What drug makes your face look puffy? Uncovering the culprits behind medication-induced facial swelling

October 5, 2025 •

4 min read

According to the Cleveland Clinic, long-term use of corticosteroids like prednisone is one of the most common causes of a rounded, puffy face known as "moon face". This type of medication-induced facial swelling highlights the importance of understanding specific drug side effects, and raises the question, "What drug makes your face look puffy?".

Quick Summary

Several medications can cause facial puffiness through fluid retention, fat redistribution, or allergic reactions. Common culprits include corticosteroids, blood pressure drugs like ACE inhibitors, certain antidepressants, and NSAIDs. The specific drug determines the underlying mechanism and the appropriate management strategy.

Key Points

Corticosteroids Cause 'Moon Face': Long-term use of steroids like prednisone is a leading cause of a puffy, rounded face due to fat redistribution and fluid retention.
ACE Inhibitors Trigger Angioedema: Blood pressure medications such as lisinopril and enalapril can cause sudden, potentially life-threatening swelling of the face, lips, and tongue called angioedema.
Other Drug Classes Are Also Responsible: Non-steroidal anti-inflammatory drugs (NSAIDs), certain antidepressants, and some diabetes medications can also cause facial puffiness or swelling.
Do Not Stop Medication Abruptly: Never discontinue a prescribed medication without consulting your doctor, especially corticosteroids, as this can lead to severe withdrawal symptoms.
Seek Immediate Care for Angioedema: If facial swelling is accompanied by difficulty breathing, seek immediate emergency medical attention, as angioedema can obstruct the airway.
Managing Puffiness Involves Lifestyle: Simple strategies like reducing sodium intake, staying hydrated, using a cold compress, and elevating your head while sleeping can help mitigate puffiness.

Corticosteroids: The Primary Culprit for "Moon Face"

For many, the most well-known medication that causes a puffy face is prednisone, a type of corticosteroid. This facial rounding, medically known as "moon facies" or colloquially as "moon face," is a hallmark side effect of long-term steroid therapy. Corticosteroids are powerful anti-inflammatory drugs used to treat a wide array of conditions, from autoimmune diseases and severe asthma to skin conditions.

How steroids trigger puffiness

Corticosteroids mimic cortisol, the body's natural stress hormone. High levels of these steroids for an extended period can lead to metabolic changes, including altered fat distribution and increased water retention. The body begins to store extra fat in specific areas, including the sides of the face, the neck, and the abdomen. This fat accumulation, combined with the body holding onto more fluid, results in the swollen, rounded appearance of the face.

Conditions treated with corticosteroids

Severe hives and allergic reactions
Asthma and other inflammatory lung diseases
Rheumatoid arthritis and lupus
Inflammatory bowel disease (IBD)
Certain blood and lymphatic cancers
Organ transplant rejection prevention

Angioedema: A More Serious Cause of Facial Swelling

Beyond the gradual puffiness from steroids, some medications can cause a sudden, more severe type of swelling known as angioedema. This condition involves swelling of the deeper layers of skin and tissue, often affecting the lips, tongue, throat, and face. While angioedema can be an allergic reaction, certain drugs can cause a non-allergic, bradykinin-mediated form.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are common blood pressure medications that can cause a dangerous form of angioedema. These drugs, including lisinopril, enalapril, and ramipril, interfere with the breakdown of a protein called bradykinin. An excess of bradykinin can increase vascular permeability and cause swelling. Unlike an allergic reaction, this type of angioedema is not accompanied by hives, can occur at any time during treatment (even years after starting), and does not respond to standard allergy medications. Swelling of the throat can become life-threatening, making immediate medical attention crucial.

Other drug classes associated with angioedema

ARBs: Angiotensin II receptor blockers, such as losartan and valsartan, are a related class of blood pressure medication that also carries a risk of angioedema.
NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen can sometimes trigger angioedema, particularly in individuals with aspirin-sensitive respiratory disease.

Less Common and Illicit Drug-Related Causes

Several other drug types and substances have been linked to facial puffiness or swelling, each with its own mechanism of action.

Diabetes medications

Certain oral medications for type 2 diabetes, specifically thiazolidinediones like pioglitazone, can cause fluid retention and lead to swelling in the face and extremities. Additionally, DPP-IV inhibitors (like sitagliptin), also used for diabetes, can increase the risk of angioedema when used with ACE inhibitors.

Antidepressants

Some antidepressants, particularly tricyclic antidepressants (TCAs), can cause fluid retention as a side effect. Though less common, this can contribute to facial puffiness, especially in long-term use.

Illicit drugs

Certain illegal substances can also lead to facial swelling. Cocaine use can cause what is sometimes called "coke bloat," a puffiness of the face often associated with fluid retention, constricted blood vessels, or contamination with other substances, such as levamisole, which causes gland swelling.

Comparative Look: Steroid vs. Angioedema Swelling


Feature	Corticosteroid-Induced Puffiness ("Moon Face")	Angioedema (e.g., from ACE inhibitors)
Onset	Gradual, over weeks to months with long-term use.	Can be sudden and dramatic, sometimes years after starting the medication.
Mechanism	Fat redistribution and water retention due to hormone mimicry.	Increased vascular permeability, often bradykinin-mediated.
Appearance	Symmetrical, rounded, puffy face due to diffuse fat and fluid.	Localized swelling of lips, tongue, face, or throat; often asymmetrical.
Accompanying Symptoms	Often comes with other steroid side effects (e.g., central obesity, skin thinning).	Can be life-threatening if it involves the airway. Not typically associated with hives unless allergic.
Treatment	Gradual dose reduction under a doctor's supervision.	Immediate cessation of the offending drug. May require emergency care.

How to Manage Medication-Induced Facial Puffiness

Consult Your Healthcare Provider: If you notice new or worsening facial puffiness, contact the prescribing doctor immediately. Do not stop taking a prescribed medication abruptly, especially corticosteroids, as this can cause dangerous side effects.
Report the Symptom: Describe the changes and discuss potential adjustments to your treatment plan. Your doctor may be able to lower your dosage, switch you to an alternative medication, or prescribe diuretics (water pills) if fluid retention is the issue.
Reduce Sodium Intake: High salt consumption can exacerbate fluid retention. Opt for fresh foods and avoid processed items high in sodium to help minimize swelling.
Stay Hydrated: Paradoxically, drinking plenty of water can help flush out excess sodium and reduce fluid buildup.
Use a Cold Compress: Applying a cold compress to the face can provide temporary relief by constricting blood vessels and reducing inflammation.
Elevate Your Head: Sleeping with your head elevated on extra pillows can help prevent fluid from pooling in your face overnight.
Address Lifestyle Factors: Regular exercise promotes circulation and lymphatic drainage, and adequate sleep helps reduce facial inflammation.

Conclusion: Navigating Medications and Side Effects

Understanding what drug makes your face look puffy is the first step in addressing this distressing side effect. Whether it's the classic "moon face" caused by long-term corticosteroid use or the more dangerous angioedema from ACE inhibitors, recognizing the potential for facial swelling is critical. Always consult a healthcare provider before making any changes to your medication regimen. While the cosmetic effects can be frustrating, the underlying causes, particularly in cases of angioedema, can be serious and require professional medical management. With proper medical guidance, it is often possible to reduce or eliminate the puffiness associated with necessary medications.

For more in-depth information on managing steroid side effects, visit the Cleveland Clinic's page on moon face.

Frequently Asked Questions

Long-term, high-dose use of oral corticosteroids (like prednisone) is commonly associated with a pronounced, diffuse facial swelling known as "moon face" due to fluid retention and fat redistribution. However, ACE inhibitors can cause a rapid, and potentially life-threatening, swelling of the face and throat known as angioedema.

The danger depends on the cause. "Moon face" from corticosteroids is generally not harmful, but it can affect self-esteem. Angioedema, especially from ACE inhibitors, can be life-threatening if the swelling affects the throat and airway, requiring immediate medical attention.

The most effective long-term solution is to address the underlying cause with your doctor, who may adjust your dosage or switch your medication. Temporary relief can be found by reducing salt intake, staying hydrated, applying a cold compress, and elevating your head while sleeping.

The timeline varies. For "moon face" caused by corticosteroids, it may take several weeks to months for the puffiness to resolve after the medication is gradually tapered and stopped under a doctor's supervision. Angioedema from ACE inhibitors often subsides within 48 to 72 hours of discontinuing the drug.

Yes, some over-the-counter medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, can cause facial swelling or angioedema in some individuals. It is important to be aware of all ingredients when experiencing a reaction.

"Moon face" is a gradual, symmetrical facial puffiness resulting from hormonal changes due to long-term corticosteroid use. Angioedema is a sudden, often asymmetrical swelling of the deeper skin layers, most notably the lips, tongue, and throat, caused by an allergic or inflammatory response to a medication like an ACE inhibitor.

Yes, chronic cocaine use is associated with facial puffiness, sometimes called "coke bloat". This can result from fluid retention, constricted blood vessels, or contaminants like levamisole that cause gland swelling.