Prednisone Side Effects: Deal With The Devil?

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.

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.

Severe COVID-19:

Corticosteroids, especially dexamethasone and methylprednisone, are used to prevent cytokine storms in patients with severe COVID-19 (EXCLI Journal, Feb. 15, 2021). By tamping down an over-exuberant immune response, they help patients who require ventilation. On the other hand, they can trigger side effects such as fluid retention, reduced glucose tolerance, behavioral and mood alteration, weight gain, high blood pressure and increased appetite. Occasionally, patients will develop seizures as a reaction.

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.

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. That is especially true for the psychological roller coaster ride that sometimes occurs.

Ella had an experience somewhat similar to Joe’s:

“I’m really glad to have found this article. I’ve been on prednisone for 2 weeks now for sudden hearing loss in one ear. At my last doctor visit I was given another prescription for 2 more weeks to eventually taper off the drug. I am so ready to be off of this drug so, I thought that I would skip tapering off of it. But after reading about side effects others have had without the tapering, I will definitely taper off as prescribed.

“The side effects are awful: Difficulty focusing, brain fog, jittery shaky inside feeling. I am irritated by things I’m not normally irritated by. I am also waking up in the middle of the night.”

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. Strange dreams troubled my rare nights of sleep. 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. For three days, I didn’t sleep 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. Since I had to continue the tapered dose till I was done, 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. Work was too much of a challenge. 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. There was a swollen, red lump on my neck, and I felt very disoriented. When I went back to the doctor, 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. Although I was discharged that day, there was no change. The next day, I 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 they say that 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), ulcers and infections.

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).