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 infections (sepsis) and bone fractures (Waljee et al, BMJ, April 12, 2017). We offer a more complete list below.

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 Bottom Line:

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. Alice
    PA
    Reply

    I was prescribed 40 mg of prednisone for 7 days for poison sumac. I didn’t do well on this medication at all. The rash is just as bad and I am exhausted, confused, shaking and really not happy. I finished the prescription yesterday and hope to let the rash run it’s course. I’ll use antihistamines for the itch. I hope to get the steroid out of my system soon. I was foolish to go and play tennis…I couldn’t even hit the ball. That didn’t help. Never again.

  2. Went Natural
    Co
    Reply

    I was on Prednisone and had severe withdrawal side effects when I went off of it even with tapering off.
    I chose a natural approach to rebuild my adrenals and the whole HPA Axis. It can
    take from 6 months to 2 years for the body to normalize. After 6 mons. on my natural program I noticed alot of improvement ( it helped some from the start too) and now after 1 and a half yrs. I am tapering down slowly from some of the naturals. Dr. Wilson’s Adrenal Rebuilder is amazing as is Integrative Therapeutics Cortivive among others. One could also find what they need to know from the book by Dr Wilson, Adrenal Fatigue. It covers the full program many have chosen and is vital! I also used Dr King’s 9-1-1 Burnout spray in my program among many others. If you go natural study well first and of course be careful.
    There is hope even though the symptoms are a nightmare for sure so don’t loose heart. Hang in there! Blessings to All in this Situation

  3. Joe
    Florida
    Reply

    As a child at age 12 I was diagnosed with Dermatomyositis and admitted to the hospital. The disease got into my shoulders and was put on 30 tablets a day my guess is 5 mg tablets, they were small and white. I could not walk because of the disease.

    Two months later I started therapy and was walking 6 months later. I had a life expectancy of 18 to 25 years of age and am now 62. Doctor tapered me off for a year when I was 19. I would have flare ups and would be put on 2 week runs.

    When I was 27 I was on a 2 week run of prednisone and my Doctor called me himself and told me to go straight to the hospital since my glucose was 740. I have not been on prednisone since.

    As I got older I had minimal problems with the disease. In the last 5 years my diabetes has been out of control and considered very brittle but my Doctor after 9 months is about to get it right after changing my insulin type 4 times. My BP has always been a little low but in the last 5 years have had problems with it being too high. Now I have leg and foot cramps if I am on my feet too long.

    Five years I could walk 2 miles without any problems but this gradually got worse and now I can walk only about 150 to 200 feet and my leg calves get very tight where I have to walk slow or stop. Then 2 months ago I was just walking down the stairs and had a pop in my calf and was walking on my toe on that leg and the Doctor gave me a boot and crutches. Then after an MRI that showed nothing torn he put me on 800 mg of ibuprofen twice a day.

    Two months later my calf and foot swells everyday and is still very painful to walk on. I know it has a lot to do with my long term use of prednisone and also my Dermatomyositis since it destroyed the muscles and connective tissue in both calves. My eyes are fine, have had 2 mild heart attacks. My energy level seems to be depleted.

    I feel most of my problems are the result of my long time use of prednisone. When I tell a Doctor about my dose they look at me like I’m crazy but I have an 88 yr old mother and a 91 year father that can vouch for me.

  4. Joan F
    Pottsville, Pa. 17901
    Reply

    I’m on prednisone for a bronchial infection with severe coughing It helped that but IM GETTING SPASMS IN MY R SIDE LOWER AND UPPER BACK I only have 2 days left on a half pill a day Spasms are like quick shots of pain just turning a certain way

  5. Cheri
    FL
    Reply

    I had to go to the ER today for a super severe allergic reaction; we think it was a crossover in my chicken fried rice of shrimp which I am very allergic to. Anyhow they hooked me up to the IV within 5-minutes max of me walking in (yep, that bad) and they gave me a few meds into the IV including 120 mg of Prednisone. The Dr. sent me home with a prescription of Prednisone 20 mg. tablets to take 3 pills once a day for 5-days. He did say it would affect my type 2 diabetes, but WOW he never said it would go to 499 tonight! Is it that high because of that large 120 mg dose? And what can I do to bring it down? Not sure if I should start the rest of the script tomorrow or what? I’m very worried; the allergy attack came close to killing me today, so I am not sure what to do here? Any advice?

  6. Voni H.
    Oklahoma
    Reply

    I almost died because of Prednisone:

    At age 51 I was bedridden for 3 months as a result of Lupus. The typical Prednisone Packs that I took over the last 13 years to bounce back were no longer working. So I went on Prednisone full time. Soon after, I was feeling on top of the world and had my life back. However, I was not fully informed of the side affects of Prednisone, and I did not do my own research as I should have.

    About a month later I realized I could no longer see to do my makeup without a magnifying mirror, and even that was getting difficult. I went from having 20/20 vision to not being able to read the largest print on the eye chart with my right eye. The prednisone had caused cataracts in both eyes, and both would need surgery to get my full sight back. I tried to taper off the prednisone because of that, but I ended up bedridden again so I went back on the Prednisone full time.

    By the 4th month I could tell I was not myself. I was moody, seriously depressed and having angry outbursts. None of this was like me at all. I also started to have insomnia. I couldn’t concentrate, and I was struggling with confusion off and on.

    And as if that wasn’t enough, I started having dangerously high blood pressure spikes that caused chest discomfort and pain. When this happened I was very hyper and would speak very fast. It was like I was on a ton of caffiene, but I wasn’t on any. I was given blood pressure medication to take when this would happen because the numbers were in the heart attack and stroke territory, my doctor said.

    Because I was on so many medications, it took me a couple of months to figure out that the mood problems were being caused by the Prednisone. By then I was fighting serious suicidal thoughts and crying daily. I talked to both of my doctors and learned I would have to wean off the Prednisone very slowly since I had been on it for 6 months. So I got a counselor and was calling suicide hot lines, doing whatever I could to fight the suicidal thoughts.

    It was taking so long to wean off it, and I could tell I wasn’t going to make it, so I changed the weaning from 2 weeks at a time to 2 days at a time toward the end. I did so without talking to my doctor, which I don’t recommend. I knew full well that the side affects could be dangerous, difficult and painful, but I figured it was better then being dead from suicide. I was days from being off the prednisone when I lost that battle.

    Against my true wishes, against my true self, I tried to kill myself by overdosing. I used a different prescription to do this. I spent 3 days in the hospital fighting for my life. When I regained consciousness in ICU, I was told by 2 different doctors that I could have died.

    They confirmed that of all the medications I was on, they believed the Prednisone was what was causing the depression and suicidal thoughts. But they said it could take a week to a month for the prednisone to be completely out of my system. They did an IV flush to help with that, and several days later I felt more like myself again. I was sent home from the hospital with a safety plan. After that the depression was gone but I had one more episode of an angry outburst one day later that week. And then that nightmare was finally over.

    After stopping the prednisone the mood problems, blood pressure spikes, the chest pains, the need for blood pressure medication, the insomnia, confusion and difficulty concentrating, it all got better. I had surgery for the cataracts in one eye, and that vision has improved, but I still need surgery on the other eye to get back to 20/20 vision. No one had told me about any of these side affects.

    A month and half later I was scheduled for dental work that included a bone graft. Prednisone was part of the recovery, and I was assured I would be okay since I wouldn’t be on it long. I did okay but I will forever be careful with Prednisone and avoid it whenever possible.

    There needs to be more awareness about this drug with doctors as well as patients. I almost died because of it. It makes me wonder how many people have died from it and aren’t here to tell their stories.

  7. Mary
    Florida
    Reply

    Do I go blind or do I take the 60 mg. Per day. . I am past 8O and in excellent health, headaches coming back, and affecting both eyes now, mood changes, no sleep for 35 hours, itching, chest pains returning, coughing..all things I had under excellent control. Each morning as I take that poison I ask what am I doing to myself????

    I made a pact with the devil, and if I don’ t cooperate he will take away both my eyes. Is it worth it?

    Bad thing is the monitoring doctors in Florida do not jump to respond to your dire need. They are here for the good life, beach, sun, and less taxes. It seems more important that you have a great insurance plan so they get their money. No follow up, no returned phone calls. Their obligation is to prioritize these cases.

    So you risk taking another week or month of this poison unnecessarily, damaging more parts of your healthy body.

  8. barbara
    Reply

    Hi,

    My daughter had a sports injury as a college athlete with severe whiplash. She had four shots of steroid in her neck last Friday for occipital neuritis and oral Medrol pack for tapered oral prednisone. She is feeling totally out of it, panicky, not herself, foggy. She leaves for a job in Europe this summer a week from now and I am totally freaked out. The neurologist office is not returning our calls. I don’t know whether to have her finish the pack or not (she is on the day where you take three so there are three days left). I am guessing she got bombarded with the four shots to the neck and then the oral meds. I don’t know how to help her and am freaked out she will have a total breakdown while in another country far away from home. I am so so angry they talked us into this course of treatment and I looked at the consent form for the shots- no talk about psych symptoms at all.

    • barbara
      Reply

      Also, wondering if anyone can please please tell me if these symptoms go away once you stop taking the oral meds.

  9. Melissa
    FL
    Reply

    Last night after my 5th day of tapered dose of prednisone (for sinusitis infection) I became dizzy, disoriented, couldn’t swallow or catch my breath and all my muscles in my neck and upper back became sore like I had bruises. I had a panic attack and had my mom take me to ER at 1am. They found nothing wrong with me amd treated me like I was crazy.

    I screamed at them to give me something to counteract the prednisone. The doctor and nurses said prednisone doesn’t do this to people. So I left angry nd ate a ton of food because I was so hungry and upset. My blood pressure was 155/91 when it is normally 117/72. I hate prednisone and floridian doctors who don’t know how to do their job. I’d never take the drug again. I’m still sore!!!

  10. Eugene C.
    SC
    Reply

    I was amazed to learn (from another site) the wide range of dosages for prednisone: from less than 10 mg per day to the hundreds! I have been taking prednisone for four days now: 40 mg./day the first three days, 20mg./day for the next three, 10mg./day for days 7-9, and 5mg./day for days 10-12.

    Tonight when I lay down, I could feel my heart shaking in my chest. I was having bizarre dreams of people walking through my room and objects coming to life, then disappearing — not at all normal for me. I’m taking it because my asthma is not well-controlled right now and my pulmonologist wants to calm down my severely overactive allergic responses (diagnosed by blood work).

    I’m continuing Dulera 200/5 (2 puffs twice daily) plus a new prescription for inhaled Singulair (canister, not capsules). The Singulair makes me a bit dizzy for a few minutes to an hour after use, though I’m hoping that will get better as I adjust to it. I’m planning to ask about consulting a rheumatologist if the pulmonologist thinks I may need long term oral corticosteroids.

    Thank God for good prescription benefits — the pharmacy told me the retail for a 90-day supply of Singulair is $1,600, but my copay is $40! What can politicians be thinking who want to undo the half-measures of the ACA? I know this is not a political site, but healthcare has become a political football in this country and Americans are the ones being kicked around. Thank you for letting me rant.

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