve, may be noted. Early recognition of temporal arteritis and initiation of corticosteroid therapy are of paramount importance in avoiding the adverse development of the disease. Before the introduction of corticosteroid therapy into therapeutic practice, blindness occurred in 60% of patients. High ESR is typical for temporal arteritis, however, a normal indicator does not exclude the disease (it is noted in 1-2% of cases). To confirm the diagnosis, Doppler ultrasound of the branches of the external carotid artery can be performed, revealing a typical hypoechoic zone associated with inflammation and edema of the artery wall, as well as segmental stenoses or occlusion of the artery. The gold standard of diagnosis is biopsy and histological confirmation of inflammation of the vascular wall of the affected artery. In the presence of ischemic complications, such as acute loss of vision (including transient) or acute cerebrovascular accident, methylprednisolone is prescribed at a dose of 1000 mg per day for 3-5 days, followed by a transition to oral prednisolone (1 mg / kg per day daily). In addition, aspirin is prescribed at a dose of 100 mg per day. In the absence of ischemic lesions, prednisolone is administered orally at a dose of 1 mg/kg of body weight. Clinical improvement is usually noted after 5-6 days. A smooth dose reduction can be started after normalization of ESR, usually after 3-4 weeks, maintenance therapy is continued from 1 to 2 years [7].

Common causes of headache in the elderly include intracranial tumors, especially gliomas (highest incidence between 45 and 70 years of age), meningiomas (maximum incidence between 50 and 70 years of age), and metastases. About 60% of patients with neoplasms complain of headache. Approximately 83% of patients who previously suffered from headaches note a change in the nature of the pain. Headache severity does not correlate with tumor size [28]. Chronic subdural hematomas also lead to increased intracranial pressure and similar symptoms, often developing weeks or months after minor injuries, which patients often forget about by the time symptoms develop. The median time between injury and diagnosis is 49days [23]. The likelihood of volumetric formation increases significantly if epileptic seizures occur against the background of a growing headache. Thus, in patients with new or changed headaches, especially if they increase with time, intensify during or after sleep, are accompanied by vomiting or other cerebral phenomena, neuroimaging (CT / MRI of the brain, if necessary – with contrast ).

Headache can be a side effect of both prescribing and discontinuing drugs.

The drugs most commonly associated with headache include: phosphodiesterase inhibitors, dipyridamole, nitric oxide donators, short-acting calcium channel blockers. The use of nitrates may be the cause of migraine-like headaches. Immunosuppressive drugs and non-steroidal anti-inflammatory drugs (NSAIDs), including indomethacin, diclofenac, ibuprofen, are capable of causing headaches. This group does not include the so-called drug-induced (“abuse”) headaches caused by excessive intake of analgesics or triptans, since in this case we are talking about a complication of the course of primary forms of headache.

In this case, the withdrawal of analgesics leads at the beginning to a marked deterioration and intensification of headache, but if the patient “holds on” 4-8 weeks without analgesics, the frequency of headaches decreases. Caffeine or alcohol can also cause withdrawal headaches.

About 2% of women and 4% of men suffer from sleep apnea, with an average age of onset of the disease being 50-70 years. Patients with obstructive sleep apnea often complain of bilateral morning headaches resembling TTH. Probably, the pathogenetic mechanism of these pains is hypercapnia/hypoxia and an increase in intracranial pressure as a result. Treatment of sleep apnea (with pharyngeal surgery) usually improves these complaints. Insomnia also leads to an increase in the frequency of complaints of headache, but such headaches are not of a morning nature [1].

The most controversial issue is the relationship between headaches and arterial hypertension [32]. Epidemiological studies have not revealed an association between blood pressure levels and headaches [22, 29]. Nevertheless, with a sharp increase in blood pressure (“hypertensive crisis”), headache occurs quite often, although there is also no direct correlation between blood pressure and headache. Sometimes other symptoms are also noted – disorientation, drowsiness, nausea and vomiting, focal neurological symptoms, primarily visual impairment due to an earlier violation of vasoregulation in the basin of the posterior cerebral arteries. At the same time, a prolonged increase in diastolic pressure above 120 mm Hg. can also lead to headaches [12].

Among patients with chronic renal failure on hemodialysis, 71% of patients complain of headaches at the beginning of treatment, and only 28% report a decrease in headache [2]. Thus, both renal failure and hemodialysis, leading to fairly rapid metabolic shifts, can cause headaches.

Hypothyroidism can also cause headaches. Approximately 30% of patients with hypothyroidism suffer from regular pressing diffuse headaches. At the same time, correction of hypothyroidism causes an improvement in symptoms [21]. Little attention has been paid to this problem in the literature, but it may be a common cause of headache – about 20% of the elderly have some degree of hypothyroidism.

Chronic hypoxia and hypercapnia, such as in chronic obstructive pulmonary disease and anemia, can cause diffuse pressure headaches. With respiratory failure, headache often occurs in the morning and disappears within 1 hour after waking up.

Other possible causes of headaches in elderly patients can be glaucoma (maximum pain in the orbital region, associated symptoms – redness of the eye, pain on palpation of the eyeball and blurred vision), as well as sinusitis (as at any age, the development of sinusitis leads to headaches , which in localization correspond to the inflamed paranasal sinuses, increase with palpation in the sinus area and sudden movements of the head).

Trigeminal neuralgia, like temporal arteritis, is a classic pain syndrome in the elderly. The peak incidence falls on the 7-8th decade of life. Shooting brief pain attacks are typical, so intense that patients often shudder. Pain attacks last a few seconds or minutes and are repeated many times a day. Touching the face, chewing, talking, yawning, or shaving are typical triggers for pain. Most often, the pain is localized infraorbitally or in the lower jaw, respectively, in the zone of innervation of the 2nd and 3rd branches of the trigeminal nerve. With age, a constant mild hypalgesia in the corresponding innervation zone can be added to the typical neuralgic paroxysms. As a rule, the cause of the classical form of the disease is close contact (“conflict”) of the trigeminal nerve with an artery, usually the superior cerebellar (in this sense, the term “idiopathic neuralgia” is rather historical). If trigeminal neuralgia develops in the area of ​​the 1st branch of the trigeminal nerve, is accompanied by facial hemispasm, has an atypical pattern of pain (for example, persistence of pain between attacks), other symptomatic forms caused, for example, by a tumor of the cerebellopontine angle, aneurysm, arteriovenous malformation, or vaccination should be excluded. [24]. To exclude the symptomatic form of trigeminal neuralgia, it is necessary to perform an MRI of the brain with MR angiography.

Glossopharyngeal neuralgia is even more rare. Sharp shooting pains in the pharynx can be triggered by swallowing, coughing, or speaking. Some patients stop eating. For some, an intense pain attack is accompanied by loss of consciousness.

In some patients, mental illness is suspected for some time.

Features of the treatment of headache in the elderly

The basic principles of the pharmacotherapy of headaches in the elderly are the same as those in young or middle-aged people, but when it is carried out, it is necessary to take into account age-related changes in the pharmacokinetics and pharmacodynamics of drugs. So, with age, there is a decrease in the volume of distribution of water-soluble drugs and, accordingly, their concentration in plasma increases. On the contrary, due to an increase in the content of adipose tissue, the volume of distribution of fat-soluble drugs increases, their concentration in plasma decreases, but they remain longer in the body. Metabolic processes slow down, and renal and hepatic elimination of drugs is less effective [14].

With regard to individual groups of drugs, the increased risk of renal and gastrointestinal side effects must be taken into account when using NSAIDs. Regular use of NSAIDs requires the appointment of proton pump inhibitors. The use of triptans is limited to ischemic heart disease. Although triptans have not been found to increase the risk of myocardial infarction and stroke, their use is officially approved only in patients under 65 years of age [15]. Of particular concern is the use of sumatriptan in the form of subcutaneous injections in elderly patients with cluster headache. Given the possible concomitant cardiac pathology and the lack of official indications for the appointment of triptans, oxygen inhalation is safer in the elderly. However, patients who respond well to triptan therapy continue to take them well into older age. For the treatment of nausea in patients with migraine, metoclopramide should be used with caution due to the risk of extrapyramidal complications – preference should be given to domperidone, which does not penetrate the blood-brain barrier. It is more rational to start the selection of prophylactic agents for migraine with beta-blockers, which are often prescribed for cardiological indications. In the presence of concomitant depression, it makes sense to prescribe antidepressants. Due to the anticholinergic and cardiotoxic effects, the appointment of tricyclic antidepressants in elderly patients is not recommended, especially in the presence of glaucoma, prostatic hyperplasia and cardiac pathology. Selective serotonin reuptake inhibitors have not shown a significant therapeutic effect in HDN and migraine, so only serotonin and noradrenaline reuptake inhibitors, such as venlafaxine and duloxetine, can be an alternative to tricyclic agents. When using them, it is recommended to regularly monitor the level of blood pressure [19].

When using antiepileptic drugs used to prevent migraine (topiramate, valproic acid preparations), it is necessary to regularly monitor blood coagulation parameters, liver enzymes (when taking valproic acid) and blood creatinine levels (when taking topiramate). With the simultaneous presence of cardiovascular diseases, it is possible to prescribe aspirin at a dose of 300 mg per day (taking into account the risk of gastrointestinal complications).

Verapamil and short courses of corticosteroids may be recommended as prophylaxis for cluster headache. Topiramate or lithium preparations can be used as second-choice drugs. When prescribing verapamil, it is necessary to monitor atrioventricular conduction with the help of an ECG. When prescribing lithium preparations, it is necessary to monitor the function of the kidneys and thyroid gland [9]. In hypnic headache, as a rule, it is possible to achieve an effect when prescribing caffeine, verapamil, or lithium [24].

Long-term use of corticosteroids for temporal arteritis should be aware of the risk and use vitamin D, calcium, or bisphosphonates as prophylaxis. When treating trigeminal neuralgia in elderly patients, surgical treatment is recommended only in the most severe cases. Due to the relatively high rate of spontaneous remissions, conservative treatment is preferred. The drug of choice, even in elderly patients, remains carbamazepine, and its alternative is oxcarbazepine. The dose of carbamazepine and oxcarbazepine has to be titrated more slowly than in younger patients, and comparable dosages are often not achieved due to side effects. Patients often develop hyponatremia, confusion, and slow thinking. Alternatively, pregabalin, topiramate, or lamotrigine may be given.

Conclusion

Thus, the diagnosis and treatment of headaches in elderly patients have their own specifics. Headache in general in the age group is less common, but more often presents with symptomatic forms and can cause diagnostic difficulties. Knowledge of the features and nature of headaches in various diseases makes it possible to distinguish relatively benign cephalgic syndromes from situations requiring emergency treatment.

Therapeutic and diagnostic blockade for pain in the back and joints: indications, methodology

In recent decades, one of the most effective ways to relieve pain in various degenerative diseases of the spine is a therapeutic blockade. The meaning of the blockade is to deliver a strong anti-inflammatory drug to the site of inflammation, thus, it is often possible to significantly reduce the intensity of pain or stop it completely in various diseases and syndromes. For example, to eliminate pain in the lower back during exacerbation of spondyloarthrosis or sacroiliitis, to reduce the intensity of pain in the leg or arm in various radiculopathies (with protrusion and hernia of the disc, various other stenoses of the spinal canal). But, if the prescribed drug therapy does not raise questions in patients, then the fact of receiving an injection, also in the focus of pain, becomes, for the majority, a frightening prospect.

Does it make sense to be afraid of a blockade and is it really that effective?

Therapeutic-diagnostic blockade is a drug injection (injection) that is made directly into the center of inflammation, thus, in the shortest possible time, it relieves pain. To achieve an accurate hit in the focus of inflammation allows the blockade under ultrasound or X-ray control in a specially equipped operating room. Fluoroscopy, ultrasonic sensor allow you to control the position of the inserted needle in accordance with anatomical landmarks throughout the procedure. Depending on the localization of pain and its causes, in a strictly individual order, the administered drug / group, its dosage and frequency of administration are selected.

The main purpose of the blockade is to stop inflammation. The second, but important purpose of the blockade is a diagnostic search for the source of pain, which is why the blockade is called diagnostic and treatment. Often, patients with diseases of the spine and musculoskeletal system have a whole list of pathological changes in the vertebrae, intervertebral discs and joints, ligaments, adjacent muscles, and large joints of the limbs. Each of these pathological foci can generate a pain impulse, the inflammatory process can involve nearby nerve structures. Pain signals from several foci can “overlap” and “mask” or “potentiate” and reinforce each other. To determine the source of pain, establish the correct diagnosis and determine the optimal treatment tactics, they resort to conducting the so-called. selective (selective) blockades. Having brought the pain medication to the probable source of the patient’s suffering, and evaluating the result, we can draw the appropriate conclusions: the blockade did not help – the source of pain is hidden in another place, it is necessary to continue the diagnostic search; the blockade helped – the source of the pain was found, if the pain occurs again, it is necessary to discuss options for its elimination (surgical treatment, revision of conservative therapy, rehabilitation measures).

How does the blockade work and where is the drug injected?

Depending on the source of the pain impulse, the doctor determines the indications, the level and area of ​​administration of the drug, as well as its dosage.

With indications, appropriate equipment and skill, the drug can be applied to almost any anatomical structure of the body. The following blockades are most often performed:

1. Blockade of the intervertebral joints – the drug is injected under the control of fluoroscopy directly into the cavity of the facet (facet) joints – these small joints bind the vertebrae together into one rigid, but movable chain (vertebral column). Their inflammation (spondyloarthrosis) is the most common cause of low back pain.
2. Epidural blockade – the drug is injected into the cavity of the spinal canal under the arch of the vertebra, in the space between the ligament that covers the sheath of the spinal cord roots and the sheath itself, under X-ray control. Indications are radicular (radicular) symptoms of various origins: in the presence of a herniated disc, degenerative stenosis (narrowing) of the spinal canal, inflammation after injury and surgery. The drug introduced into the canal spreads in loose fiber over the roots, stopping the inflammation and associated pain.
3. Foraminal blockade (blockade of the “outgoing” root) – the drug is injected, under X-ray control, not into the spinal canal, but into the area of ​​​​the opening (lat – foramen) through which the nerve root extends beyond the spine. Indications for carrying out are similar to indications for epidural blockade.
4. Blockade of the sacroiliac joint – the drug is injected into a large joint, which is the junction of the sacrum and pelvic bones. Inflammation of the sacroiliac joint – sacroiliitis is the cause of pain in the sacrum, extending to the gluteal region, sometimes the pain is so intense that it does not allow a person to walk. It is carried out under x-ray control.
5. Various blockades of muscles (piriformis, scalenus, rotator cuff) and peripheral nerves (lateral femoral cutaneous nerve, pudendal nerve, etc.) are performed under ultrasound guidance and serve both therapeutic and diagnostic purposes. Carried out for various peripheral neuropathies, tunnel syndromes, consequences of injuries and operations
6. Blockade in spastic syndrome – the introduction of a substance based on botulinum toxin to eliminate excessive muscle tone – spasticity

Is blockade a cure?

In diseases of the spine, for example, protrusion of the disc with radicular syndrome or herniated disc, spondylarthrosis, degenerative stenosis, the blockade is not the main method of treatment, but is an “ambulance” to relieve pain, improve quality of life, increase patient mobility. It is noteworthy that after the blockade, the pain syndrome can go away for a very long time, possibly for years. With bursitis, periarthritis, non-infectious arthritis, that is, diseases associated with inflammation of the joints, blockade can be considered as a separate type of treatment, with the right combination of administered drugs.

What medicines are used for blockade?

The main active substance used in various types of blockades is a derivative of the group of glucocorticosteroid hormones, which has a powerful anti-inflammatory, desensitizing effect. Preparations of this group are divided depending on the duration of action:

1. Short-term action: cortisone, hydrocortisone (8-12 hours)
2. Intermediate duration: prednisolone, methylprednisolone, triamcinolone (24-36 hours)
3. Long acting: dexamethasone, betamethasone (36-54 hours)

In addition to corticosteroid hormones, the composition of the drug solution administered during the blockade includes local anesthetics, which effectively block the pain impulse that occurs in the nerve fiber. These include:

• Lidocaine (duration of action 0.75-2 hours)
• Mepivacaine (1-1.25 hours)
• Bupivacaine (2.5-6 hours)
• Ropivacaine (naropin) (2.5-5 hours)

This combination of drugs allows you to achieve an analgesic effect in the shortest possible time: the first few hours the local anesthetic acts blocking the pain impulse, at the end of its activity, the steroid hormone begins to act and acts for several days. It should be remembered that the introduction of these drugs should be performed only after the appointment and under the supervision of a physician! Local anesthetics with an incorrect dose or incorrectly administered have a toxic effect, can cause tissue necrosis, a sharp decrease in blood pressure, loss of consciousness, psychosis and hallucinations. Glucocorticosteroids have a whole range of adverse reactions and contraindications, including vascular crises, gastrointestinal bleeding, increased intraocular pressure, and systemic infection.

Are there any contraindications?

As with any treatment, blockade has a number of contraindications:

• allergic reactions,
• mental disorders,
• diseases of the cardiovascular system,
• hypotension,
• presence of infectious diseases,
• hemophilia and other bleeding disorders.

Which specialist should I contact?

Axis clinic specialists advise to carefully choose a doctor – a specialist, in view of the fact that serious complications, including infectious inflammations and anaphylactic shock, can occur if the drugs are administered or selected incorrectly. When contacting Axis patient:

• receives a consultation with a neurologist or neurosurgeon, during which an examination is carried out, a complete patient history is collected, the results of neuroimaging methods are evaluated to establish a diagnosis, the cause of pain and an individual selection of a drug, in order to avoid possible complications and aggravation of the condition
• blockade is carried out under conditions of complete sterility, usually in a sitting or lying position.