13 Prednisolone Side Effects: How to Deal With Swelling, Insomnia, and More

Prednisolone (Orapred ODT, Pediapred) is a corticosteroid medication that treats a variety of medical conditions, usually by helping to manage inflammation. Prednisolone comes as regular and oral disintegrating tablets, an oral solution and syrup, and eye drops.

Corticosteroids like prednisolone are notorious for having many potential side effects, especially when taken by mouth. Some side effects may be more likely if you take a corticosteroid longer than 2 weeks. But others can happen anytime during treatment.

Prednisolone side effects at a glance

Some prednisolone side effects are common, while others are more rare. The common side effects also tend to be milder, and you can often manage them at home. With serious prednisolone side effects, you may need medical treatment to relieve your symptoms.

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Common prednisolone side effects include:

• Trouble sleeping (insomnia)

• High blood glucose (sugar) levels

• High blood pressure

• Swelling (fluid buildup)

• Stomach pain

• Muscle weakness

• Headaches

• Heartburn

• Appetite changes

• Weight gain

• Mood changes

• Acne

• Sweating

Less common but potentially serious prednisolone side effects include:

• Infections due to a weakened immune system

• Heart problems, such as heart failure

• Changes in kidney function

• Eye problems, such as cataracts or glaucoma

• Severe stomach problems, such as gastritis or stomach ulcers

• Weakened bones

• Slowed growth in children

• Withdrawal symptoms after long-term use if stopped suddenly

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Generally, you’re more likely to have side effects if you’re taking prednisolone for a long time or taking a higher dosage. Below, we cover 13 notable prednisolone side effects and tips for managing them.

1. Swelling

Swelling due to fluid buildup (edema) is a common prednisolone side effect that can happen at any time during treatment. With this type of fluid buildup, you may notice that your legs and feet look or feel puffy. It can also lead to temporary weight gain. While this side effect can be mild, it can be concerning if you have a health condition such as heart failure or kidney disease.

You can limit fluid buildup from prednisolone by exercising regularly and limiting your salt intake. Wearing compression stockings can also help with swollen or puffy feet, ankles, and legs. Tell your prescriber if you have swelling that is bothersome or isn’t going away.

2. High blood pressure

Prednisolone can cause high blood pressure anytime during the course of treatment. But this side effect seems to be more likely with higher dosages and long-term use. Other prednisolone side effects, such as fluid buildup and weight gain, may also contribute to increased blood pressure.

Your prescriber may suggest checking your blood pressure at home, especially if you have a heart condition. Tell them if your blood pressure readings are higher than usual. Although high blood pressure isn’t always noticeable, it’s possible to experience symptoms such as headaches, blurry vision, and heart palpitations.

3. High blood glucose levels

Prednisolone and other corticosteroids are known for causing high blood glucose levels (hyperglycemia). People with diabetes may need to monitor their blood glucose more closely while taking prednisolone. But this side effect can affect people who don’t have diabetes, too. In fact, corticosteroids can increase the risk of developing diabetes, especially if they’re taken long term.

If you’re living with diabetes, tell your prescriber if your blood glucose readings are higher than usual. Depending on the situation, your prescriber may need to adjust your diabetes medications. It’s also a good idea to watch for hyperglycemia symptoms, such as peeing more often and feeling thirsty and hungry all of the time.

4. Muscle weakness

Muscle weakness is another possible side effect of prednisolone, especially with higher dosages or long-term use. If you experience this side effect, you may have difficulty standing up, walking, or climbing stairs.

When prednisolone causes muscle weakness, it tends to happen slowly — over weeks to months of taking it regularly. If you notice worsening symptoms of muscle weakness, talk to your prescriber. They can recommend ways to manage this side effect, such as regular exercise and resistance training. If needed, they may also consider having you stop prednisolone treatment or reduce your dosage.

5. Insomnia

While taking prednisolone, you may notice that you have trouble sleeping (insomnia). Taking prednisolone in the morning can help manage this side effect. You may be more likely to experience insomnia if you take a dose later in the day.

You can also practice good sleep hygiene, or strategies for falling asleep. This might include avoiding large meals, caffeine, and electronic screens before bedtime, as well as creating a dark and comfortable sleep environment.

If you’re still having trouble sleeping after making these changes, talk to your prescriber. They may suggest lowering your dosage or switching to a different medication, if possible.

6. Headaches

Headaches are another possible prednisolone side effect. You may be able to manage mild headaches with an over-the-counter (OTC) pain reliever like acetaminophen (Tylenol). But if you’re unable to get relief, or if the headaches are interfering with your daily activities, talk to your prescriber.

Keep in mind that headaches can have several different causes. Other prednisolone side effects, such as lack of sleep, hyperglycemia, and high blood pressure, are also potential culprits. Your prescriber can help you determine the cause of your headaches and how to address them.

7. Appetite changes

Corticosteroids like prednisolone can cause appetite changes and weight gain, especially if taken long term. You might notice that you feel like eating more while taking prednisolone. And this appetite increase can lead to weight gain. Though, fluid buildup (mentioned above) is another reason you may be gaining weight.

If you have concerns about weight gain while taking prednisolone, talk with your prescriber. They can discuss potential lifestyle changes and other ways to manage this side effect.

8. Stomach irritation

Prednisolone and other corticosteroids can cause stomach upset. And in more serious cases, they can cause conditions such as stomach ulcers and gastritis. Stomach-related side effects are more likely if you take prednisolone with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin).

If you have mild symptoms of stomach upset, you can likely manage them at home. For example, taking your dose with food and eating smaller, more frequent meals can help. If you experience symptoms of serious stomach problems, including black, tarry stools or vomit that looks like coffee grounds, get medical help right away.

9. Sweating

Some people report feeling warmer or sweating more while taking corticosteroids like prednisolone. These side effects tend to be more likely with higher dosages. While it may not be dangerous to your health, excess sweating can be unpleasant and inconvenient.

If you experience excess sweating, it may help to avoid triggers such as spicy foods, apply a topical antiperspirant, and wear light, moisture-wicking clothes. But if your sweating is bothersome or doesn’t go away, your prescriber can suggest next steps.

10. Mood changes

Mood changes, such as feelings of depression or anxiety, are possible with prednisolone. In rare cases, severe mood swings or hallucinations known as steroid-induced psychosis can happen.

Mood changes related to prednisolone are often mild and will likely resolve when you finish treatment. But if you have symptoms that are bothersome, let your prescriber know. And if you’re having thoughts of self-harm, or you’re seeing or hearing things that aren’t there, seek emergency care as soon as possible.

If you or someone you know is struggling with self-harm, you’re not alone, and help is available. Call the 988 Suicide & Crisis Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

11. Weakened immune system

One of the ways prednisolone works is by dampening the immune system. While this can help lessen inflammation, a weakened immune system can also make it more likely to get infections. This is more likely with higher dosages or long-term use.

Tell your prescriber if you notice symptoms of an infection, such as a fever, sore throat, or red, swollen skin. They can help evaluate your symptoms and recommend next steps.

12. Eye problems

Eye problems, such as glaucoma and cataracts, are a possible long-term side effect of prednisolone. This can happen with both prednisolone eye drops and oral forms of the medication.

Glaucoma from prednisolone can be reversed if it’s caught early. So it’s best to talk to your prescriber right away if you notice symptoms such as blurry vision or eye pain while taking prednisolone. They may suggest having your eyes checked by a specialist.

13. Weakening of bones

Weakened bones (osteoporosis) can happen when taking corticosteroids like prednisolone long term or at higher dosages. This can increase your risk of bone fractures (breaks). One meta-analysis found that people taking the medication had an increased bone fracture risk within 3 to 6 months after starting treatment.

Depending on your age and how long you’ll be taking prednisolone, your prescriber may order bone mineral density tests before and during treatment. If needed, they may reduce your dosage, modify your medications, or add treatments to increase bone density. They can also recommend ways to lower your fracture risk, including regular weight-bearing exercise.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Niousha Nader, PharmD, BCCCP

Niousha Nader, PharmD, BCCCP is a critical care and geriatric specialist. She has over 12 years of hospital experience, which also includes pediatric, emergency, surgical, and oncologic pharmacy.

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