Steroids are often used in the treatment of various clinical conditions that have an element of inflammation underlying them. Prednisone is a commonly prescribed steroid agent that is useful in numerous clinical conditions. Unfortunately, it does have certain side-effects that can affect an individual in the short-term and long-term. In this article, we shall briefly review both of these aspects of prednisone.
Short-term side-effects of prednisone
As such, there are not many short-term side-effects of prednisone use. Patients taking high doses may notice increased acid production in the stomach which can cause upper abdominal pain. Such cases often required treatment with antacids. In individuals who suffer from diabetes mellitus, prednisone use can result in high blood sugars which can be difficult to control. Any underlying skin problems such as acne may get worse during prednisone treatments.
Long-term side-effects of prednisone
In the long-term however prednisone has a larger side-effect profile. Below are some of the common side-effects with long-term use of steroids.
1. Cardiovascular side-effects
The common cardiovascular side-effects include an increase or decrease in heart rate, irregularities in the heart rhythm, heart failure and cardiac arrest. However, a number of different symptoms may occur as well such as dizziness and palpitations which could be due to the different abnormalities that occur within the heart. Long-term steroid use can decrease potassium levels. Low potassium is a well-recognised risk factor in the development of irregular heart rhythms. Also, it can contribute to an increase in blood pressure which is yet another risk factor for heart disease. In patients who have recently suffered a heart attack, taking prednisone can contribute to rupture of the heart muscle tissue which can be life threatening. Finally, steroids can also cause blood clots in the legs and in the lungs which can cause stress on the heart and difficulty breathing.
2. Endocrine problems
Long-term use of prednisone can cause adrenal insufficiency which is typically characterised by reduced steroid production from the adrenal gland itself. When steroids are stopped, the body does not produce the required steroids and as a result patients can develop low blood pressure, alteration in electrolytes and become generally unwell. The long-term side-effects of prednisone in women can include bleeding following menopause and irregularities in the periods.
Another side-effect that can occur from long-term steroids is the development of a condition known as Cushing’s syndrome. In Cushing’s syndrome, patients can become obese and can develop weakness and diabetes.
Diabetes is a well-recognised complication of long-term prednisone use. It begins with high levels of glucose in the blood and in the urine (called glycosuria) which eventually becomes full-blown diabetes.
3. Skin problems (dermatologic)
Acne and rashes such as purpura may arise due to long-term steroid use. Some patients can develop alopecia (hair loss). On the other hand, some people can develop excessive growth of hair on the face along with swelling of the face. Due to diabetes that develops from long-term steroid use, any injuries that are sustained on the skin can take a lot longer to heal and are prone to infections. Patients may notice excessive sweating as a side-effect of prednisone.
4. Blood problems (haematological)
Low haemoglobin and a drop in the neutrophil count can be seen with long-term steroid use. Neutrophils are cells within the blood stream that are responsible for fighting any bacteria that attempt to invade the body. Due to a lack of the defence mechanisms, patients can become prone to infections and can develop high fever. Treatment with antibiotics is often warranted.
5. Muscular and bone side-effects
The long-term use of prednisone can cause weakness of the muscles of the thigh and shoulder (known as proximal myopathy). Patients may find it difficult to stand up from a sitting position or to raise their arms above the level of the shoulders. But muscles are not the only part of the musculoskeletal system affected by prednisone. In addition, bone thinning can occur - a condition called osteopenia. As this condition progresses, it can result in extreme thinning of bones known as osteoporosis. Osteoporosis can make the bones susceptible to fracturing easily from minimal trauma. It can affect the vertebral bones of the back and the hip joint primarily.
6. Eye side-effects
Prednisone use of a long period of time can cause blurring of vision, cataract formation, increased pressure within the eye (glaucoma), infections with in the eye and swelling of the optic disc (called papilloedema). It is important for patients who are on long-term prednisone to regularly see their ophthalmologist to ensure they are not developing any of these side-effects.
7. Metabolic side effects
This has been previously discussed in brief. Prednisone use over a prolonged duration of time can increase body weight. This is primarily due to accumulation of fat in the body especially around the abdomen, along with retention of fluid. The appearance is known as ‘cushingoid appearance’ and can be accompanied by joint pains and other problems. Prednisone use is also accompanied by reduced immunity which can make an individual prone to developing infections that are difficult to treat.
8. Prednisone side-effects in men
Long-term side-effects of prednisone in men can include testicular atrophy meaning the testicles can become smaller. This can affect their fertility as the number and mobility of the spermatozoa can reduce remarkably. In the event of any concerns regarding fertility and testicle atrophy, patients must seek medical advice regarding their prednisone use and whether it should be continued are not.
9. Prednisone side-effects in women
The above side-effects are common to both men and women. However, in women, long-term prednisone use can alter the periodicity of menstrual cycles and can increase bleeding and worsen abdominal cramps. Mood swings, anxiety and depression may occur. Pregnant women must avoid prednisone as it can have effects on the fetus.
Prednisone is an excellent drug in the management of different inflammatory conditions. However, short-term and long-term use of prednisone is associated with side-effects in both men and women. It is therefore important that all patients taking this drug be closely monitored by their health care professional and suitable preventative measures be adopted to ensure that these side-effects do not occur.