a bottle of PredniSONE 1mg, short-term steroid use, prednisone side effects

Prednisone can be a life saving drug. It saved my sanity when I developed sudden hearing loss in one ear. That was a really scary experience for someone who depends on hearing to be able to do live radio. Being deaf in one ear was incredibly disorienting.

The ear, nose and throat specialist diagnosed my deafness as “idiopathic sudden sensorineural hearing loss.” In other words, he didn’t have a clue what caused it. He prescribed high doses of prednisone for a short time and within a few days my hearing returned.

Other Corticosteroids:

There are a number of other medications that act in a similar manner to prednisone. They may be used in skin creams (topical preparations) or taken as pills. These include:

  • Cortisone
  • Dexamethasone
  • Hydrocortisone
  • Methylprednisolone
  • Prednisolone

All of these medications have different potencies, so they are prescribed at different doses. Even though they work in a similar way, they are not interchangeable.

Some steroid medicines such as fluticasone are designed primarily for inhalation or as eye drops. We are not discussing uses and side effects of those medications in this article.

As useful as corticosteroids can be for a wide range of conditions, the drugs can also cause an extraordinary number of serious side effects. Some people have likened such prednisone side effects to a deal with the devil. Even short-term use can cause problems for some people.

What Prednisone Treats:

Allergic Reactions:

One of the reasons prednisone and other corticosteroid drugs are prescribed fairly frequently is that their powerful anti-inflammatory action can be useful in many situations. These include very serious allergic reactions, such as serious poison ivy.

Another type of allergic reaction, to latex, peanuts, wasp stings, medication or other triggers, can result in anaphylactic shock. The immediate treatment is epinephrine. Prednisone or other steroids may be used to stabilize body systems after epinephrine opens the airways.

Neurological Inflammation:

Steroids such as prednisone are often used to reduce inflammation in brain or nerve tissue. This might be caused by a brain tumor or a traumatic brain injury. Prednisone can prevent brain swelling and the serious consequences that could result. Corticosteroid drugs may also help calm the inflammation of optic neuritis and multiple sclerosis.

Prednisone or another corticosteroid can prevent blindness when it is used to calm acute inflammation of blood vessels in the head, called giant cell arteritis. It can also reduce the swelling of the brain that may occur with altitude sickness.

Asthma:

In an acute asthma flare-up that can’t be controlled with the usual inhaled steroid or bronchodilator, prednisone can improve breathing. It reduces airway inflammation and can be very helpful in an emergency, though it is not appropriate as a standard asthma treatment.

Autoimmune Diseases:

Autoimmune conditions such as inflammatory bowel disease (also known as Crohn’s disease), lupus, polymyalgia rheumatica and rheumatoid arthritis can all cause severe pain and inflammation. Corticosteroids such as prednisone calm the hyperactive immune response as well as the inflammation. None of these steroid medications is a long-term solution, but they can get patients through difficult flare-ups.

Addison’s Disease:

In Addison’s disease, the adrenal cortex tissue that sits atop the kidney and produces the hormones cortisol and aldosterone fails. Frequently an autoimmune attack is the cause of the this condition, although infections can also trigger Addison’s disease. Secondary adrenal insufficiency can be one of the prednisone side effects that accompany long-term treatment for another condition. To treat this serious disorder, doctors prescribe hydrocortisone, cortisone or prednisone to replace the missing cortisol and fludrocortisone to replace the aldosterone.

Cancer Treatment:

Prednisone or other corticosteroids can be useful in treating a number of cancers such as leukemia, lymphoma or multiple myeloma. In addition to reducing inflammation due to the cancer itself, such medications may help lessen the likelihood of reactions to chemotherapy, including severe nausea caused by chemo.

Joe’s Personal Experience with Prednisone Side Effects:

Joe’s experience taking prednisone to reverse his acute hearing loss illustrates some of the prednisone side effects that other people may encounter. That week or two, he couldn’t sleep, became incredibly irritable and hard to live with, and felt as if he had turned into someone else he didn’t know or like.

His experience was not at all unique. A May, 2012, study in the American Journal of Psychiatry analyzed data from hundreds of thousands of European patients over an 18 year period.

They discovered that people taking corticosteroids were more likely to experience neuropsychiatric symptoms including depression, suicidal thoughts (and actions), delirium, disorientation, confusion, panic and manic episodes.

The authors conclude that:

“Glucocorticoids [another term for corticosteroids] increase the risk of suicidal behavior and neuropsychiatric disorders. Educating patients and their families about these adverse events and increasing primary care physicians’ awareness about their occurrence should facilitate early monitoring.”

Joe responds to this conclusion:

“I can relate. I certainly felt disoriented and out of control on the relatively high dose I was taking. The trouble is that patients and their families are not always warned about such side effects.”

We have heard from a surprising number of people that they were given very little information about prednisone side effects.

What Should You Know About Prednisone Side Effects?

There are some key questions you should ask whenever you are handed a prescription. You should know what the drug is and why you are taking it. Find out how to take it (how many times a day, with food or not, etc.) and how long to take it. Ask how to stop taking it, as that information is often left out of the discussion and it can be very important.

The most important information, however, is what side effects to expect. You have a right to know what side effects are most common. You might also want to ask about reactions that are rare but deserve immediate medical attention. This reader did not get any advance warning about prednisone side effects.

Surprised by Prednisone Side Effects:

Q. I was prescribed prednisone for sinusitis. It was a nightmare.

I gained weight and my face puffed up. I had strange dreams when I could sleep, which was rare. I became irritable and aggressive. Things that wouldn’t normally bother me made me want to scream.

I wish my doctor had warned me about these prednisone side effects in advance so I would have been better prepared.

A. Prednisone is a corticosteroid used to ease a variety of inflammatory conditions ranging from asthma and severe poison ivy to arthritis and lupus.

As useful as it can be for serious health conditions, there is a long list of troublesome side effects. Some of the most common include fluid retention (edema), insomnia, irritability, mood swings, disorientation, high blood pressure, loss of potassium, headache and swollen face.

Long-term complications may include muscle weakness, osteoporosis, cataracts, glaucoma and ulcers. Prescribers and pharmacist should warn patients what to expect in the way of prednisone side effects so they do not suffer in the dark as you did.

Steroid Psychosis from Prednisone Prescribed for Sinusitis:

Q. I am in very good health except for recurrent sinus infections. Recently, my internist put me on a 12-day tapered course of prednisone.

Within days I thought I was going crazy. I became extremely agitated and irritable and the least little thing set me off. I didn’t sleep for three days, even with sleeping pills. I couldn’t concentrate. My blood pressure soared and I became very fearful.

My doctor never warned me about any of this. Are these normal side effects of prednisone and what will I do if I have to take this drug again?

A. Prednisone and other corticosteroids (Medrol and Deltasone Dosepaks) relieve symptoms from a variety of conditions, including sinusitis. Many people experience severe psychological reactions to high doses of such drugs, however.

Steroid psychosis can cause anxiety, agitation, euphoria, insomnia, mood swings, personality changes and even serious depression. Some patients may experience memory problems or hallucinations.

Let your doctor know you are susceptible to this kind of reaction. If you ever have to take more than 40 mg of prednisone at a time, you may need medication to counteract the psychiatric side effects.

Scary Prednisone Side Effects that Have Been Reported to Us:

A.C. shared this story:

“Years ago I was given prednisone in the emergency room for a severe anaphylactic reaction that affected my ability to breathe and caused massive hives. Although the treatment may have been necessary, I too had a severe psychotic reaction and when I finally went to my own doctor and had blood tests, my blood chemistry was all over the map. I had to continue the tapered dose till I was done but I wish someone had warned me of possible side effects so at least I wouldn’t think I was totally crazy.

“I questioned my ability to drive, slept constantly and was quite volatile. I had to take a day off from work. Knowledge is power! People should be warned about possible side effects so they have the information should prednisone side effects occur.”

When people are unprepared for the psychological side effects of prednisone, they can be caught off guard. So can family, friends and co-workers. In A.C.’s case, the prednisone was was essential for survival. That said, A.C. should have been alerted to possible side effects.

As we mentioned earlier, corticosteroids are essential drugs for many conditions. A severe asthma attack may require a short course of oral prednisone or a similar steroid. People who are put on the new immunotherapy checkpoint inhibitors against cancer such as Keytruda or Opdivo may experience an overactive immune system. That can result in skin rash and itching, severe diarrhea and colitis, hepatitis, pneumonitis, adrenal insufficiency, eye inflammation and neurotoxicity. High doses of corticosteroids may be required to counteract such reactions to the cancer medications. Even then, people must be warned about complications.

Ely describes what happened after a moderate dose of prednisone:

“I’m having prednisone side effects. My doctor prescribed this drug last Thursday. She prescribed 20 mg twice daily for five days. I was sleepless for three days in row. On day 4 after a short nap I awake feeling so nervous. I am crying, my hands are shaking, and my heart is beating so hard. These are awful feelings.

“My doctor told me I will feel that way for about nine days. She didn’t show any care about me. She also said I can go back to work (and drive a long way) the next day. But the way I was and am feeling, I’m not daring to drive even one block.

“I do not understand why she prescribed that medicine, without any warning, for a small allergy I had. I mean the medicine was worse than my illness.”

Bob describes what it’s like to be sleepless on steroids:

“My wife had sleepless nights when on prednisone and the doctor said that she might do some odd things that she normally wouldn’t do. He was right. One night she got up and tore down the wall paper in our bathroom :-) We still get a laugh over this one.”

How to Stop Prednisone:

We may have mentioned that when steroids are taken even for a short time, such as a week or ten days, the usual protocol is to start at a relatively high dose and then taper it down gradually. That reduces the risk of an unpleasant withdrawal reaction. Always ask the prescriber about the taper and follow the instructions.

A.M.S was not told how to stop steroids:

“I was on 20 mg twice a day of prednisone for a sinus infection. Had I known anything about this horrible drug, I would have never taken the meds and let my sinus infection clear up on its own. That would have been better than these prednisone side effects.

“I was not told to taper the dose, so I took as prescribed 20 mg twice daily for 7 days. The day after stopping, my whole body hurt to the touch, as if I was black and blue all over. I was swollen, red and had a lump on my neck, not to mention being very disoriented. I went back to the doctor and he insisted this had nothing to do with the drug.

“I checked myself into the ER where they put an IV drip with Benadryl and the like. I was discharged that day. No change. Next day, didn’t hurt to the touch anymore. New side effect – rash from head to toe and severe indigestion. Following day, rash subsiding, indigestion getting better. Still feeling a bit loopy, but I am told by next week I should be back to myself again.

“I am warning everyone I know not to ever take a steroid unless your life is in danger. It is a very scary feeling – all for a sinus infection.”

S.K.F. describes prednisone withdrawal:

“I am experiencing high blood pressure, agoraphobia, panic attacks, lightheadedness, confusion, weakness, intolerance to heat, IBS, shaking, etc. These side effects all started the day I stopped the drug. It has been 7 days with not much improvement. I was hospitalized for 3 days. I pray I do not EVER have to take prednisone again… EVER.

“I am hoping I get past this. My quality of life stinks. I took 30 mg 1 day 20 mg 2 days and 1 mg 2 days. Absolutely HATE this.

Just the Tip of the Corticosteroid Iceberg:

These are just a few of the messages that have been posted to our website. At last count there were over 800 comments in the feedback section of this post. Feel free to add your story or comment below.

We find it astonishing that some prescribers do not warn patients about the possibility of psychological side effects brought on by prednisone and friends. Even a short-course of high-dose steroid can precipitate symptoms. And not telling patients about gradual tapering borders on bad medicine. To protect yourself and your loved ones from such medical mistakes we suggest our latest book, Top Screw-ups Doctors Make and How to Avoid Them.

Psychological reactions such as insomnia and irritability are common, but they are certainly not the only prednisone side effects. Some of these adverse consequences, such as osteopenia, diabetes or glaucoma, appear only after long-term use of the drug. Others, such as confusion, high blood pressure or a drop in potassium, can occur on a shorter time frame. The most serious prednisone side effects that may happen within a week or two of use are dangerous blood clots (deep vein thrombosis), blood

Other Prednisone Side Effects:

  • Fluid retention, edema
  • Insomnia
  • Irritability, nervousness, mood swings, mania, depression, psychosis
  • Disorientation, confusion
  • Hypertension
  • Loss of potassium
  • Headache
  • Dizziness, vertigo
  • Muscle weakness
  • Blood sugar elevation (diabetes)
  • Irregular menstrual cycles
  • Swollen face
  • Hair growth (including on the face)
  • Itching, rash, hives
  • Increased susceptibility to infection
  • Weakened bones (osteopenia, osteoporosis)
  • Tendon rupture
  • Glaucoma
  • Cataracts
  • Ulcers
  • Deep vein thrombosis (blood clot)
  • Avascular necrosis of the hip

The higher the dose and the longer someone takes a drug like prednisone, the more likely there will be prednisone side effects. A recent study of people with steroid-dependent asthma reported that the majority of patients who had been taking prednisone for years experienced side effects such as bone density loss (72%), high blood pressure (60%), cataracts (42%), easy bruising (35%), diabetes (16%) and glaucoma (14%) (Aziz-Ur-Rehman et al, Allergy, Asthma and Clinical Immunology, online April 4, 2017).

The People’s Pharmacy Perspective:

Make sure your physician is monitoring things like potassium, blood sugar, bone density and psychological well being. And again, never stop a corticosteroid suddenly!

We want to emphasize that corticosteroids can be very valuable. Some people must take them for the rest of their lives because of a very serious or life-threatening condition. And NO ONE should ever stop taking a drug like prednisone suddenly. It must be phased off gradually under medical supervision.

If you found this article of value, please take 3 seconds to scroll to the top of the page and vote on the usefulness of this information. Many thanks from The People’s Pharmacy.

Revised: 4/28/17

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  1. Barb
    Reply

    Hello all. I have just finished a 9-day course of prednisone due to an allergic reaction to a bee sting, and I’m thankful that I’m done. The most challenging side effects have been disorientation, disassociation, and anxiety. If I took the medication in the morning I was fine by the evening. Sleep – forget that! I recommend having your doctor prescribe an anti-anxiety med along w/the medication if you’re so prone. That way at least you can sleep at night.

    In the meantime I’m so glad I’m done. Am grateful that my rash is gone, and that I will soon get my sanity back.

    Such an odd, weird 9 days – and ones that I choose not to repeat – EVER!

  2. SUE
    New Zealand
    Reply

    I am very worried about my mother. She has been on and off prednisone for polymyalgia for several years. Today the Dr. has given her what he calls a “kick start” dose of 20mg which she is to take for a month, and then less for the next month and on and on. I had informed the Dr. previously that she is more mentally alert when off the drug. She has had odd behaviors when on it, and we feel that at 83 she has a level of dementia. So today he prescribed this nightmare drug before even seeing a blood test result. When asked what the side effects are, he said “nothing really.”

    I believe my mother is addicted to the false sense of energy that it gives her. She has played Dr. Google and presents to the Dr all the symptoms of the illness. Now this evening, after one pill, she is away with the fairies, talking in a little girl voice. I am alarmed and do not know what to do. Leading up to this latest round she has talked constantly about aches and pains in her legs but when I question her she cannot describe the pain, and I have worked out that it is muscle weakness, which I now know is a side effect of the drug. Anyone reading this who has an elderly parent: stay away from this drug. The consequences can be alarming. I have spoken with a Dr. friend who has said to me that this was lazy Doctoring and an awful clinical decision.

  3. Molly E
    NY, NY
    Reply

    I almost lost my 20-year-old daughter to a fast-onset psychotic reaction to prednisone given to her by an oral surgeon. Day 3 of a normal 7-day medpack dose, she started screaming about dying and trying to take her own life, and thus began a nightmare that included 2 forced hospitalizations. It was finally brought to a close by a great psychiatrist and some Depakote. I learned a lot about corticosteroids in the months that I dealt with this, such that I will NEVER take them or allow anyone around me to if I can stop them.

    It is unconscionable that they are given out for non-life-threatening swelling or skin irritation, and after watching the incredible distortions to my child’s mind and perception, every time I read about someone who suddenly went off the rails I question whether they had been dosed with this drug in the recent past. Six months after cessation from the drug my child was normal again, and she hasn’t had psych issues since (it’s been 3 years). She stayed on Depakote for 3 months. I can’t say enough good things about Depakote for steroid psychosis, it knocked the wild bipolar mood swings, suicidal ideation, and raging paranoia down within 3 days.

    Don’t touch corticosteroids unless your life depends on it. If you have to use them, get someone you trust to watch over you carefully. Based on our experience, if you are having a negative reaction, it will end completely 6 months past your last dose.

  4. Dutch
    Pennsylvania
    Reply

    Have been on Prednisone for 3+ years for PMR . Highest amount was 15 mgs. Recently started taper off again. Am currently down from 4-3 mgs for about a week. Seems like every time I try to taper I get terrible GI problems with acid reflux , diarrhea, upper abdominal pain . Yesterday and last night I had upper abdominal pain and reflux. Got only about 3 hours sleep . Anyone else out there with similar complaints ?

  5. sarah
    nj
    Reply

    I’m a 63 year old female with several auto immune diseases. The worst symptom I’ve experiences was severe flu like feeling without the flu. I’d vomit for days on end, be too weak to stand, violent headaches and pains in muscles and joints. I was also tremulous during these attacks. I’ve been on high dose prednisone, about 40 mgs per dose on and off for 22 years. Without it I would have preferred death because the way I felt was intolerable. It doesn’t work anymore for the pain but it still keeps the flu like symptoms under control. I take it about every 4 days and for me that eliminates the horrible side effects I used to experience when on it daily. I’ve been reading about the theory that Alzheimer’s is primarily caused by inflammation . Have there been any studies of people on long term high dose prednisone? Could it prevent Alzheimer’s?

  6. Ruth
    Adairsville Ga
    Reply

    I was put on 20mg twice a day for 4 days. I have very low blood pressure, and I’m very tired,confused and dizzy. I never heard of prednisone for this. I’ve taken it before for rashes from unknown causes and for asthma. I really don’t like it, but it’s only for 4 days.

    • Melissa
      Nova Scotia
      Reply

      I’ve been on prednisone for 3 weeks now for ITP. My dose began at 18 pills every morning (90mg), and starting this week was tapered by 10mg and every week on out to wean myself off.
      I’ve had every one of these symptoms covered, and I just wonder if the weight gain/moon face will start to decrease???

      I feel like I’m going crazy.

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