Prednisone: Effects, Side Effects, and How It Changed My Life Forever
There is no doubt that prednisone saves lives and probably saved mine. But this prescription steroid, when taken over the long term, produces some effects, side effects, and serious complications that may create lifelong problems. Because of prednisone, I have osteoporosis at age 40.
Most of the articles I write about medical topics are written from my perspective as a doctor. This one is personal, though. In the last seven years, since being diagnosed with ulcerative colitis, I have spent quite a bit of time as a patient. In this article, I'm sharing both information about prednisone the drug as well as my experience with it as a patient.
What Is Prednisone?
Prednisone is a drug usually prescribed for:
- Asthma and other lung conditions
- Autoimmune diseases like rheumatoid arthritis, lupus, and inflammatory bowel disease
- Allergic reactions
- Skin diseases
Prednisone suppresses the body's immune response and inflammation. This allows relief from symptoms when the immune system is "confused" (as in my case) or overactive.
Prednisone is an catabolic steroid. That means it breaks down body tissue (like muscle and bone) rather than building it up. Anabolic steroids are the type illegally used by bodybuilders and athletes since they have the opposite effect and help build muscle.
- Drug Class: Corticosteroid, specifically glucocorticoid
- Mechanism of Action: Works at the DNA level in the nucleus of cells to suppress inflammatory mediators. This is a simplification of a complicated process
- Uses: Used to suppress the immune system and to suppress inflammation
- Common Conditions Treated: Ulcerative colitis and Crohn's disease, rheumatoid arthritis, asthma, lupus, psoriasis, allergic reactions, and many others
- Side Effects: Affects nearly every body part and organ system (see discussion and links)
- Dosing: Usually 5 to 60 mg per day. This dose is adjusted to the needs of the patient. Courses longer than a week need to be tapered to allow the adrenal glands to start making their own steroids again. If this isn't done, life-threatening low blood pressure or other reactions may occur.
Have you ever taken prednisone for any reason?
My Background and History With Prednisone
I was diagnosed with ulcerative colitis in 2003. At first, I had a pretty mild case and used only mild medications to treat it. Ulcerative colitis is an autoimmune disease where the immune system mistakenly attacks the colon. The cause is unknown, but current evidence shows that it's probably a combination of genetic predisposition and an environmental trigger. Along with Crohn's disease, UC is an inflammatory bowel disease. These inflammatory bowel diseases can be life-threatening. They should not be confused with irritable bowel syndrome, which is often a debilitating condition though it is not life-threatening.
When I got pregnant with my first child, the colitis got worse. The mild medications stopped working. Because prednisone was the safest drug for UC during pregnancy (that would work), I started a low-dose regimen. No problem.
Unfortunately, the colitis continued to get worse and I started the on-and-off, up-and-down cycles of prednisone use. Other medications would only work for a short time or not at all. During my second pregnancy, the colitis became pretty bad. It would improve on prednisone, but nothing else worked. I was requiring quite high doses at this point.
Cumulatively, I spent the better part of two years on moderately high to high doses of the medication, which is why I ended up with lifelong consequences. Prednisone saved my life, but it also changed it forever.
I Felt Great Most of the Time, but Couldn't Prevent Weight Gain
While on prednisone, most of the time I felt great. I hoped that after I had my baby, I would improve and get a remission. Unfortunately, I didn't and I needed to continue the prednisone while breastfeeding. Luckily, the mental changes of prednisone means I didn't need much sleep and the manic energy made me quite productive. I would get up before 5am to exercise.
I knew that weight gain was an expected side effect of prednisone and I was determined not to gain weight so I would just exercise during the time that I'd normally be sleeping. And with all the energy and exercise I had, I thought, I would not gain weight so that shouldn't be a problem. WRONG.
I worked out 2 hours a day, four or more days a week, hard. I realized I was still gaining weight, so I limited my calories to 1400 per day on non-workout days and 1550 calories a day on workout days, and then cut back even further when that didn't work. Surely, I would lose some of the weight and stop gaining.
WRONG. I became depressed that my efforts were failing. I gained TWENTY pounds in a year and the depression never abated. I figured out later that the expected weight gain considering my dosage and length of use would have been closer to 50 or 60 pounds. Still, I found it hard to be happy about only gaining 20 pounds of fat while working out like a maniac and limiting calories in spite of the increased appetite.
My face was puffy, my hands were jittery, and I was irritable, though exercise helped me here, too. I came to the very unscientific conclusion that prednisone enabled your body to convert even the air you breathe to fat.
My Other Side Effects — High Energy and Osteoporosis
The list of potential side effects of prednisone exceeds 100 items. Every system in the body is affected. Side effects are possible in anyone taking the medication, but the incidence of side effects and complications increases at doses over 10 mg per day and/or a course lasting longer than about two weeks.
Other than the weight gain, I did have increased energy and a sense of well-being, which is normally not a bad thing. I decided one day that I should change the fan mechanism in my laptop computer (which was almost dead anyway).
This would normally be ok, but in this particular model, the fan was buried under layers of electronics and panels and circuitry. With the prednisone energy, as I called it, I could not be bothered to carefully diagram or photograph where the parts came from. I got the new fan in, but when I got the computer back together, I had over 60 leftover little screws. Yep, 60! Uh, no, it didn't work.
The worst thing I have to deal with as a long-term complication is osteoporosis at the age of 40. This one really upsets me as I already fractured my foot as a result of a minor injury. I like to ski and hike and so on, but now I have to worry that every fall or slip is going to result in a broken bone. I worry about fracturing a hip before I'm 50. Of all the problems I've had with prednisone, this is the one that makes me angry. I remind myself that I really didn't have a choice due to a combination of circumstances, but what a trade-off.
I have since had my colon (yep, the whole thing—that's another story) removed to rid me of the colitis, but prednisone is the gift that keeps on giving years after you stop taking it.
Osteopenia and Fractures Remain a Risk After Prednisone Is Stopped
Partial List of Prednisone Side Effects and Complications
There are so many potential side effects and complications of prednisone that I won't bother listing them here. They can be found in medical books and on medical and pharmaceutical websites. Luckily, most of the side effects resolve shortly after stopping prednisone. These are just a few examples by body system.
- Neurological and psychological - Mental status changes such as depression, anxiety, mania, euphoria, nightmares, memory loss and psychosis
- Ophthalmic (eyes) - Blurred vision, cataracts and glaucoma
- Cardiac - Changes in heart rate, worsening of heart failure, blood clots, high blood pressure
- Musculo-Skeletal - Decreased bone density and osteoporosis, avascular necrosis of the hip, muscle breakdown and protein loss
- Skin and hair - Easy bruising, hair loss, fragile skin, acne, facial hair in women
- Endocrine and metabolic - Adrenal insufficiency (can lead to death if prednisone is suddenly stopped, instead of being tapered), sodium and water retention, disturbances in potassium, weight gain, glucose intolerance and diabetes
These are just some of the side effects. You can see a more thorough list at drugs.com.
- Prednisone Side Effects | Drugs.com
Comprehensive and accurate Prednisone side effects information for consumers and healthcare professionals.
- The Top Five Worst Side Effects and Complications of Prednisone
Prednisone is a catabolic, prescription steroid medication. Usually used to suppress an overactive immune system or decrease inflammation, prednisone is used in treating diseases such as asthma, allergic reactions, and autoimmune disorders.