Prednisone is a powerful corticosteroid medication widely prescribed to reduce inflammation caused by autoimmune diseases, allergic reactions, and other medical conditions. While effective, the systemic nature of the drug means it affects various parts of the body, leading to a spectrum of potential side effects that can leave you feeling unwell. These effects can range from immediate, noticeable changes like mood swings and sleeplessness to more subtle, long-term issues like bone thinning. Understanding the root causes of these feelings is the first step toward managing them and improving your quality of life while on treatment.
Common Physical Side Effects
Prednisone's impact on your metabolism and fluid balance contributes significantly to physical discomfort. While some effects are more pronounced with higher doses and longer use, many can occur even with short-term treatment.
Increased Appetite and Weight Gain
Prednisone can significantly increase your appetite, making you feel constantly hungry. This, combined with fluid retention, often leads to weight gain. The drug also causes a redistribution of fat, leading to characteristic features like a rounded face, known as "moon face," and fat deposits on the abdomen and back of the neck.
Fluid Retention and Swelling
Corticosteroids alter how your body processes salt and water, causing you to retain fluid. This can result in swelling in your face, hands, feet, and ankles. A low-sodium diet is often recommended to help manage this side effect.
High Blood Sugar
Prednisone can raise your blood sugar levels by interfering with insulin production, which is a particular concern for people with diabetes. Regular monitoring of blood sugar is vital, and your doctor may need to adjust other medications.
Gastrointestinal Issues
The medication can irritate the stomach lining and increase the risk of ulcers and heartburn, especially if taken with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Taking prednisone with food can help mitigate some of this discomfort.
Osteoporosis
Long-term prednisone use, particularly at higher doses, can cause bone thinning (osteoporosis), increasing the risk of fractures. Healthcare providers often recommend calcium and vitamin D supplements, along with weight-bearing exercise, to help protect bone density.
Increased Risk of Infection
Since prednisone works by suppressing the immune system, it leaves you more vulnerable to infections from viruses, bacteria, and fungi. Good hygiene practices and avoiding sick individuals are important precautions.
Psychological and Neurological Side Effects
Beyond the physical effects, prednisone can have a profound impact on your mental and emotional state, which is often a major contributor to feeling "awful."
Mood Swings and Irritability
Patients can experience significant mood swings, ranging from a feeling of euphoria and excessive energy to irritability, anxiety, and depression. These changes can occur even early in the treatment course and may require open communication with family members and your doctor.
Insomnia and Sleep Disturbances
Prednisone can make you feel restless and alert, disrupting your natural sleep cycle. The best strategy is to take your dose in the morning to allow the effects to wear off by bedtime.
Fatigue and Weakness
Ironically, while prednisone can cause jitteriness, many people also experience fatigue and muscle weakness, which can linger even after stopping the medication.
A Comparison of Corticosteroids
While this article focuses on prednisone, many side effects are common to other oral corticosteroids. However, there are nuances in how the body processes them.
| Feature | Prednisone | Prednisolone |
|---|---|---|
| Activation | Requires activation by the liver | Biologically active form |
| Use in Liver Disease | Not ideal for patients with liver disease | Preferred for patients with liver disease |
| Common Effects | Mood swings, weight gain, insomnia, fluid retention | Mood swings, weight gain, insomnia, fluid retention |
| Tapering | Essential to taper gradually | Essential to taper gradually |
The Dangers of Abruptly Stopping Prednisone
Even if the side effects are severe, it is critical not to stop taking prednisone suddenly, especially if you have been on it for more than a couple of weeks. Prednisone mimics the body's natural cortisol, and prolonged use suppresses the adrenal glands' ability to produce their own hormones. Stopping abruptly can lead to a potentially fatal condition called adrenal crisis, with symptoms like extreme fatigue, weakness, body aches, and dizziness. Your doctor will create a tapering schedule to allow your adrenal glands to recover gradually.
Managing Side Effects and Finding Relief
While some side effects are inevitable, many can be managed with proactive strategies and working closely with your healthcare provider. This includes:
- Dietary modifications: Limiting sodium can help with fluid retention, while a balanced diet with controlled carbohydrates can manage blood sugar.
- Medication timing: Taking your dose in the morning can combat insomnia.
- Consistent exercise: Regular, low-impact exercise can improve mood, help with weight management, and maintain muscle and bone health.
- Mental health awareness: Informing family and friends about potential mood changes can build a support system. Stress-reduction techniques like meditation can also be helpful.
Conclusion
Feeling awful on prednisone is a common and valid experience due to its complex and wide-ranging systemic effects. By understanding the causes—from metabolic and fluid disruptions to profound mood changes—patients can better communicate their symptoms with their healthcare providers. Never stop the medication abruptly. Instead, focus on managing side effects through a proactive approach that includes lifestyle adjustments and a doctor-guided tapering plan. Though challenging, the benefits of prednisone often outweigh the risks, and with proper management, the period of feeling unwell can be made more tolerable. For more information, the American College of Rheumatology provides excellent patient resources on prednisone management.
