Adverse Effects of Prednisone

Introduction to Adverse Effects

• The use of prednisone is associated with an increased risk of weight gain, which is one of the most concerning side effects for patients, according to a study published in 2020 1
• The American Academy of Neurology recommends regular mental status assessment, including evaluation of mood, sleep patterns, and cognitive function, for patients on prednisone therapy, with more vigilant monitoring needed if therapy continues beyond 6 weeks 2

Psychiatric Effects

• Emotional lability and insomnia are common psychiatric side effects of prednisone, leading to preference for combination therapy over monotherapy, as stated by the American Association for the Study of Liver Diseases and the American Society of Hematology 3, 2
• The risk of severe complications, including psychiatric side effects, increases with duration of therapy, typically developing after 18 months of continuous therapy, as noted by the American Association for the Study of Liver Diseases 3
• The general medical consensus is to use the lowest effective dose of prednisone for the shortest duration possible to minimize psychiatric side effects, although the specific guideline society is not mentioned in the provided text 2
• Using the lowest effective dose of prednisone for the shortest duration possible is recommended by the American Society of Hematology and the American Association for the Study of Liver Diseases to minimize psychiatric side effects 2, 4

Management and Prevention of Adverse Effects

• The Lancet Neurology recommends reducing the daily dosage of prednisone by 25-33% if side effects are unmanageable, considering the minimum effective daily dose, and alternate-day dosing if appropriate for the condition 5
• The Lancet Neurology suggests administering prednisone in the afternoon for patients experiencing behavioral issues, and considering switching to deflazacort if weight gain or behavior are main issues 5
• The Lancet Neurology recommends considering intermittent scheduling (10 days on/10-20 days off) if side effects are severe, and using pharmacological interventions such as lithium and newer antipsychotics for patients who must remain on corticosteroids 5
• Dose reduction or medication discontinuation may be necessary if symptoms are severe, and alternate-day dosing can be considered to reduce side effects when appropriate 4
• Consideration of combination therapy with steroid-sparing agents, such as azathioprine, may reduce corticosteroid-related side effects, as suggested by the American Association for the Study of Liver Diseases and the European Society of Gastrointestinal Endoscopy 3, 6, 7
• Regular assessment of mental status, including monitoring for sleep and mood disturbances, is recommended by the American Society of Hematology to identify high-risk patients 2
• Inadequate monitoring can lead to misattribution of psychiatric symptoms to underlying disease, highlighting the importance of regular assessment of mental status, as emphasized by the American Society of Hematology 2

Monitoring and Prevention Strategies

• Regular monitoring of blood glucose, blood pressure, and potassium levels is recommended for patients taking prednisone, as well as baseline bone mineral density testing before or within 1 month of starting therapy 4, 8
• Lifestyle interventions for metabolic syndrome, calcium supplementation (800-1000 mg daily), and vitamin D (800 IU daily) are recommended for patients taking prednisone, as well as consideration of bisphosphonates for high-risk patients to prevent osteoporosis and increased fracture risk 4, 8
• Complete immunizations before starting therapy and consideration of prophylactic medications for high-risk patients can help prevent infections 8

Risk Factors for Adverse Effects

• Patients with pre-existing conditions, such as diabetes, osteoporosis, glaucoma, or hypertension, are at higher risk of adverse effects from prednisone 8
• Higher doses of prednisone (>10 mg daily) significantly increase the risk of adverse effects, including psychiatric side effects, as reported by the American Association for the Study of Liver Diseases 4, 7