Prednisone Side Effects

In the first three months of 2024, the FDA received 5,402 cases of adverse events involving prednisone, according to the FDA Adverse Event Reporting System. The 2024 monthly average exceeded that of 2023 by 276 cases. If the trend were to continue, 2024 would overtake 2023 as the year with the most reported cases of adverse events involving prednisone.

Disclaimer: Reports sent to the FDA don’t necessarily mean the drug caused an adverse event. Consult a health care professional before stopping or changing medication.

There are no recent FDA warnings or actions for prednisone.

Prednisone is one of the 30 most widely prescribed medications in the United States. Despite the uptick in cases reported in 2024, it has a strong safety record. Only about 152,500 cases of adverse events have been reported since 1968, which is less than 1% of people taking it today.

Of the more than 5,400 cases received in 2024, roughly 22% involved ineffective medication and off-label use. Shortness of breath, fatigue and pain account for the next three highest number of cases reported to the FDA, according to a Drugwatch analysis of the latest FDA data updated on March 31, 2024.

The UK’s National Health Service reports that weight gain, indigestion, insomnia, restlessness, sweating and mood changes are the only side effects of prednisone that impact more than 1% of users, but more specific data is unavailable. Mood changes could progress to mental illness, so it’s important to communicate any behavior changes with your health care provider.

There are gender differences in how side effects manifest. For example, women reported experiencing adverse side effects more frequently than men did. Additionally, women are more likely to develop osteoporosis, while men may experience erectile dysfunction.

Weight Gain and Prednisone

Increased appetite, a common side effect of prednisone, is linked to weight gain. Bree Phillips, a registered dietitian in pediatric rheumatology at UCSF Benioff Children’s Hospital, regularly counsels patients on the nutritional side effects of long-term prednisone use.

“Steroids can have a significant impact on appetite. This can lead to overeating and weight gain, putting patients at greater risk for diabetes and cardiovascular disease,” Phillips told Drugwatch. “It’s important to be proactive with establishing healthy nutrition and lifestyle habits before starting prednisone.”

Phillips recommends eating fiber-rich foods to help you feel “fuller” and curb urges to overeat when taking prednisone. She suggests filling half your plate with non-starchy, healthy, high-calcium foods.

How Long Do Prednisone Side Effects Last?

The length of prednisone side effects depends on the side effect. Typically, minor side effects can last a few days to weeks. If you experience side effects lasting longer than that, or they become severe, you should contact your doctor.

While serious side effects are rare, it is important for patients with a prednisone prescription to understand these serious side effects and to discuss the risks with their doctor.

Patients should carefully monitor these rare but serious side effects. These side effects have the potential to cause long-term effects that affect the patient even after the prednisone treatment ends.

Several medically significant conditions can increase a patient’s risk of serious side effects. For example, people in menopause are at a higher risk of osteoporosis, and people with prediabetes are more likely to have elevated glucose. If you have or are predisposed to a medical condition, it is important to discuss this with your health care provider before starting prednisone.

Prednisone and Type 2 Diabetes

One side effect of prednisone use is elevated blood glucose. This can lead to prediabetes, which may develop into Type 2 diabetes without proper treatment.

Taking prednisone may lead to insulin resistance in the liver, increasing blood sugar levels and potentially causing steroid-induced diabetes. Steroids can also exacerbate existing diabetes symptoms.

While on prednisone, you should receive regular A1C tests.

Adrenal Insufficiency

Increased cortisol from long-term use of prednisone (and other corticosteroids) can cause adrenal glands to shut down, leading to adrenal insufficiency. Adrenal insufficiency is when the adrenal glands don’t produce enough hormones.

The condition leads to Addison’s disease, a life-threatening episode characterized by low blood pressure, low levels of blood sugar and high levels of potassium. Stopping prednisone suddenly can increase your risk of Addison’s disease.

Prednisone and Osteoporosis

Prednisone can cause a reduction in bone density, but calcium may help.

“Regularly incorporating calcium foods into your diet can improve bone health,” Phillips said. “Following a low sodium diet can also support healthy bones as too much sodium can cause a loss of calcium through urine.”

When To Seek Medical Attention

Call your doctor if you experience abnormal reactions to prednisone. Seek treatment immediately if you experience unexpected chest pain, because this may be indicative of a cardiac reaction. Additionally, even something that seems minor, like thinner skin, can increase the odds of infection.

Doctors should prescribe the lowest effective dose for the shortest duration to minimize prednisone side effects. Regular monitoring is essential, and your health care provider should educate you on the potential side effects and recommended lifestyle modifications. Collaboration between patients, their doctors and their pharmacists is crucial for optimizing outcomes.

For many patients, while the side effects of prednisone are frustrating, they aren’t always debilitating. Even if you feel you can manage these side effects alone, talking to your doctor is always a good idea. They may have ideas for additional support or management options.

The following list includes several alternatives to prednisone.

Prednisone is a synthetic corticosteroid used to treat various conditions, including inflammatory diseases, autoimmune disorders, allergies, asthma and certain types of cancer. It is an immunosuppressant that works by suppressing the immune system and reducing inflammation.

The best alternative depends on your medical condition. It is important to discuss these alternatives with your physician to ensure the replacement will provide appropriate treatment for your condition.

Editor Lindsay Donaldson contributed to this article.