Let me be clear – I wouldn’t want to be on prednisone either. In fact, when suffering from a wicked case of vertigo, I fought my doctor buddies who advised I take a Medrol dose pack to ease the symptoms.
“I’m going to gain weight!” “I’m going to have anxiety!”
As a Rheumatologist, I am well-versed in all the possible side effects of prednisone (and similar meds) and feared the worse.
But I also know that there is a time a place for prednisone. Not only was I currently in need of the benefits of prednisone, many of my patients are as well. But there ARE side effects that need to be considered and discussed.
How to think about prednisone side effects
When starting any new medication the first questions anyone has is “what are the potential side effects?” Most are worried about what can happen immediately. It’s certainly a fair question, but when thinking about prednisone, this is only half of what we need to consider. “What can happen to me right away and what can happen to me 5 or 10 years from now?” is a more appropriate question. The medical terminology would be acute side effects and chronic side effects.
The risk any individual has for the following side effects rises with:
- the length of time and
- the dose of prednisone used.
For example, someone on a moderate or high dose of prednisone (40mg- 60mg/day) for 6 months will have a higher risk than someone on a low dose (5mg/day) for a few weeks.
Acute prednisone side effects
When starting a moderate or high dose of corticosteroids, such as prednisone, there are key symptoms to look out for. These can occur within days to weeks of starting the medication and may be cause for adjusting or even stopping the medication (with guidance from your doctor, of course).
Prednisone, and all the glucocorticoids, is very activating. Meaning, it can rev up your system. This is a big reason most people feel great while on moderate to high doses. People experience less pain and higher energy. But sometimes this can go overboard. Energy levels may increase so much so that sleep becomes difficult, leading to insomnia. Adjusting the time you take the medication (taking it earlier in the day) can help with this.
Along with this energy “activation” is an increased hunger. Snacking is more frequent and this, along with a propensity for water retention, can lead to initial weight gain. Along with the munching, prednisone can lead to more frequent or severe heart burn. This can be helped with an acid-suppressing medication.
Mood is also affected. Mood can be elevated but when taken too far can result in mania, anxiety or even psychosis. Thankfully, this isn’t common. But if you have a history of these conditions or if you or a loved one notices any serious mood changes, let your doctor know immediately.
Along with any mood disorders, there a number of medical conditions that need to be considered when starting prednisone. High blood pressure (hypertension) and diabetes can both worsen with prednisone and need to be monitored closely. Even in those without a previous history of high blood pressure, this can be seen soon after starting steroids. Similarly, blood sugar levels can become elevated and difficult to control in those with or even without diabetes.
Chronic side effects
Along with the potential prednisone side effects that can occur right away, a number of issues can occur years later.
With prolonged use, the skin becomes thinner and more prone to bruising. This is especially true for the skin on the forearms and hands. Prednisone users have a higher risk of developing cataracts or glaucoma especially when using steroid eye drops. Osteoporosis is also a long term effect many do not appreciate. Osteoporosis in and of itself isn’t painful, but can lead to bone fractures, something no one wants to deal with! A healthy Vitamin D level, Calcium supplements, weight bearing exercise and (sometimes) bone building medication are used to prevent this side effect.
The risks to the heart, blood vessels and brain are rarely discussed when starting prednisone but should be considered. Taking steroids not only raises blood pressure and blood sugar, but overall raises one’s risk for heart attacks and strokes. When steroids are needed for only a few days or weeks there isn’t much concern. But when needing it longer, there should be measures taken to control all other possible risk factors. This includes controlling the blood pressure, cholesterol and blood sugar levels either through diet and lifestyle or with medications.
Prednisone & Infection
Lasting, we can’t talk about prednisone side effects without discussing the risk of infection. Within Rheumatology, we work with many potent “immune-suppressing” and “immune-mediating” medications that can elicit a lot of fear. It’s true that many immune-based therapies can increase one’s risk for infection, but it is often not appreciated how much prednisone contributes to this risk. Prednisone at low, but especially, at high doses can increase the risk for severe infection. For this reason, it is imperative someone take the day-to-day precautions we were all taught in grade school – wash our hands, keep our distance from those that are ill and when appropriate, get vaccinated. Taking prednisone doesn’t make someone more likely to catch a bug, but it impairs their ability to fight it off should they catch it.
How to get off prednisone
With all the risks, it’s legitimate to ask why you should even start it in the first place. For a more in-depth view of that, I recommend checking out this blog post. But suffice it to say, sometimes we just need some prednisone to control our condition. But just like with every medication, you need to understand the pros and the cons, the risks and the benefits, and all the potential side effects. And understand that only in a minority of cases should prednisone be considered a long-term therapy.