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 prednisolone affect mood and mental health.

Understanding Prednisolone: A Powerful Corticosteroid

Prednisolone is a potent corticosteroid medication widely prescribed for various inflammatory and autoimmune conditions. While it can be highly effective in managing these disorders, long-term use of prednisolone can lead to a range of side effects that patients and healthcare providers must carefully consider.

The risk of experiencing side effects increases with higher doses and prolonged use of prednisolone. Patients taking lower daily doses are generally less likely to encounter adverse effects. However, it’s crucial to understand that even at lower doses, some side effects may still occur.

Factors Influencing Side Effect Risk

• Dosage: Higher doses correlate with increased risk
• Duration of treatment: Longer periods of use increase the likelihood of side effects
• Individual patient factors: Age, overall health, and concurrent medications can impact susceptibility

Common Side Effects of Prednisolone: Recognition and Management

Prednisolone can cause a variety of common side effects that affect more than 1 in 100 people. While these effects can be concerning, many can be managed with proper strategies and medical guidance.

Weight Gain: A Common Concern

Weight gain is a frequently reported side effect of long-term prednisolone use. This occurs due to increased appetite and fluid retention induced by the medication. How can patients manage prednisolone-related weight gain?

• Maintain a balanced diet without increasing portion sizes
• Engage in regular exercise to help stabilize weight
• Monitor fluid intake and consult with a healthcare provider about potential dietary modifications

It’s important to note that weight-related changes typically normalize once prednisolone treatment is discontinued.

Gastrointestinal Disturbances

Indigestion is another common side effect of prednisolone. To minimize gastrointestinal discomfort:

• Take prednisolone with food to reduce stomach irritation
• Avoid rich or spicy foods that may exacerbate symptoms
• Consult your doctor about potential protective medications if symptoms persist

Sleep Disturbances and Restlessness

Prednisolone can interfere with sleep patterns and cause feelings of restlessness. How can patients improve sleep quality while on prednisolone?

• Take the medication in the morning to minimize nighttime effects
• Establish a consistent sleep routine
• Create a relaxing bedtime environment
• Avoid caffeine and stimulating activities close to bedtime

Excessive Sweating

Increased perspiration is a bothersome side effect for some prednisolone users. To manage this issue:

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

Serious Side Effects: When to Seek Immediate Medical Attention

While less common, prednisolone can cause serious side effects that require prompt medical intervention. Patients should be aware of these potential complications and know when to seek help.

Signs of Infection

Prednisolone can suppress the immune system, increasing susceptibility to infections. When should patients contact a healthcare provider regarding potential infections?

• High fever or chills
• Severe sore throat or ear pain
• Persistent cough or changes in sputum
• Painful urination
• Non-healing wounds or mouth sores

Endocrine and Metabolic Complications

Long-term prednisolone use can affect various endocrine functions. What symptoms might indicate endocrine or metabolic disturbances?

• Excessive thirst or hunger
• Increased urination frequency
• Rapid breathing or fruity breath odor (signs of high blood sugar)
• Cushing’s syndrome symptoms: weight gain in upper back or abdomen, “moon face,” severe headaches
• Adrenal insufficiency: severe fatigue, dizziness, nausea, muscle weakness

Cardiovascular and Respiratory Concerns

Prednisolone can affect the cardiovascular and respiratory systems. Which symptoms warrant immediate medical attention?

• Sudden shortness of breath
• Swelling in arms or legs
• Chest pain or irregular heartbeat
• Severe dizziness or fainting

Mental Health and Mood Changes: A Significant Concern

Prednisolone can have profound effects on mood and mental health. These changes can range from mild to severe and may significantly impact a patient’s quality of life.

Recognizing Mood Alterations

How might prednisolone affect a patient’s mental state? Common mood changes include:

• Feelings of depression or anxiety
• Euphoria or mood swings
• Irritability or agitation
• Difficulty concentrating or memory problems
• In rare cases, hallucinations or psychotic symptoms

It’s crucial for patients to communicate any mood changes to their healthcare provider promptly. The intensity of these effects often correlates with the dosage of prednisolone.

Strategies for Managing Mood Changes

While mood alterations can be challenging, there are strategies to help cope with these effects:

• Maintain open communication with your healthcare team
• Consider counseling or therapy to develop coping mechanisms
• Practice stress-reduction techniques like meditation or deep breathing exercises
• Ensure adequate sleep and maintain a regular routine
• Engage in regular physical activity, as approved by your doctor

Bone Health: Long-Term Concerns with Prednisolone Use

Extended use of prednisolone can have significant impacts on bone health, potentially leading to osteoporosis and increased fracture risk. How can patients protect their bone health while on long-term prednisolone therapy?

Preventive Measures for Bone Health

• Ensure adequate calcium and vitamin D intake
• Engage in weight-bearing exercises as tolerated
• Consider bone density scans to monitor bone health
• Discuss potential bone-protective medications with your healthcare provider

Early intervention and consistent monitoring are key to maintaining bone health during prednisolone treatment.

Tapering and Discontinuation: Avoiding Withdrawal Effects

Abrupt discontinuation of prednisolone, especially after long-term use, can lead to withdrawal symptoms and potentially dangerous adrenal insufficiency. How should prednisolone be safely discontinued?

Safe Tapering Strategies

• Never stop prednisolone suddenly without medical guidance
• Follow a gradual tapering schedule as prescribed by your healthcare provider
• Monitor for signs of adrenal insufficiency during the tapering process
• Communicate any concerning symptoms to your doctor promptly

The tapering process may take weeks or even months, depending on the duration and dosage of prednisolone use.

Long-Term Monitoring: Ensuring Safe and Effective Treatment

Patients on long-term prednisolone therapy require regular monitoring to ensure the medication’s safety and efficacy. What aspects of health should be routinely assessed?

Key Areas for Monitoring

• Blood pressure and cardiovascular health
• Blood sugar levels
• Bone density
• Ocular health, including intraocular pressure
• Electrolyte balance, particularly potassium levels
• Mental health status
• Growth and development in pediatric patients

Regular check-ups and open communication with healthcare providers are essential for managing the long-term effects of prednisolone use.

Balancing Benefits and Risks: Individualizing Prednisolone Treatment

While the side effects of long-term prednisolone use can be significant, for many patients, the benefits of treatment outweigh the risks. How can healthcare providers and patients work together to optimize prednisolone therapy?

Strategies for Optimizing Treatment

• Regularly reassess the need for continued prednisolone use
• Explore alternative treatments or combination therapies to reduce prednisolone dosage
• Implement lifestyle modifications to mitigate side effects
• Ensure comprehensive patient education about potential risks and management strategies
• Maintain open dialogue between patients and healthcare providers to address concerns promptly

By carefully balancing the therapeutic benefits against potential risks, healthcare providers can help patients achieve optimal outcomes with prednisolone treatment while minimizing adverse effects.

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

Prednisolone – what you need to know about 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 prednisolone 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.
3. When taking prednisolone for a very long time, check blood glucose levels.
4. State of mental health. Children very often become capricious, sometimes even aggressive. This condition resolves on its own after discontinuation of the drug.
5. Watch your weight and diet. Against the background of taking prednisolone, the appetite increases very much. However, you, as a parent, can control the nutrition of your child, it is necessary to limit the intake of easily digestible carbohydrates.
6. In order to monitor and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by – EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes only. It is necessary to consult with your doctor.

If you have any questions about this topic or have suggestions, we are happy to answer questions and accept your suggestions.

What helps, analogues, dosage, side effects

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. It is necessary to consult a specialist. Allergies in joints and muscles of the joint -bearing asthma -powder of joint -tank -tag -tanks from allergies

, author of Article

Podoynitsyna Alena Andreevna,

Diploma of pharmaceutical education: 105924 3510722 reg. number 31917

All authors

Contents of the article

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

Prednisolone has been successfully used to treat inflammatory and autoimmune diseases since 1955 years old. 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.

All products Prednisolone

4 reviews

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 the components of the drug.

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 are set 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 condition occurs with a risk to life. 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 products Metipred

25 reviews

All products Medrol

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All products Kenalog

6 reviews

All products Dexamethasone

14 reviews

Let’s summarize the information.

Prednisolone is a powerful analog of natural glucocorticoids. It suppresses the immune system and has an anti-inflammatory effect.