What Happens When You Take Prednisone? Common Side Effects and Tips to Avoid Them

1. Appetite changes

Most people notice an increase in their appetite while taking prednisone. Since prednisone acts like a stress hormone (cortisol) in the body, it can act directly on the brain to stimulate appetite. 

Prednisone can also have the opposite effect. It can cause nausea and indigestion, decreasing appetite. These symptoms often resolve with eating.

2. Indigestion 

Prednisone can lead to stomach irritation for some people. This can happen pretty quickly — often within minutes of taking a dose. This is much more likely to happen if you’re also taking nonsteroidal anti-inflammatory drugs (NSAIDs) at the same time. Other digestive changes, like diarrhea, are not common side effects of prednisone (more on this below).   

3. High blood sugar 

Prednisone affects insulin levels and insulin resistance. This can cause increased blood sugar, even with low doses. This is especially a risk for people with diabetes or prediabetes. People with diabetes should monitor their blood sugar levels with a glucose monitor while on prednisone, especially if they’re taking them for a long period.

4. Fluid retention

Many people notice that their face, hands, or feet feel a little puffier than normal when taking prednisone. This may lead to temporary weight gain for some people. This swelling (edema) is more likely to be a problem for people with heart failure or kidney disease. People with known heart and kidney conditions should monitor their blood pressure and keep an eye out for symptoms of fluid retention.

5. Sweating and hot flashes

You may feel warmer or sweat more than normal with prednisone. And some people have full-on hot flashes while taking it. People taking higher doses of prednisone are more likely to experience these side effects. It can help to avoid triggers like caffeine, alcohol, and spicy foods if you experience excessive sweating while on prednisone.

6. Mood changes

People report a wide variety of changes in their mood while taking steroids. These symptoms can start within a few hours of taking a prednisone dose. Some people experience an improved mood, while others feel more depressed. 

In rare cases, people experience disorientation and hallucinations — a condition called “steroid-induced psychosis.” This is more likely if you’re taking high doses of prednisone for a longer period of time.

7. Restlessness

In addition to mood changes, prednisone can increase energy levels. Some people may not mind this side effect, but others may feel unpleasantly jittery. It can also make it harder to concentrate. 

8. Sleep disturbance 

Prednisone keeps some people awake. This is because it affects the hormones that help you feel energized (cortisol) and sleepy (melatonin). So it’s common for people to report difficulty sleeping while they’re taking prednisone. This is more likely when someone has to take several doses of medication throughout the day — including one at night.

Does prednisone cause diarrhea?

Prednisone doesn’t cause diarrhea. That being said, bleeding in the stomach or intestine can lead to more frequent and/or softer stools. And it doesn’t always look like bright red blood. Sometimes this can look like black and tarry stool.

Stomach bleeding is more likely to happen if you’re taking NSAIDs at the same time. If you notice a change in the frequency or color of your bowel movements while taking prednisone, it’s important to check in with your healthcare team. They can do a simple test to see if there’s blood in your stool. 

1. Weight gain 

Weight gain is a common concern with long-term steroid use. Experts think long-term weight gain from steroids happens due to a combination of different reasons:

• Increased appetite, as we discussed in the section above

• Changes in sugar and fat metabolism

• Fluid retention

• For people who experience indigestion relief with eating, it can lead them to eat more than usual.

Steroids like prednisone can also cause a change in where fat is deposited in the body. People on steroids long term might notice more fat across their shoulders, in their face, and around their belly.

2. Osteoporosis

Osteoporosis is a well-known and potentially serious side effect of long-term steroid use. And decreased bone density can occur within weeks of starting treatment. This side effect significantly increases the risk of fracturing a bone in people who take prednisone. The risk increases the longer a person is on prednisone and the higher the dose.

3. Eye conditions

Cataracts and glaucoma are eye conditions that are more likely in people who use steroid eye drops. But they can still happen in people who take oral prednisone long term. This risk increases in people taking more than 10 mg of prednisone a day for over 1 year. 

Steroids — taken both in the short and long term — are also the most common cause of an eye condition called central serous retinopathy. This is an eye condition that can lead to permanent vision changes if left untreated. So anyone experiencing vision changes while taking steroids should reach out to a healthcare professional right away. 

4. High blood pressure and heart disease 

There has been a lot of research into whether long-term use of prednisone can cause high blood pressure or heart disease. And some evidence suggests there’s a risk. But it’s more likely to happen when someone is taking high doses of prednisone for a long period of time. 

High blood pressure from steroid use is likely due to several factors. These include fluid retention, weight gain, and the direct effect of steroids on receptors throughout the body.

5. Weakened immune system

Many people take prednisone intentionally to weaken their immune system. This can help treat certain autoimmune conditions, for example. But this also increases their risk of bacterial, viral, and fungal infections. Like most of the other side effects on this list, this risk likely increases with higher doses of prednisone. It’s also affected by any underlying conditions that may also affect immune function. 

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