Prednisone and puffy face

Side-effects of Prednisone

In the chapter Treating Lupus With Medications, I talked about prednisone as being the single most important factor in improving the outlook for lupus patients. It is a very powerful tool in the treatment of lupus, it is usually effective in bringing lupus under control and it saves lives. However, there is a price to be paid for this success. If we observe what happens to patients taking high doses of prednisone, there is no doubt this drug can cause a wide variety of side-effects. In this section, I will be talking about

Short term side-effects
It is important to be aware that not every lupus patient will develop these side-effects, that each patient reacts differently to the drug, that only a high dose of prednisone will cause major side-effects and that a high dose has to be continued for several weeks before these side-effects will occur.

Most importantly, these side-effects are reversible; they will go away when the dose is decreased or when the drug is stopped. Always remember that the beneficial (good) effect of prednisone cannot be separated from the onset of at least some of these side-effects. Therefore, your swollen cheeks, the hump on your back or the bloating of your abdomen should be interpreted as evidence that the medication is active and is working for you. If you’re living through these unpleasant side-effects, you have to think that the bottom line is – this drug is helping me. The short term unwanted effects of prednisone are:

  1. Swelling of the face, often referred to as “moon face” or “chipmunk cheeks”; some patients feel ugly and say that they do not recognize themselves in the mirror. Remember, these changes are reversible.
  2. A hump on the upper part of the back; this hump is made of fat, not bone.
  3. Bloating or swelling of the abdomen.
  4. Weight gain; prednisone may cause a great increase in appetite. Weight gain can be controlled by a low calorie diet, by exercise and by avoidance of salt. Avoid salty foods and do not add any salt.
  5. Stomach problems; to ease the burning, try taking prednisone with food. This problem may require anti-ulcer medication.
  6. Mood changes; sometimes the change is for the better. However, depression may be made worse by prednisone.
  7. Insomnia; patients may have difficulty sleeping at nights.
  8. Shakiness; patients may have feelings of being “hyper: or that “things are running fast inside my head”.
  9. Weakness of the thigh muscles; patients may have difficulty in climbing stairs, getting out of the bath or getting up from a chair or toilet seat.
  10. Interruption of the menstrual cycle; periods may stop altogether.
  11. Increased risk of infections; patients may have more infections including some caused by germs that the body is normally resistant to.

As the dose of prednisone is decreased and then stopped, these side-effects will disappear. However, as the dose is being tapered or decreased, patients may experience symptoms of withdrawal such as joint pain or fatigue. The body usually adapts to the new dose within a few days and these symptoms will disappear. However, if the fatigue and pain persist, it is important to bring this to the attention of the physician, as this may indicate adrenal insufficiency.

Long term side-effects
These side-effects may occur when prednisone has been decreased to a low dose and only occur when prednisone has been used for a long time. In many patients, these side-effects can be reduced by appropriate prevention. The long term side-effects are:

  1. Easy bruising of the skin; bruising from prednisone use often happens without any obvious injury and may require that blood clotting ability be checked by the physician. When prednisone is the cause of the bruising, blood clotting will be normal. This easy bruising disappears when prednisone is stopped and is not associated with any risk of internal bleeding.
  2. Stretch marks; these may occur on the upper body, the arms, the abdomen and the thighs. Some patients have this problem while others do not. Unfortunately, there is no treatment and the marks are permanent.
  3. Excessive growth of body hair; this hair growth usually appears on the face and will stop when prednisone is decreased. The hair that has grown will tend to stay but it can be effectively removed by using a hair-removal cream.
  4. Cataracts; these are a cloudiness of the lens of the eyes that cause a decrease in vision. Occasionally, surgery may be required.
  5. Osteonecrosis; this condition means “dead bone” and most frequently affects a bone in the hip joint called the femur (other bones may be involved as well). Osteonecrosis is becoming a more important cause of pain and disability in lupus patients. If this problem is found early, worsening of the process may be prevented by performing a surgical procedure. In many patients, the damage caused by osteonecrosis eventually comes to a stop. In some patients, where damage to the bone has been severe, an artificial joint may be needed.
  6. Osteoporosis; this results from a loss of calcium from the bones and often leads to fractures, particularly in the spine. These may be a major cause of pain and disability. However, this process is at least partly reversible if prednisone can be stopped. If prednisone must be continued, this side effect may be decreased by exercise, by eating foods rich in calcium and by taking extra calcium and vitamin D as prescribed by your physician. These preventive measures should be started as soon as a high prednisone dose is begun.
  7. Heart attacks; several factors (including smoking, high blood pressure and high blood sugar) combined with long term prednisone treatment may lead to a narrowing of the blood vessels of the heart and early heart attacks. This risk can be decreased by maintaining a reasonable weight, controlling blood pressure and, most importantly, not smoking.

Other unwanted effects.
The side-effects listed above will obviously create some problems for lupus patients taking prednisone. Changes in appearance are difficult to deal with and often the unhappiness of the patient about these changes is made worse by the comments of relatives and friends. Here is an example. A patient told her friend, “I have gained 8 pounds since prednisone was started”. Her friend’s comment, “Yes, it really shows on your face”.

This is not the kind of peptalk that lupus patients need. The answer could have been, “Maybe it’s time to start this diet that your doctor talked to you about”. It is important that lupus patients on prednisone keep their focus not on the problems themselves but on what can be done about them. When a negative comment about your appearance hurts you, try making this response, “Yes, I’m really upset about that. Could you help me find out what I can do about it?”. Or, have your relative or friend read this section.

Other comments made to lupus patients are more frightening than unkind. Another patient went to her pharmacist to renew her prescription. She was told, “Are you aware that prednisone is a dangerous drug?” Although the pharmacist had good intentions, the comment didn’t really help to build the patient’s confidence in her treatment. My message to family members and friends is this – if you are close to someone who has lupus, it is very important that you keep a positive attitude towards prednisone and the changes that it causes.

Physicians who prescribe prednisone always give careful instructions as to how it should be taken. Over the years, I still find it remarkable how often, in spite of these careful explanations, some patients tend to change their dose and/or their schedule without talking to their physician. A patient, the mother of three young children, took all her prednisone dose at bedtime instead of twice daily as I had prescribed. She was so busy getting the kids ready for school that she regularly forgot her morning dose. Patients must understand there is a good reason for the instructions their physician gives them. Patients are instructed never to take all their daily prednisone at night because it will cause more side-effects. However, it is usual to split the dose (for example, half with breakfast and half with supper). What should you do if you forget a dose of prednisone? Nobody is perfect. If you have missed a dose, simply take it as soon as you think about it. Don’t wait until tomorrow.

Patients who take prednisone may find this long list of side-effects overwhelming. It is important to remember that no physician ever prescribes prednisone unless it is needed, that prednisone is often the most important tool in the fight against lupus and that the physician always tries to keep any side-effects to a minimum. The patient must keep in mind – this drug is helping me.

12 Photos You Might Relate to If You’ve Taken Prednisone

Prednisone is used to treat a variety of diseases in our chronic illness community, from arthritis to multiple sclerosis to asthma, among others, so if you’re reading this chances are you’ve experienced this common drug. While prednisone is known for being helpful in reducing inflammation, it’s also known for the range of side effects it can cause, like weight gain (particularly in the face, causing “moon face”), difficulty sleeping and mood swings. (Though if you haven’t taken prednisone yet, don’t panic! Everyone’s reaction to prednisone is different and not everyone experiences severe side effects.)

Prednisone’s side effects typically improve once you stop taking the drug, but for those weeks or months you are taking it, and if you’re on a long-term dose or dealing with long-term after-effects, it can be tough. You might feel like there’s no one around who really understands what you’re going through. So we asked our Mighty community to share a photo that shows what prednisone was like for them. If you’ve been on prednisone or are on it now, hopefully these warriors’ experiences will help you feel a part of a community who supports you and your experiences.

Here’s what our community shared with us:

1. “I call it poofiness… my whole body is a little more swollen while on low dose steroids for my interstitial cystitis, irritable bowel syndrome and lymphocytic colitis. Because of my smaller frame, I can see and feel myself poofing up quite a bit more than usual. On a positive note, I get to spend quality time with my kitty, Tobie.” — Julie H.

2. “This photo is after being off prednisone long enough to lose all the water weight. I’m pointing to a stretch mark on my face caused by high doses of prednisone.” — Marisa S.

3. “This photo was taken when I was rocking the ‘moon face.’ Even so, I traveled 1,000 miles and cuddled baby animals, had monkeys climb on my head and was mugged by camels who wanted the sweet potato I was hiding in my hand. I look at the photo and see how happy I was, even though I felt and looked my worst. Living with relapsing polychondritis, I know that my health will continue to fluctuate and I will continue to live the best life possible despite how I look and feel.” — Debby R.

4. “This photo was after I had my port placed. I had already had a few rounds of steroids and chemo but kept having an allergic reaction to the chemo. So we started something even stronger and I had to get a port placed because my veins crapped out on me. I had my port placed on a Tuesday then started chemo the very next day. I was horribly swollen and in so much pain just trying to smile through it somehow.” — Maricella M.

5. “The picture on the left is my senior homecoming after being on prednisone for several months. I had serious weight gain and ‘moon face!’ The picture on the right is the following summer after being off of prednisone and getting back to my normal, healthy weight.” — Brianna D.

6. “When I first begin a round of prednisone, I experience an unreal burst of energy – to the point where I have to exercise a lot more than usual so I can concentrate, or sleep! A burst of energy might sound nice, especially when I’m super fatigued, but it’s really extreme and feels so unnatural and awful – in some ways it’s similar to a manic episode. Then there’s the crash that follows a few days later…” — Paige W.

7. “This picture was taken on 60 mg of prednisone. I had recently dropped 5 mg as I have been in a continuous state of weaning and then having to increase my dosage as my body either adjusts or doesn’t to the change in the dose. When this picture was taken, I was swollen, crying, in tremendous physical and mental agony, because it’s more than just pain, it’s a complete physical and mental assault on your body when you change your dose, especially if you have become dependent on it… until your body adjusts and begins to function again better slowly. It’s also mentally and physically exhausting to continuously go through the war of trying to taper prednisone. You do become traumatized. But you keep trying to get your dose reduced so the side effects will become easier and you hopefully won’t need as much to keep you out of a flare.” — Donna A.

8. “Four months on 12 mg of methylprednisone. Developed Cushing syndrome induced by medication, gained , developed arrhythmia, high blood pressure, as well as other common effects of Cushing. I did not recognize myself in the mirror. It has been months since I stopped the cortisone, however I am still dealing with side effects. It is definitely a miracle drug, but the side effects sometimes outweigh the benefits.” — Ana C.

9. “Two minutes before this I was laughing. Pred gives me nasty mood swings. Not to mention my moon face.” — Rhiannon J.

10. “I didn’t know my face could actually change shape. I didn’t look or feel myself for the months I was on prednisone (both pill and shot form) and I’m still suffering effects from having been on it so long. Moon face to the max.” — Lex F.

11. “I’m at work. My face is so swollen with excess fluid that I cannot smile normally.” — Marisa S.

12. “I was on steroids for the first month when I started getting puffy and swollen. Not to mention the redness and hot flashes that come with it all.” — Marisa P.

Looking for guidance in getting through the challenges of prednisone? Our community has you covered. Check out this Declassified Prednisone Survival Guide, 16 questions people wish they had asked their doctors about prednisone, 6 wacky side effects of prednisone they don’t tell you about, and advice for coming to terms with face changes due to prednisone.

Inspired by Ashley Judd, My Own ‘Puffy Face’ Saga

When I was a kid, I was diagnosed with lupus. For the past 10 years, I’ve been on a steady cocktail of drugs designed to combat swollen joints, mouth sores, and kidney failure. For a while, they worked. But when I was 21, I was diagnosed with thyroid cancer. My thyroid was removed, I underwent radiation, and lupus threw a party in my body to celebrate. And so for the past four years, I’ve been on prednisone, a highly toxic steroid used to stop my body from killing itself.

Prednisone is often used to combat the inflammation brought on by autoimmune diseases. By bolstering the body’s natural level of cortisol, it changes the way the body’s immune system functions and prevents swelling. Lupus patients usually take it to keep their organs functioning; prednisone is effective in reducing damage to the brain, kidneys, heart, lung and liver. But aside from its life-saving skills, it can also cause side effects like insomnia, depression, manic behavior—and extreme hunger for Fruity Pebbles (in my case, anyway).

Most notably, prednisone can trigger something called moon face. The description is painfully and comically accurate: you could stick an American flag in my forehead, hang me in the sky, and I doubt anyone would notice.

Between lupus’s signature malar rash (a butterfly rash that causes facial redness and for everyone and their mother to tell you to put on sunscreen, to which I’ve taken to replying: That isn’t effing sunburn and hey, your face sucks too) and prednisone’s swelling, I have a hard time feeling good about my face. Sure, my eyes are Pierce Brosnan blue and I look killer in sunglasses, but ole moon face is no one’s idea of pretty.

On these bad days, I step out of bed and look in the mirror at the bloat in my face. I wish it away. I am modest but my face is prettier without the bloat. Sometimes, I perversely imagine a man looking back at me in a taxi cab and thinking “What a pretty face she’d have without all that fat.”

I fantasize banging balled-up fists onto the back of his leather seats, screaming that it is not my fault. That I hardly eat, I hardly eat at all. I’ve lost my appetite so many times that Glucose Control Boost shakes are my treat of choice these days. (Hey, the chocolate flavor’s not bad.)

Although no cab driver has had the nerve to say this to me, I’ve received plenty of comments about my face. “Did you go tanning with those little goggles on?” One girl in high school asked me this every single day. The answer was always the same: This may be the Jersey Shore, but I don’t go tanning.

One day, after she had asked me for at least the twentieth time, I turned around and asked her if she was deaf. “NO. Like I said yesterday, the rash is from lupus. It’s a disease that will probably kill me. Please stop asking me if I went tanning.”

That was the start of my honesty policy. Just tell the truth, I thought. They’ll never ask again. And so I have. For nearly eight years, I have told the truth—albeit in a gentler, kinder way. It has made people squirm and spurt out apologies, and it has made my face burn a darker red.

Sometimes a week or two will go by and no one will ask. I live in Los Angeles now, where a sunburned face is more common in the dead of winter than in New York. People are less rude out here too; if it looks like your friend got a chemical peel, you dare not ask, because it’s probably true.

Two weeks ago, I went to get my hair colored. The women who run the salon are older and unabashed in their fashion and hair advice. The woman cutting my hair asked if I got a chemical peel, because my face was so “swollen and dry.”

“Nah,” I laughed. “I’m only 26. Maybe next year.”

“Then why is it so red?” she pressed.

Although I’ve heard the question at least 100 times, it always makes me nervous. Jumbling my words, I tried to explain the disease and prednisone and its side effects.

“No,” the hairdresser said. “You are too young to have lupus.” I coughed and said 10 years of tests proved otherwise, but she persisted. “You are not doing enough for that face. What are you eating? Your face should not be so bloated.”

I sunk deeper in my chair and said nothing more. I refused the blow dry, knowing that would only make my face an angrier red. Maybe she’s right, I thought as she finished up. Maybe I deserve to look this way. Maybe the outside should match the terror on the inside.

But as I drove home, I became enraged. Why do we do this, I thought. What gives us the right to comment freely on a stranger’s looks? I can’t control this disease any more than she can control the traffic on the 405.

I’ve spent years being angry that my health is so reliably crappy. I have mourned for what I have not been able to do. I’ve cried over the youth that is lost to cancer and I have looked in the mirror and sobbed at the incisions made in my face to remove a bout of the bacteria MRSA.

I’m not angry at my disease anymore, or the hand I was dealt. But I am angry that in our society, it’s acceptable to say mean things about other people’s appearance, especially to their face. It’s not right. Ashley Judd’s recent op-ed, in which she decried the recent media speculation about her face, is a good reminder of just how wrong this looks-based society is. The international speculation and critique over her face is every steroid-treated patient’s worst nightmare. It’s a nightmare for every person who feels even a little bit insecure. It’s recess bullying, on a larger stage, and worst of all, it’s done by adults. It has to stop.

Each morning I take the prednisone and it sticks in my throat. Today it stuck a little bit more, unwilling to go down, as if my body knew what would happen when it mixed into my bloodstream and went about saving my life. I went to yoga and when I came home, I iced my knees and I stared in the mirror and wished we would all cut each other a little slack.

I think we need to.

Relief for Prednisone-Related Face Swelling

Q1. I am taking the maximum dosage of prednisone for treatment of polymyositis. My face is swollen, hard as a rock, and very painful. Is there anything I can do to relieve the facial pain or swelling until the prednisone can be reduced? I am already wearing a pain patch for muscle pain.

High doses of prednisone can cause many side effects including swelling of the face, also known as Cushingoid or moon facies. Unfortunately, there are no medicines that can negate this effect of prednisone; the only solution is to decrease the prednisone dose or stop taking it. Many rheumatologists will therefore add a steroid-sparing agent (for example, methotrexate) to prednisone to help patients lower their prednisone dose more quickly and safely without worsening the underlying inflammatory condition. Because these steroid-sparing agents work slowly, it often still takes several months before patients can lower their prednisone to a level at which they experience few side effects.

Q2. My husband has psoriatic arthritis and it’s getting worse – it has progressed from his first finger joints to his second, and I’m worried. He’s not willing to take Enbrel or methotrexate because of the side effects (he’s worried about liver damage and potential sterility caused by both drugs). How serious are the side effects, and with what frequency do they occur? Also, how do you determine if and when you should start serious treatment for psoriatic arthritis?

The side effects of these drugs can be serious, but a lot depends on what else is going on with your husband’s health. The drugs can be very helpful, but certain conditions make it inadvisable for some people to take them.

What we look for in treating psoriatic arthritis is not only to relieve pain but to reduce inflammation of joints and skin. A severe psoriatic rash can become very uncomfortable, and possibly embarrassing, which is why we may opt to resort to “bigger guns” than nonsteroidal anti-inflammatory drugs (NSAIDs).

Enbrel (etanercept) does not affect male (or female) fertility, nor does it cause liver damage. It does create some risk of infection, so before starting Enbrel a patient should get a skin test for tuberculosis. If the test is positive, or if there is a history of tuberculosis, he or she needs prophylactic treatment with the drug INH so tuberculosis will not come back. Other side effects of Enbrel are very rare — they include other infections and neurologic problems. In addition, people with poorly controlled diabetes have a tendency to develop infections, and Enbrel can increase the chances of this. Enbrel can also increase the risk of heart failure.

There is no evidence that methotrexate affects male fertility, even in the large doses given to treat cancer. Methotrexate can cause liver damage, but not in the doses used to treat psoriatic and rheumatoid arthritis (7.5 to 25 mg per week), unless the patient drinks alcohol or has chronic hepatitis. Before starting methotrexate, we test for hepatitis B and C. Patients who test positive should be evaluated for hepatitis treatment and not take methotrexate. Some rheumatologists allow patients on weekly methotrexate up to 3 glasses of wine per week, but I feel it’s best to have none or no more than one. If a patient finds it hard to stay away from alcohol, it’s best not to start methotrexate.

There’s a strong chance that methotrexate will cause birth defects, so women should stop taking the drug at least 4 to 6 months before they attempt to conceive. For a man taking methotrexate, conception can be attempted 2 months after stopping the drug.

The decision to start methotrexate or Enbrel (or a combination of both) depends on how severe and aggressive the psoriatic arthritis and psoriasis are. The sooner treatment is started, the greater the chance to control or even stop disease progression, which can damage and deform joints and cause permanent disability. Psoriasis can also affect the spine (psoriatic spondylitis) with inflammation, stiffness, and immobility. Keep in mind that methotrexate is quite cheap, while Enbrel is very expensive, although most insurance companies recognize the advantages of this costly therapy for severe kinds of arthritis.

Q3. Two years ago, I noticed that my fingers were getting very dry and scaly — calloused, actually. They began to crack open and bleed. I needed to wear plastic gloves to cook and do housework. I am also having joint pain, especially at night, and I do not know if it is related. A dermatologist told me she thinks it is hand psoriasis, but it doesn’t look exactly like psoriasis. I want to know if getting cortisone shots is harmful. Every three months, I get a cortisone shot and my fingers clear up for three months. My achy joints improve, too. Is it harmful to keep getting these shots? What sort of doctor might diagnose this condition? When I don’t take the shots my fingers become very painful and unsightly. I am 52. What do you think it could be?

– Liz, Virginia

It is impossible to make a diagnosis without examining you. The fact that you improve for three months after each corticosteroid injection (it is not actually cortisone, but a derivative) means that you have a skin plus joint illness that is responsive to steroid. There is a variety of psoriasis that affects the palms, may involve joints, and is difficult to diagnose.

Your question about cortisone-like steroids is very appropriate. If intramuscular steroid is given over a period of years it can cause all the side effects that oral therapy can. These include osteoporosis, especially if the patient is a menopausal or postmenopausal woman, avascular necrosis (death of bone tissue), diabetes in predisposed people, hypertension, skin thinning and blood vessel fragility, myopathy (weakness of muscles), and suppression of the adrenal glands, which produce our body’s own cortisone.

A rheumatologist is best suited to diagnose the various types of arthritis. Rheumatologists are especially trained for a minimum of two years after internal medicine training, to diagnose and treat patients with arthritis and systemic rheumatic diseases.

By the way, aside from rash, psoriasis can also cause nail changes that sometimes could be present before the rash. These changes include nail pitting, ridging, onycholysis (dissolution of the nail), and hyperkeratosis (thickening of the nail).

I am not very clear about the details of your joint pains, so it’s difficult for me to comment. Nevertheless, what helps in making a diagnosis is knowing which joints are involved, and what other manifestations there are: swelling, redness, heat of the joints, extraneous sounds or sensations (creaking, for example), whether the joint locks or catches, and how the function of the joints is impacted.

And while it is not clear that you have psoriatic arthritis, here’s some background on this condition: Psoriatic arthritis causes inflammation of the joints. There are several types of psoriatic arthritis; one involves only the last joints of the fingers (distal interphalangeal joints) with redness, swelling, heat, and pain; another involves more joints without symmetry; a third has symmetry and looks almost like rheumatoid arthritis; at times there is a great deal of joint destruction and this type is called arthritis mutilans; when the spine joints are involved that is known as psoriatic spondylitis.

My advice is to find a good rheumatologist in your area to determine if, indeed, this is the form of arthritis you have. Your local Arthritis Foundation can help you find a rheumatologist. Do seek out an experienced physician to help you sort through this, and good luck.

Learn more in the Everyday Health Arthritis Center.

Prednisone

SIDE EFFECTS

(listed alphabetically, under each subsection)

The following adverse reactions have been reported with prednisone or other corticosteroids:

Allergic Reactions

anaphylactoid or hypersensitivity reactions, anaphylaxis, angioedema.

Cardiovascular System

bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, ECG changes caused by potassium deficiency, edema, fat embolism, hypertension or aggravation of hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction (see WARNINGS: Cardio-Renal), necrotizing angiitis, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis.

Dermatologic

acne, acneiform eruptions, allergic dermatitis, alopecia, angioedema, angioneurotic edema, atrophy and thinning of skin, dry scaly skin, ecchymoses and petechiae (bruising), erythema, facial edema, hirsutism, impaired wound healing, increased sweating, Karposi’s sarcoma (see PRECAUTIONS: General Precautions ), lupus erythematosus-like lesions, perineal irritation, purpura, rash, striae, subcutaneous fat atrophy, suppression of reactions to skin tests, striae, telangiectasis, thin fragile skin, thinning scalp hair, urticaria.

Endocrine

Adrenal insufficiency-greatest potential caused by high potency glucocorticoids with long duration of action (associated symptoms include; arthralgias, buffalo hump, dizziness, life-threatening hypotension, nausea, severe tiredness or weakness), amenorrhea, postmenopausal bleeding or other menstrual irregularities, decreased carbohydrate and glucose tolerance, development of cushingoid state, diabetes mellitus (new onset or manifestations of latent), glycosuria, hyperglycemia, hypertrichosis, hyperthyroidism (see WARNINGS: Endocrine), hypothyroidism, increased requirements for insulin or oral hypoglycemic agents in diabetics, lipids abnormal, moon face, negative nitrogen balance caused by protein catabolism, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery or illness) (see WARNINGS: Endocrine), suppression of growth in pediatric patients.

Fluid And Electrolyte Disturbances

congestive heart failure in susceptible patients, fluid retention, hypokalemia, hypokalemic alkalosis, metabolic alkalosis, hypotension or shock-like reaction, potassium loss, sodium retention with resulting edema.

Gastrointestinal

abdominal distention, abdominal pain,anorexia which may result in weight loss, constipation, diarrhea, elevation in serum liver enzyme levels (usually reversible upon discontinuation), gastric irritation, hepatomegaly, increased appetite and weight gain, nausea, oropharyngeal candidiasis, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis, vomiting.

Hematologic

anemia, neutropenia (including febrile neutropenia).

Metabolic

negative nitrogen balance due to protein catabolism.

Musculoskeletal

arthralgias, aseptic necrosis of femoral and humeral heads, increase risk of fracture, loss of muscle mass, muscle weakness, myalgias, osteopenia, osteoporosis (see PRECAUTIONS: Musculoskeletal), pathologic fracture of long bones, steroid myopathy, tendon rupture (particularly of the Achilles tendon), vertebral compression fractures.

Neurological/Psychiatric

amnesia, anxiety, benign intracranial hypertension, convulsions, delirium, dementia (characterized by deficits in memory retention, attention, concentration, mental speed and efficiency, and occupational performance), depression, dizziness, EEG abnormalities, emotional instability and irritability, euphoria, hallucinations, headache, impaired cognition, incidence of severe psychiatric symptoms, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, increased motor activity, insomnia, ischemic neuropathy, long-term memory loss, mania, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychiatric disorders including steroid psychoses or aggravation of pre-existing psychiatric conditions, restlessness, schizophrenia, verbal memory loss, vertigo, withdrawn behavior.

Ophthalmic

blurred vision, cataracts (including posterior subcapsular cataracts), central serous chorioretinopathy, establishment of secondary bacterial, fungal and viral infections, exophthalmos, glaucoma, increased intraocular pressure (see PRECAUTIONS: Ophthalmic), optic nerve damage, papilledema.

Other

abnormal fat deposits, aggravation/masking of infections, decreased resistance to infection (see WARNINGS: Infection), hiccups, immunosuppresion, increased or decreased motility and number of spermatozoa, malaise, insomnia, moon face, pyrexia.

Read the entire FDA prescribing information for Prednisone (Prednisone Tablets, USP)

Prednisone is a corticosteroid. In contrast to anabolic steroids (used by “bodybuilders”), corticosteroids are used in inflammatory conditions for their anti–inflammatory effects. They have a rapid onset of action, and profoundly affect many parts of the immune system as well as most other body systems. Corticosteroids are a cornerstone of treating most types of vasculitis, and are often used in combination with other immunosuppressive medications.

Side Effects

Many of the side–effects of steroids are predictable. All are related to: 1) the amount of steroid a patient takes in his/her daily dose, and 2) the length of time the patient remains on the medication. We emphasize that not all side–effects occur in all patients.

Despite the numerous potential side–effects of corticosteroids listed below, their introduction into patient care 50 years ago revolutionized the treatment of many diseases, including vasculitis. When used properly, these drugs save lives and avert threats to the function of important organs.

One of the numerous potential side–effects of prednisone and other forms of corticosteroid treatment is hirsutism — excessive growth of body hair. Patients vary in the degree to which this side–effect of steroids occurs.

Although some experience minimal hirsutism, the patient depicted here developed this side effect after taking 10 milligrams of prednisone for a few months.

  • Weight Gain
  • Glucose Intolerance
  • Hypertension
  • Increased Susceptibility to Infections
  • Bone Thinning
  • Easy Bruising
  • Mood Swings/Insomnia
  • Avascular Necrosis of bone
  • Abdominal Striae
  • Cataracts
  • Acne

Weight Gain

Weight gain is usually the most dreaded side–effects of steroid use, incurred to some degree by nearly all patients who take them. The amount of weight gain varies from individual to individual. In addition to causing weight gain, prednisone leads to a redistribution of body fat to places that are undesirable, particularly the face, back of the neck, and abdomen. Pictured below is a example of redistribution of body fat to the back of the neck. Accumulation of fat in this area is sometimes referred to as a “buffalo hump”.

Another example of this “redistribution” is pictured below. Supraclavical “fat pads” are collections of fat at the base of the neck, just above the collarbones, which are common in patients on steroids. They sometimes cause concern among patients if mistaken for lymph nodes or other causes for worry, but will gradually subside as the prednisone dose is tapered to below 10 milligrams/day.

Glucose Intolerance

High blood sugar, or steroid–induced diabetes. This usually resolves when the steroids are decreased or discontinued.

Hypertension

High blood pressure. This usually improves as the corticosteroid dose is reduced.

Increased Susceptibility to Infections

Patients are at increased risk for many types of infections, from minor fungal infections in the mouth (“thrush”, caused by Candida) to life–threatening infections such as Pneumocystis carinii pneumonia. The higher the steroid dose and the longer the duration of therapy, the greater the risk of infection. The risk is also increased when patients receive combinations of immunosuppressive medications, such as cyclophosphamide (cytoxan) and prednisone. The risk of some infections can be greatly reduced by taking specific types of antibiotics prophylactically.

Pictured below is woman under treatment with prednisone and methotrexate for vasculitis and a concurrent neurologic condition (myasthenia gravis) developed painful vesicles in her mouth. The vesicles were confirmed by culture to be caused by re–activation of a Herpes simplex infection, and responded to treatment with acyclovir.

Bone Thinning (Osteoporosis)

Prednisone may cause thinning of the bones even in people who are not usually at high risk for osteoporosis (for example: males, young people). In people susceptible to osteoporosis, prednisone may accelerate the process of bone loss. Fortunately, in the past few years, excellent treatments and preventive measures have become available for osteoporosis. All patients on prednisone for prolonged periods are candidates for these medicines.

Easy Bruising

Prednisone also causes “thin skin”. Patients on moderate to high doses of prednisone often notice that they bruise easily, even with only slight trauma. Pictured below is a patient with giant cell arteritis who suffered a skin laceration after she struck her leg against a chair.

Mood Swings/Insomnia

Many patients find it difficult to sleep when taking high doses of steroids. Many also find that they are more irritable than usual. Steroids sometimes even induce depression, which improves when the drug is decreased or discontinued.

Avascular Necrosis of Bone

For reasons that are not known, high dose prednisone (for example, greater than 20 milligrams a day) predisposes some patients to joint damage, most often of the hips. In avascular necrosis (or osteonecrosis, meaning “bone death”) of the hip, the part of the leg bone that inserts into the pelvis dies, resulting in pain with weight–bearing and some loss of joint function. Many patients with avascular necrosis require joint replacements.

Abdominal Striae

Abdominal striae (“stripes”), as pictured below, frequently occur in patients who take high doses of steroids for long periods of time.

Cataracts

Long–term steroid use may lead to cataract development in the eyes, which frequently require surgical removal.

Acne

High dose prednisone predisposes some patients to acne, especially facial acne, as pictured below. The facial acne developed after several weeks of high steroid doses.

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