According to the NHS (National Health Services): “Corticosteroids, often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions. They’re a man-made version of hormones normally produced by the adrenal glands (two small glands that sit on top of the kidneys).” (2)
Other uses include severe allergies, skin diseases, cancer, eye problems, and immune system disorders. It’s typically taken orally in tablet or liquid form.
Oddly enough, the drug is also used to treat skin rashes, lupus, fungal infections, and even to prevent transplant rejection. You can find a whole list of the conditions treated by the drug here.
But prednisone has side effects, and some are pretty serious.
Why Prednisone Is Prescribed
This is because the hormone regulates, modifies, and influences your body’s reaction to stress, including:
- Blood sugar (glucose) levels
- Fat, protein and carbohydrate metabolism to maintain blood glucose (gluconeogenesis)
- Immune responses
- Anti-inflammatory actions
- Blood pressure
- Heart and blood vessel tone and contraction
- Central nervous system activation
Having too much cortisol in your system can lead to (4):
- Impaired cognitive performance
- Dampened thyroid function
- Blood sugar imbalances, such as hyperglycemia
- Decreased bone density
- Sleep disruption
- Decreased muscle mass
- Elevated blood pressure
- Lowered immune function
- Slow wound healing
- Increased abdominal fat
On the opposite end of the spectrum, too little can lead to:
- Brain fog, cloudy-headedness, and mild depression
- Low thyroid function
- Blood sugar imbalances, such as hypoglycemia
- Fatigue – especially morning and mid-afternoon fatigue
- Sleep disruption
- Low blood pressure
- Lowered immune function
In short, Prednisone acts as an immunosuppressant by blocking the production of antibodies. This helps control an over-active immune system. The drug also works against inflammation to reduce heat, redness, swelling, and pain.
Prednisone Side Effects
The side effects of prednisone normally only last as long you’re on the medication. However, some of the side-effects are permanent and will continue even after you’re clean from the drug (5).
Since prednisone hinders your body’s ability to fight off bacterial, viral, fungal and parasitic infections. For one, prednisone has been found responsible for an increased risk of the reactivation of tuberculosis. This is problematic because tuberculosis is one of the most fatal infections in the world (6).
If can also increase your risk of more common infections like the cold and flu. In fact, patients are warned to avoid people infected with chicken pox or measles. If you do end up getting ill, tell your doctor right away.
2. Eye Damage
People taking prednisone need to undergo periodic eye examinations because they are more susceptible to cataracts and glaucoma. This occurs because the medication increases intraocular pressure (the fluid pressure inside the eye) (7).
Most steroid-induced eye problems disappear immediately or shortly after you stop taking the drug. However, in rare cases, glaucoma persists after quitting the medication.
According to a study published in Drugs And Aging “Patients over 40 years of age and with certain systemic diseases (e.g. diabetes mellitus, high myopia) as well as relatives of patients with POAG are more vulnerable to corticosteroid-induced glaucoma.” (8).
3. High Blood Sugar
One of the mot common side effects of prednisone is that the drug can worsen or even trigger diabetes. This occurs because corticosteroids increase insulin resistance, which causes blood glucose levels to rise and remain higher (9).
People who have a family history of diabetes, who are overweight, who’ve experienced gestational diabetes or who are over 40 are more likely to experience this side-effect.
4. Fluid Retention
Cortisone is involved in regulating the body’s balance of water, sodium, and other electrolytes. Hence, prednisone can promote fluid retention, typically in the lower legs. While this can be managed somewhat by lowering your salt intake and taking diuretics, it’s still an uncomfortable side-effect (10).
Fluid retention is also a complication of drug-induced diabetes
5. Increased Urination
While prednisone causes fluid retention, it also acts as a diuretic. In fact, some patients experience nighttime urination or hourly urges in the day (11).
Prednisone also increases protein loss through urine (12).
6. Weak Bones
All steroid therapy thins the bones and increases your risk of fractures. High doses and long-term prednisone use increase your risk of experiencing this side-effect. However, low doses of prednisone may also reduce bone repair or renewal. At any dose, prednisone may have adverse effects on bone mass and/or bone strength.
Between 14-51% of patient will experience osteoporosis while taking the drug (13).
In large doses, prednisone can cause “aseptic necrosis”, a condition characterized by the death of the bone.
7. Impaired Adrenal Glands Function
Your adrenal glands produce cortisol. Your cells recognize the synthetic version of this hormone during steroid therapy. This means that your adrenals produce fewer hormones. Symptoms of adrenal fatigue include severe fatigue, loss of appetite, weight loss, nausea, vomiting, diarrhea, muscle weakness, irritability, and depression (14).
Just a few weeks of prednisone at a dose of 10 mg will diminish your body’s ability to fight in a stressful situation.
8. Thin Skin
Corticosteroids influence all phases of wound healing, including bruising.
A study published in the American Journal of Surgery found that “patients treated for 30 days prior to wounding or an operative procedure were reported to have had a 2-fold increase in wound infection, 2 to 3 times higher incidence of wound dehiscence, and a 4 times greater mortality compared to those not taking steroids for that period of time” (15).
Taking corticosteroids can trigger severe acne. Varieties include acne vulgaris as well as Malassezia folliculitis, characterized by itchy bumps. Triggered by prednisone, both varieties of acne can get so bad that they cause lifelong acne scars (16).
10. Weight Gain
According to the University of California San Francisco “Weight gain while taking prednisone is typically due to fluid retention and increased calorie intake because of increased appetite.” Plus, patients are more likely to exercise less during their illness (17).
Weight gained while taking the drug normally settles in your abdomen, face and the back of your neck.
11. Mood Problems
When taken in doses of 30 milligrams per day or more, prednisone can cause intense mood swings as well as irritability and anxiety. A review of the MEDLINE and psycINFO databases found that “Symptoms of hypomania, mania, depression, and psychosis occur during corticosteroid therapy as do cognitive changes, particularly deficits in verbal or declarative memory.”
“Psychiatric symptoms appear to be dose-dependent and generally occur during the first few weeks of therapy. Patients who must remain on corticosteroids may benefit from pharmacotherapeutic approaches, such as lithium and the new antipsychotic medications.”(18)
Although prednisone and other corticosteroids are the second most prescribed drugs to treat psoriasis, most experts recommend against them. This is because the drugs themselves can actually trigger flare-ups of generalized pustular psoriasis (19). Odd, huh?
13. Liver Damage
Like most prescription drugs, corticosteroids can cause several forms of liver injury and worsen an underlying liver disease. When administered intravenously, corticosteroids are known to cause acute liver injury, acute liver failure and death (20).
Again, in a contradictory twist, the drug is also used to treat several forms of liver disease.
14. Breathing Difficulty
Despite widespread use for treatment of asthma and allergies, glucocorticoids may cause allergic reactions, including bronchospasm and anaphylaxis. According to a literature review published in Journal of General Internal Medicine, “allergic reactions have been reported with intramuscular, intraarticular, periarticular, intralesional, oral, inhalational, and intravenous routes of glucocorticoid administration.”(21)
After reading this list, it doesn’t seem like the benefits of prednisone outweigh the risks. Especially when you consider that inflammation can be controlled naturally with no side effects.
Frequently Asked Questions
How risky is it to take prednisone?
Other than the side effects, prednisone can have serious health implications in the doctor’s office and at the dentist. In fact, all health professionals you come into contact with needs to be advised that you are taking the medication. So should your family and friends. Some doctors even recommend that you should carry an identification card stating that you are taking prednisone that includes
your doctor’s name and phone number.
What can worsen the side effects of prednisone?
Prednisone interacts with many drugs, including Mifepristone, Bupropion, Haloperidol and live vaccines.
Being predisposed to certain conditions like diabetes, mental health issues, and acne heightens your risk of being affected by these side effects.
How do I know if my side effects are serious?
Call your doctor at once if you have shortness of breath, severe pain in your upper stomach, bloody or tarry stools, severe depression, changes in personality or behavior, vision problems, or eye pain (22). These side effects should never be taken lightly.
Can I quit prednisone cold turkey?
Do not stop taking this medication without consulting your doctor. Unfortunately, some conditions may become worse when this drug is suddenly stopped. Getting off the drugs can also cause weakness, weight loss, nausea, muscle pain, headache, tiredness, and dizziness.
If you want to stop taking the drug, it’s important to slowly reduce your dose under the supervision of your doctor.
How do I manage inflammation naturally?
There is an immense wealth of anti-inflammatory foods just in your local supermarket. Pineapple, vitamin c, omega-3s, turmeric, all have potent inflammation-fighting properties, just to name a few (22,23,24,25).
On the other end of the spectrum, there are many foods that can trigger or worsen inflammation. To reduce inflammation, the first thing you should do is cut out sugar, processed foods, gluten, and alcohol (26).
It also goes without saying that it’s beneficial to practice low-impact exercise, stretching, and yoga.