Prednisolone Side Effects – Introduction
When facing acute asthma exacerbation, systemic corticosteroid therapy is the treatment choice for immediate results and life-saving conditions. For patients with organ transplantation, corticosteroids will help the transplanted organ to be accepted. Prednisolone is a corticosteroid used in these or other medical conditions. (1)
The doctor’s role is critical when it comes to possible side effects. Increased blood pressure or blood sugar, slower growth in children, osteoporosis, or Cushing’s syndrome are possible side effects that make doctors judge if the patient will benefit from the therapy. Patient collaboration in being aware of side effects and recognizing adverse events is more than helpful for the proper treatment decision. (1)
This article explains the most common side effects and the effects that can be serious and need medical consultation or care. Keep reading to learn about prednisolone side effects and when you need to act immediately.
What is prednisolone used for?
Prednisolone side effects – What is prednisolone used for?
Prednisolone is a corticosteroid, a chemical substance very similar to cortisol (a hormone produced by our bodies). When bacteria or virus infects our body, the immune system is activated, so the body produces white blood cells and chemicals (interleukins) to defend itself from the infection. (1-3)
In some conditions, when this system does not work properly, it can cause inflammation (redness, warmth, swelling, or pain) harmful to our body. In such cases, corticosteroid drugs, such as prednisolone, suppress the immune system and reduce the production of those chemicals. The result is inflammation relief of the affected body area. (2, 3)
Prednisolone helps in the treatment of inflammatory conditions such as severe allergy, asthma, rheumatoid arthritis, blood or bone marrow problems, ulcerative colitis, skin problems (eczema, psoriasis), eye or kidney problems, or endocrine conditions. (1, 4)
In certain neoplastic conditions (types of cancer), prednisolone is used as palliative therapy. (1)
Common Prednisolone Side Effects
Aside from the positive effects, prednisolone, like other corticosteroids, has the following common side effects:
Fluid retention – prednisolone can make sodium stay in the body, resulting in water retention. Swelling of the face is a common sign, but swelling in the lower legs may also happen. (1, 5) Therefore, watch the swollen areas, legs, ankles, and face, and tell your doctor; it might be necessary to give you drugs to eliminate the fluids;
Alteration in glucose tolerance – prednisolone may cause an increase in blood sugar levels in people with or without diabetes. Those with diabetes should regularly monitor blood sugar and practice healthy habits to reduce sugar levels. High blood sugar can be serious, with early signs of blurred vision, increased thirst or hunger, headache, and frequent urination. (1, 6)
Inform your doctor of any changes or symptoms that occur in case of therapy adjust required; (1)
Blood pressure elevation – while taking prednisolone, you might experience elevated blood pressure for the first time, or if you have high blood pressure (hypertension), it may worsens. (1)
Only a few people might experience symptoms of hypertension, such as headache, shortness of breath, or bleeding from the nose if the blood pressure is high, while most will have no symptoms. However, high blood pressure can be serious and lead to life-threatening conditions. (7) Consult your doctor for a regular blood pressure check if needed while on prednisolone treatment.
Behavioral and mood changes – you might feel energized and feel down after. Prednisolone may initiate mood changes in other ways, some rare but more severe (see Patient information). Be aware that mood changes might happen, and talk to your doctor if you notice changes that bother you and cannot manage by yourself. (1, 8)
Increased appetite and weight gain – corticosteroids affect the metabolism, so increased appetite may happen when prednisolone is used for a few weeks or longer. You may feel hungry, leading to eating more and retaining water. While on therapy, try to eat as usual and have regular exercise. Increased appetite will disappear when you stop using prednisolone, and you can regulate your weight again. (1, 8)
What are the serious prednisolone side effects?
The other reported side effects that are associated with prednisolone affect the skin, cardiovascular, endocrine, gastrointestinal, musculoskeletal, nervous, and reproduction systems. Despite the low frequency, some side effects can be serious and require medical help. Here are some of them.
1. Osteoporosis
Long-term use of corticosteroids increases the risk of osteoporosis. Osteoporosis happens when the old bone tissue is not replaced with new bone. As a result, bones become weakened and can easily break. (1, 9) Keep in mind to take calcium and vitamin D with your diet, or if insufficient, take supplements after the doctor’s advice.
2. Depression, insomnia
Depression can be a serious effect that can negatively affect feelings, thinking, and acting. Feeling sad, losing interest in regular daily activities on the one hand, and initiating emotional problems altogether lead to losing the ability to work and function at home. (1, 10)
People who have insomnia have difficulties falling asleep, sleeping long enough, and with good quality. That negatively affects the mood, make you feel sleepy the next day and less energized for daily activities. Insomnia is also linked to health problems such as diabetes, increased blood pressure, or, more likely catching a cold. (1, 11)
3. Increased risk for infection
The suppressive effect of corticosteroids on the immune system raises the risk of infections. The results from the study performed in the UK suggest that:
“Risk for infection was increased two- to almost six-fold, depending on the type of infection, age, diabetes, and corticosteroid dose.” (12)
Therefore, corticosteroids should be used at the lowest effective dose and discontinued as soon as the treatment goal is achieved.
4. Suppression of growth in children
Corticosteroids are approved for use in children to treat chronic conditions, although side effects are known. It is good to know that corticosteroids, including prednisolone, can slow the growth in children.
In 2017, three scientists performed a systematic review of studies evaluating adverse reactions in long-term corticosteroid treatment in patients under 18. Results showed a growth retardation incidence rate of 18.1%. In addition, 21.5% of the patients had decreased bone density and 0.8% osteoporosis. (13)
When prescribing corticosteroids to children, the pediatrician evaluates if the treatment benefit is bigger than the possible side effects that might occur.
5. Severe allergic reaction
Anaphylaxis is an allergic reaction that occurs minutes after taking the medication or something you are allergic to. When the allergen triggers the immune system, it produces substances that cause decreasing blood pressure, narrowing of the airways, breathing difficulties, or even blockage. (1, 14)
Angioedema is the edema of the deeper layers of the skin, affecting the face and lips. It can be life-threatening if the swelling happens to the tongue or the throat. (1, 15)
If you notice any of these symptoms, call your doctor immediately.
6. Cushing’s syndrome
Long-term use of corticosteroids may develop into a Cushingoid state, a disorder where there is excess corticosteroids in the body. Cortisol is a hormone that reduces inflammation but also helps the body when stressed and plays an important role in blood sugar regulation and blood pressure maintenance. (1, 16)
The signs of high corticosteroid levels for a long time are a round face, increased fat around the base of the neck, weight gain, thin arms and legs, easy bruising, and wide purple stretch marks on the stomach, breasts, hips, and under the arms. In children, Cushing’s syndrome causes obesity and slower growth. The most serious complications are heart attack and stroke, blood clots in the legs and lungs, bone loss and fractures, high blood pressure, and unhealthy cholesterol levels. (16) Be aware of any symptoms described and consult your doctor if they appear.
The whole list of side effects is present in Medication Guide. However, ask your doctor about any concerns you may have. (1)
Prednisolone Dosage
Your doctor will prescribe prednisolone based on your disease severity and how you respond to therapy. The initial dose is 10 to 60 mg, while the doctor will decide on the lowest dose with clinical effects as a maintenance dose. Treatment discontinuation of long-term or high-dose therapy goes with a gradual dose decrease. (1)
Take prednisolone as your doctor prescribed and follow the instructions on the label. Check with your doctor before you stop taking the medication; your doctor will tell you if you need to decrease the dose before discontinuing. (1)
Final Thoughts
Prednisolone is a medication that doctors prescribe using its anti-inflammatory, immunosuppressive, or antineoplastic effect. It has proven its clinical effect over 60 years of clinical practice and is yet used as first-line treatment in some diseases.
Its safety profile is already known so learn about possible side effects that may appear and learn when to call a doctor. Call your doctor if you experience an adverse event, and you can report it to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
Tell your doctor if you have had recent or ongoing infections or recently received a vaccine. In addition, inform your doctor of any other prescription or over-the-counter medication, supplements, or herbal products due to possible interactions or dose adjustments.
Prednisolone is prescribed to help your medical condition; therefore, take the medication following medical instructions and practice healthy habits to manage some of the side effects.
References:
1. Food and Drug Administration, Orapred ODT® (prednisolone sodium phosphate orally disintegrating tablets), prescribing information, 2010 Jul,
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021959s004lbl.pdf
2. Cleveland Clinic, Corticosteroids, 2020 Jan,
https://my.clevelandclinic.org/health/drugs/4812-corticosteroids
3. National Library of Medicine, Prednisone, 2022 May,
https://www.ncbi.nlm.nih.gov/books/NBK534809/
4. MedlinePlus, Prednisone, 2020 Mar,
https://medlineplus.gov/druginfo/meds/a601102.html
5. Cleveland clinic, 8 Prednisone Side Effects + How to Minimize Them, 2020 May,
https://health.clevelandclinic.org/8-prednisone-side-effects-how-to-minimize-them/
6. Cleveland Clinic, Hyperglycemia (High Blood Sugar), 2020 Feb,
https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar
7. Mayo Clinic, High blood pressure (hypertension), 2022 Sep,
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
8. NHS, Side effects of prednisolone tablets and liquid, 2022 Feb
https://www.nhs.uk/medicines/prednisolone/side-effects-of-prednisolone-tablets-and-liquid/
9. National Institute of Aging, Osteoporosis, 2022 Nov,
https://www.nia.nih.gov/health/osteoporosis
10. American Psychiatric Association, What Is Depression? 2020 Oct,
https://www.psychiatry.org/patients-families/depression/what-is-depression
11. National Heart, Lung, and Blood Institute, Insomnia, 2022 Mar,
https://www.nhlbi.nih.gov/health/insomnia
12. T. Gluck, MD, Infection Risk with Corticosteroid Therapy, NEJM Journal Watch, 2016 Jun,
https://www.jwatch.org/na41557/2016/06/14/infection-risk-with-corticosteroid-therapy
13. F. Aljebab, I. Choonara, and S. Conroy, Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children, PLoS One. 2017; 12(1): e0170259.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268779/
14. Mayo Clinic, Anaphylaxis, 2021 Oct,
https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468
15. National Library of Medicine, Angioedema, 2022 Aug,
https://www.ncbi.nlm.nih.gov/books/NBK538489/
16. National Institute of Diabetes and Digestive and Kidney Diseases, Cushing’s Syndrome, 2018 May,
https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome
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