What are the common side effects of long-term prednisone use. How can patients manage weight gain associated with prednisolone. What serious side effects should prompt immediate medical attention. How does prednisone affect mood and mental health.

Understanding Prednisone and Its Long-Term Effects

Prednisone, a corticosteroid medication, is widely prescribed for various inflammatory and autoimmune conditions. While effective, long-term use can lead to significant side effects. The severity and likelihood of these effects typically increase with higher doses and prolonged use.

Do higher doses of prednisone increase the risk of side effects? Yes, the higher the dose and the longer the duration of prednisone use, the greater the chance of experiencing side effects. Patients taking lower daily doses are generally at reduced risk.

It’s crucial for patients to consult their healthcare provider before abruptly discontinuing prednisone, especially after extended use. Sudden cessation can lead to withdrawal symptoms, which can be mitigated through proper medical guidance.

Common Side Effects of Prednisone: Recognition and Management

Prednisone use can result in a range of common side effects affecting more than 1 in 100 people. These effects can manifest immediately or develop over time.

Weight Gain and Appetite Changes

Can prednisone cause weight gain? Yes, prolonged prednisone use often leads to weight gain due to increased appetite and fluid retention. To manage this:

• Maintain a balanced diet without increasing portion sizes
• Engage in regular exercise to stabilize weight
• Be patient – appetite and fluid balance typically normalize after discontinuing prednisone

Digestive Discomfort

Indigestion is a common side effect of prednisone. To alleviate this:

• Take prednisone with food to reduce stomach irritation
• Avoid rich or spicy foods during treatment
• Consult your doctor about additional stomach-protective medications if symptoms persist

Sleep Disturbances

How can patients manage prednisone-induced insomnia? Taking prednisone in the morning can help minimize sleep disturbances by ensuring lower drug levels at bedtime. This timing can also help with feelings of restlessness that may interfere with sleep.

Excessive Sweating

To manage increased sweating:

• Wear loose, breathable clothing
• Use a strong antiperspirant
• Discuss alternative medications with your doctor if sweating becomes problematic

Mood Alterations

Prednisone can affect mood in various ways. Open communication with healthcare providers is essential if mood changes become difficult to manage.

Serious Side Effects: When to Seek Immediate Medical Attention

While less common, serious side effects can occur, particularly with higher doses or prolonged use of prednisone. Patients should seek immediate medical attention if they experience:

• Signs of infection (high fever, severe sore throat, persistent cough)
• Symptoms of high blood sugar (extreme thirst, frequent urination, confusion)
• Indications of Cushing’s syndrome (weight gain in upper back or abdomen, rounded face)
• Signs of adrenal gland problems (severe stomach upset, dizziness, extreme fatigue)
• Muscle pain, weakness, or heart rate changes
• Severe abdominal or back pain
• Breathing difficulties or swelling in arms or legs
• Vision changes
• Unusual bruising or bleeding
• Black or red stools

Mental Health Implications of Long-Term Prednisone Use

How does prednisone affect mental health? Prednisone can have significant impacts on mood and mental well-being. Patients may experience:

• Depression
• Mood swings or euphoria
• Anxiety or sleep problems
• Cognitive difficulties, including confusion or memory loss
• Hallucinations or delusions
• Personality changes or unusual thoughts

The intensity of these mental health effects often correlates with the dosage of prednisone. Patients experiencing any of these symptoms should seek medical advice promptly.

Allergic Reactions: Recognizing Anaphylaxis

Although rare, severe allergic reactions (anaphylaxis) to prednisone can occur. Symptoms of anaphylaxis require immediate emergency medical attention and may include:

• Difficulty breathing or swallowing
• Swelling of the face, throat, or tongue
• Severe rash or hives
• Rapid, weak pulse
• Dizziness or fainting

Strategies for Minimizing Prednisone Side Effects

While side effects of long-term prednisone use can be significant, several strategies can help minimize their impact:

1. Use the lowest effective dose for the shortest duration possible
2. Take the medication as prescribed, typically in the morning to mimic natural cortisol rhythms
3. Maintain a healthy diet rich in calcium and vitamin D to support bone health
4. Engage in regular weight-bearing exercise to maintain muscle mass and bone density
5. Monitor blood sugar levels, especially if diabetic or at risk for diabetes
6. Have regular eye exams to check for cataracts or glaucoma
7. Practice good sleep hygiene to combat insomnia
8. Consider mood-supporting activities like meditation or counseling

Alternative Treatments and Steroid-Sparing Strategies

Are there alternatives to long-term prednisone use? In many cases, yes. Healthcare providers may explore steroid-sparing strategies to reduce reliance on prednisone:

• Immunosuppressants or biologics for autoimmune conditions
• Inhaled corticosteroids for respiratory conditions
• Topical steroids for skin conditions
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
• Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis

These alternatives may help reduce the need for systemic steroids like prednisone, potentially minimizing long-term side effects. However, each alternative comes with its own risk-benefit profile that should be carefully considered with a healthcare provider.

Monitoring and Follow-Up Care for Long-Term Prednisone Users

How should patients on long-term prednisone be monitored? Regular medical follow-ups are crucial for patients using prednisone long-term. These check-ups may include:

• Blood pressure measurements
• Blood glucose testing
• Bone density scans
• Eye examinations
• Psychological evaluations
• Assessments of adrenal gland function

Healthcare providers may adjust dosages or recommend additional treatments based on these monitoring results. Patients should openly communicate any new symptoms or concerns during these follow-ups to ensure comprehensive care.

Patient Education and Support for Managing Prednisone Side Effects

Empowering patients with knowledge and support is crucial for managing the side effects of long-term prednisone use. Key aspects of patient education include:

• Understanding the importance of not abruptly stopping prednisone
• Recognizing signs of adrenal insufficiency
• Learning about dietary modifications to support overall health
• Exploring stress-management techniques to mitigate mood changes
• Knowing when and how to seek medical attention for side effects

Support groups and patient advocacy organizations can provide valuable resources and peer support for individuals navigating the challenges of long-term steroid use. Healthcare providers should consider referring patients to these supportive networks as part of comprehensive care.

How can patients actively participate in managing their prednisone treatment? Encouraging patients to keep a symptom diary can be invaluable. This record can help track side effects, identify patterns, and provide crucial information during medical consultations. Additionally, patients should be encouraged to ask questions and voice concerns about their treatment, fostering a collaborative approach to care.

Balancing Benefits and Risks: Individualized Approaches to Prednisone Use

The decision to use prednisone long-term requires careful consideration of individual patient factors. Healthcare providers must weigh the potential benefits against the risks of side effects for each patient. Factors influencing this decision may include:

• The severity and nature of the underlying condition
• The patient’s overall health status and comorbidities
• The availability and efficacy of alternative treatments
• The patient’s personal preferences and quality of life considerations

In some cases, the benefits of prednisone in managing severe or life-threatening conditions may outweigh the risks of long-term side effects. In others, alternative treatments or combination therapies may offer a more favorable risk-benefit profile.

How can healthcare providers tailor prednisone treatment to individual patient needs? Personalized treatment plans may involve:

1. Alternate-day dosing to reduce side effects while maintaining efficacy
2. Combination therapy with steroid-sparing agents to minimize prednisone doses
3. Periodic reassessment of the need for continued steroid therapy
4. Customized monitoring schedules based on individual risk factors
5. Proactive management of potential side effects through preventive measures

By adopting a patient-centered approach, healthcare providers can optimize the use of prednisone while minimizing its potential long-term impacts on health and quality of life.

Future Directions: Research and Innovations in Steroid Therapy

Ongoing research aims to improve the safety and efficacy of steroid therapy. Some promising areas of investigation include:

• Development of selective glucocorticoid receptor modulators with reduced side effect profiles
• Exploration of novel drug delivery systems for more targeted steroid action
• Investigation of biomarkers to predict individual responses to steroid therapy
• Research into combination therapies that allow for lower steroid doses
• Studies on the long-term outcomes of various steroid-sparing strategies

These advancements may eventually lead to more refined approaches to managing inflammatory and autoimmune conditions, potentially reducing reliance on traditional corticosteroids like prednisone.

What potential breakthroughs might change the landscape of steroid therapy? Emerging technologies such as nanoparticle-based drug delivery systems could allow for more precise targeting of steroid therapy, potentially reducing systemic side effects. Additionally, advances in personalized medicine may enable more accurate prediction of individual patient responses to steroids, facilitating tailored treatment approaches.

As research progresses, patients and healthcare providers can look forward to potentially safer and more effective options for managing conditions that currently rely heavily on long-term prednisone use. However, it’s important to note that developing new therapies and bringing them to market is a lengthy process, and current best practices for managing prednisone use remain crucial for patient care.

Side effects of prednisolone tablets and liquid

The higher the dose of prednisolone that you take and the longer you take it for, the greater the chance of side effects. You’re less likely to get side effects if you take a relatively low dose of prednisolone daily.

If you have been taking prednisolone for more than a few weeks, check with your doctor before stopping it suddenly to reduce your chances of withdrawal side effects.

Some side effects, such as stomach upset or mood changes, can happen straight away. Others, such as getting a rounder face, happen after weeks or months.

Common side effects

These common side effects of prednisolone happen in more than 1 in 100 people. There are things you can do to help cope with them:

Weight gain

If you have to take prednisolone for more than a few weeks, it’s likely that you’ll put on weight. Prednisolone can make you hungrier and also can make you retain more water in your body.

Try to eat well without increasing your portion sizes. Regular exercise will also help to keep your weight stable.

Once you stop taking prednisolone, your appetite and the way your body retains water should return to normal.

Indigestion

Take prednisolone with food to reduce the chances of stomach problems. It may also help if you avoid rich or spicy food while you’re taking this medicine.

If symptoms carry on, ask your doctor if you may benefit from taking an additional medicine to protect your stomach.

Problems sleeping (insomnia)

Take prednisolone in the morning so the levels are the lowest at bedtime.

Feeling restless

If you’re feeling restless when you’re trying to sleep, take prednisolone in the morning so the levels are the lowest at bedtime.

Sweating a lot

Try wearing loose clothing and use a strong anti-perspirant. If this does not help, talk to your doctor as you may be able to try a different medicine.

Mild mood changes

Prednisolone can affect your mood in different ways. Talk to your doctor if you are finding it hard to cope.

Speak to a doctor or pharmacist if the advice on how to cope does not help and any of these side effects bother you or last more than a few days.

Serious side effects

You are more likely to have a serious side effect if you take a higher dose of prednisolone or if you have been taking it for more than a few weeks.

Call a doctor or call 111 straight away if you get:

• a high temperature, chills, a very sore throat, ear or sinus pain, a cough, more saliva or a change in colour of saliva (yellowish and possibly with streaks of blood), pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• sleepy or confused, feeling very thirsty or hungry, peeing more often, flushing, breathing quickly or breath that smells like fruit – these can be signs of high blood sugar
• weight gain in your upper back or belly, “moon face” (a puffy, rounded face), very bad headaches and slow wound healing – these can be signs of Cushing’s syndrome
• a very upset stomach or you’re being sick (vomiting), very bad dizziness or passing out, muscle weakness, feeling very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
• muscle pain or weakness, muscle cramps, or changes in your heart rate – these can be signs of low potassium levels
• severe stomach pain, severe back pain, severe upset stomach or you’re being sick – these can be signs of pancreas problems
• breathlessness
• swelling in your arms or legs
• changes in your eyesight
• any bruising or bleeding that is not normal
• red or black poo

Immediate action required: Call 999 or go to A&E if:

Mood changes

You may notice mood changes and mental health problems while taking prednisolone.

Talk to your doctor or contact 111 if you have any mood changes including:

• feeling depressed
• feeling high, or moods that go up and down
• feeling anxious, having problems sleeping, difficulty in thinking, or being confused and losing your memory
• feeling, seeing or hearing things that do not exist (hallucinations)
• having strange and frightening thoughts, changing how you act, or having feelings of being alone

The higher the dose, the more intense the mood changes can be.

Go to 111.nhs.uk or call 111.

Immediate action required: Call 999 or go to A&E if:

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to prednisolone.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Long-term side effects

Taking prednisolone for a long time can lead to side effects such as:

• thinner bones (osteoporosis)
• poorly controlled diabetes
• eyesight problems
• high blood pressure (hypertension)

Children and teenagers

Taking prednisolone at higher doses for a long time can slow down the normal growth of children and teenagers.

Your child’s doctor will monitor their height and weight carefully for as long as they’re taking this medicine. This will help them spot any slowing down of your child’s growth and change their treatment if needed.

Even if your child’s growth slows down, it does not seem to have much effect on their eventual adult height.

Talk to your doctor if you’re worried. They’ll be able to explain the benefits and risks of giving your child prednisolone.

Other side effects

These are not all the side effects of prednisolone. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 24 February 2022

Next review due: 24 February 2025

What are the side effects of low dose prednisone?

Ask the Expert, Treatment — Sep 21, 2020

Ask the Expert: What are the side effects of taking a low dose prednisone every day? It’s the only thing that helps with my pain, but I hear it’s not a long-term solution?

Prednisone belongs to the class of medications known as corticosteroids (or anti-inflammatory agents). These medications provide relief of inflammation and are used to treat a variety of medical conditions including pain, asthma, Sjögren’s and rheumatoid arthritis. As with all medications, corticosteroids have some adverse side effects related to the dose and the duration in which the medication is taken. Side effects associated with low dose (7.5 mg/day or less) daily prednisone are less severe than those seen with higher doses (greater than 30mg/day) and can usually be managed with precautions. Common side effects of daily low dose prednisone include elevated blood pressure, swelling, changes in blood sugar, increased appetite, weight gain, insomnia, osteoporosis (thinning of bones), irregular menstrual periods, and mood changes. Serious side effects associated with higher doses and long-term use (greater than 1 month) are impaired wound healing, decreased growth (in children), decreased muscle production, fat deposits, stomach ulcers or bleeding, vision problems, higher risk for infection, and in rare cases life-threatening allergic reactions.

Although the list of side effects may make you wonder whether you should take this medication or not, please be reassured that many people take daily low dose prednisone with minor or no side effects. The following self-care tips may help minimize some of the side effects associated with prednisone. For those experiencing swelling and/or elevated blood pressure, a healthy low sodium diet, regular exercise, and stress management can help to keep your blood pressure under control while taking daily low dose prednisone. If you have diabetes, it is important to monitor your blood sugar and report any severe fluctuations in blood sugar to your provider. It is recommended that prednisone be taken with food or milk to minimize stomach upset and reduce the chance of stomach ulceration. Schedule yearly eye exams and report any new changes in vision to your eye doctor. Long term corticosteroid therapy may cause thinning of bones (osteoporosis) which increases the risk of bone fracture. Talk to your doctor or pharmacist about vitamin D and calcium supplementation to help protect your bones. Since long term prednisone use can increase your risk for infection, ask your doctor or pharmacist to review your vaccination history and be sure to stay up to date on all of your recommended vaccines. Alert your family members and friends about the possibility of mood changes associated with this medication, so they can help detect any unusual changes in your behavior. Report any changes in mood or behavior to your doctor.

Although experiencing side effects is unpleasant, it is crucial to avoid sudden discontinuation of this medication. Never stop or decrease your dose unless instructed by your doctor. Your doctor can instruct you on how to slowly decrease your dose if you need to stop taking this medication for any reason.

By Ajay John, Pharmacy Intern and Kayli Smith, Pharm.D

This article was first printed in  the Foundation’s patient newsletter for members. Click here to learn more about becoming a member. 

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Comments

What helps, analogues, dosage, side effects

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS NECESSARY. Allergy Joint and muscle pain Bronchial asthma Joint inflammation 24 3510722 reg. number 31917

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Contents of the article

• Prednisolone: ​​from what
• Prednisolone for allergies
• Prednisolone for covid
• Prednisolone: ​​dosage
• Consequences of treatment with Prednisolone
• Prednisolone: ​​side effects
• Prednisolone and alcohol
• Before nisolone: ​​analogues
• Ask an expert on the topic of the article

Prednisolone is successfully used for treatment of inflammatory and autoimmune diseases since 1955. This is a proven drug. Prednisolone has thousands of clinical studies in its “baggage”, is included in the list of vital and essential drugs in Russia and WHO.

We tell you when Prednisolone helps, what side effects it has and how to use the drug correctly.

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Prednisolone: ​​what

Prednisolone is a synthetic hormone glucocorticoid. In the human body, glucocorticoids are produced by the adrenal glands. They regulate carbohydrate, protein and mineral metabolism.

Prednisolone has the following actions:

• anti-inflammatory
• decongestant
• antiallergic
• anti-shock
• immunosuppressive

The drug has a wide range of indications, it is used for:

• shock states
• allergic diseases, including anaphylactic shock
• cerebral edema
• bronchial asthma
• systemic lupus erythematosus and rheumatoid arthritis
• inflammatory diseases of the joints
• acute adrenal insufficiency
• thyrotoxic crisis, thyroiditis
• hepatitis and hepatic coma
• diseases of the skin and eyes
• diseases of the hematopoietic organs
• lung diseases (including tuberculosis and cancer)
• in organ transplantation

Hormone treatment seriously affects the organs and systems of the human body. There are a lot of contraindications for Prednisolone, a complete list is indicated in the instructions for the drug and in the Register of Medicines of Russia (RLS). The drug is contraindicated in pregnancy and breastfeeding.

For life-saving use, the only contraindication is hypersensitivity to prednisolone or any of the drug’s components.

You may be interested in: Bronchial asthma clinical guidelines for treatment and prevention

Prednisolone for allergies

The antiallergic effect of Prednisolone is due to the fact that the drug changes the body’s immune response to allergens. The hormone inhibits the synthesis of biologically active substances – allergy mediators. Reduces the number of cells responsible for immunity. Inhibits the formation of antibodies.

In case of anaphylactic shock and bronchial status, prednisolone is administered intravenously, in other cases, for allergies, the doctor prescribes intramuscular injections or tablets.

Prednisolone for covid

Glucocorticoids, including Prednisolone, are indicated for the complicated course of coronavirus infection. They are prescribed when pneumonia develops with respiratory failure.

World Health Organization (WHO) Interim Guidelines published based on clinical trial data:

• Recommendation #1: WHO strongly recommends oral or intramuscular corticosteroids (dexamethasone, hydrocortisone, or prednisolone) for the treatment of patients with severe and critical COVID-19.
• Recommendation #2: WHO does not recommend the use of corticosteroids in the treatment of patients with non-severe COVID-19 unless the patient is already taking the drug for another condition.

Prednisolone: ​​dosage

The dose of Prednisolone and the duration of therapy is determined by the doctor individually, depending on the indications and the severity of the disease.

At the beginning of the course, the drug is prescribed in a higher dose. When a therapeutic effect is achieved, it is reduced to maintenance.

The daily dose is best taken once in the morning. This corresponds to the biological rhythm of the adrenal glands. The high dose can be divided into 2-4 doses, and the largest dose taken between 6 and 8 am.

Withdrawal of the drug is carried out gradually. A smooth dose reduction is due to the “withdrawal” syndrome. When treated with Prednisolone, the adrenal glands stop producing their own glucocorticoids. With a sharp cessation of the intake of Prednisolone, the body remains without hormones.

A serious life-threatening condition occurs. It is necessary to gradually reduce the intake of the hormone from the outside in order to restore the function of the adrenal glands. The doctor should draw up a scheme on how to reduce the dose of Prednisolone. For each case, it is individual and depends on the duration of treatment and the dose that the patient took during treatment.

If Prednisolone is used urgently and not more than 3 days, then gradual withdrawal is not required

Effects of treatment with Prednisolone

Hormone treatment should be taken very seriously. Long-term therapy with large doses of Prednisolone is accompanied by numerous adverse reactions.

One of the most noticeable is weight gain. It is better from the first days of therapy to choose a diet with a lot of vegetables, exclude sugar, limit carbohydrates, fatty and fried foods. Arrange fasting days, drink plenty of water and give yourself physical activity.

Still needed:

• take medicines to protect the digestive tract, heart and bones
• monitor blood pressure
• see an ophthalmologist
• monitor glucose levels
• stop taking the drug gradually under the supervision of the attending physician

Prednisolone: ​​side effects

The frequency and severity of side effects depends on the duration of treatment, the level of doses taken and compliance with the rules for taking the drug. We indicate the most severe negative effects:

• development of diabetes
• adrenal suppression
• bleeding and gastrointestinal ulcers
• increased blood pressure, cardiac arrhythmias up to cardiac arrest, heart failure
• thrombosis
• osteoporosis
• mental disorders
• development and exacerbation of infections

Antacids and potassium preparations are prescribed to reduce side effects.

Prednisolone and alcohol

Do not drink alcohol during treatment with Prednisolone. Alcohol increases the risk of erosions, ulcers and bleeding in the gastrointestinal tract.

Prednisolone analogues

Hormone therapy is a complex and responsible process. Only the attending physician can choose an analogue to replace Prednisolone. For information, we indicate drugs that also belong to glucocorticoids:

• Dexazon
• Dexamethasone
• Kenalog
• Cortef
• Medrol
• Methylprednisolone
• Metipred
• Polcortolone
• Triamcinolone

All goods Metipred

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All products Medrol

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All products Kenalog

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All products Dexamethasone

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Let’s summarize the information.

Prednisolone is a powerful analogue of natural glucocorticoids. It suppresses the immune system and has an anti-inflammatory effect. In emergency and severe cases, the drug saves lives.

Treatment with Prednisolone is carried out only according to strict indications and under the supervision of doctors. Against the background of hormone therapy, improper treatment and abrupt withdrawal, serious side effects appear.

The drug has a pronounced “withdrawal” syndrome, so the correct termination of treatment is as important as the therapy itself.

Prednisone is available from pharmacies by prescription. Only a doctor can replace the drug with an analogue.

Ask an expert about the topic of the article

Still have questions? Ask them in the comments below and our experts will answer you. You can also share your experience with other Megatips readers.

Managing editor

Zotina Natalya Igorevna,

Expert pharmacist

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Prednisolone – what you need to know when taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many people think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisone that is considered an obligatory and necessary drug of first choice in the treatment of a disease (for example, nephrotic syndrome, which you can read about here).

We are not talking about the drug itself and for what diseases it should be prescribed, but our information block about what doctors usually forget when they prescribe prednisolone. Usually, children come for a consultation while taking prednisolone in combination with asparkam. Believe me, hypokalemia (decrease in the level of potassium in the blood), in connection with which asparks are prescribed, is not the most common complication when prescribing prednisolone.

In our practice, almost 90% of patients receiving this drug are diagnosed with nephrotic syndrome.

Prednisolone is prescribed for a long period of time (the full course of therapy before the drug is discontinued may last 6-12 months), additional drugs must be prescribed to prevent the side effects of prednisolone. They are:

1. In order to protect the mucosa of the upper gastrointestinal tract (esophagus, stomach, duodenum), prednisolone may cause indigestion, nausea, vomiting and more serious complications such as steroid ulcers. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e. Protection of the stomach in literal translation). These are antacids (eg Maalox, phosphalugel, etc.), H+ pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone thinning) can develop, which ultimately leads to bone fractures. But this condition can also be prevented, it is necessary to take calcium and vitamin D preparations . The dose of drugs is also selected individually.

Other things to watch out for:

1. Mandatory blood pressure monitoring
2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.