Side effects of Prednisone

Prednisone is the single most important factor in improving the outlook for lupus patients. It is usually effective in bringing lupus under control and it saves lives. However, there is a price to be paid for this success. If we observe what happens to patients taking high doses of prednisone, there is no doubt this drug can cause a wide variety of side-effects.

Short-term Side-effects:

*Not everyone has the same side effects or same severity of side effects. The longer and the stronger the dosage the more likely sideffects will occur. Side effects are also reversable to a degree when a dosage is lowered or when an individual is taken of the medication.

Side-effects:

- Swelling of the face, often referred to as "moon face" or "chipmunk cheeks"; some patients feel
ugly and say that they do not recognize themselves in the mirror. Remember, these changes
are reversible.
- A hump on the upper part of the back; this hump is made of fat, not bone.
- Bloating or swelling of the abdomen.
- Weight gain; prednisone may cause a great increase in appetite. Weight gain can be controlled
by a low calorie diet, by exercise and by avoidance of salt. Avoid salty foods and do not add
any salt.
- Stomach problems; to ease the burning, try taking prednisone with food. This problem may
require anti-ulcer medication.
- Mood changes; sometimes the change is for the better. However, depression may be made
worse by prednisone.
- Insomnia; patients may have difficulty sleeping at nights.
- Shakiness; patients may have feelings of being "hyper: or that "things are running fast inside
my head".
- Weakness of the thigh muscles; patients may have difficulty in climbing stairs, getting out of
the bath or getting up from a chair or toilet seat.
- Interruption of the menstrual cycle; periods may stop altogether.
- Increased risk of infections; patients may have more infections including some caused by
germs that the body is normally resistant to.

Long-Term Side-effects:

- Easy bruising of the skin; bruising from prednisone use often happens without any obvious
injury and may require that blood clotting ability be checked by the physician. When
prednisone is the cause of the bruising, blood clotting will be normal. This easy bruising
disappears when prednisone is stopped and is not associated with any risk of internal bleeding.
- Stretch marks; these may occur on the upper body, the arms, the abdomen and the thighs.
Some patients have this problem while others do not. Unfortunately, there is no treatment and
the marks are permanent.
-Excessive growth of body hair; this hair growth usually appears on the face and will stop when
prednisone is decreased. The hair that has grown will tend to stay but it can be effectively
removed by using a hair-removal cream.
- Cataracts; these are a cloudiness of the lens of the eyes that cause a decrease in vision.
Occasionally, surgery may be required.
- Osteonecrosis; this condition means "dead bone" and most frequently affects a bone in the hip
joint called the femur (other bones may be involved as well). Osteonecrosis is becoming a more
important cause of pain and disability in lupus patients. If this problem is found early,
worsening of the process may be prevented by performing a surgical procedure. In many
patients, the damage caused by osteonecrosis eventually comes to a stop. In some patients,
where damage to the bone has been severe, an artificial joint may be needed.
- Osteoporosis; this results from a loss of calcium from the bones and often leads to fractures,
particularly in the spine. These may be a major cause of pain and disability. However, this
process is at least partly reversible if prednisone can be stopped. If prednisone must be
continued, this side effect may be decreased by exercise, by eating foods rich in calcium and by
taking extra calcium and vitamin D as prescribed by your physician. These preventive
measures should be started as soon as a high prednisone dose is begun.
- Heart attacks; several factors (including smoking, high blood pressure and high blood sugar)
combined with long term prednisone treatment may lead to a narrowing of the blood vessels of
the heart and early heart attacks. This risk can be decreased by maintaining a reasonable
weight, controlling blood pressure and, most importantly, not smoking.

Symptoms which may Indicate a Lupus Flare

It is important to note that this list of symptoms applies only to patients with a diagnosis of systemic lupus erythematosus. In addition, remember that lupus is often a disease that repeats itself. Be on the lookout for a return of symptoms that were experienced at the beginning or onset of your disease


- Persistent (continuing) fatigue which is out of proportion to what you consider your normal
- fatigue
- Persistent weakness
- Aching all over without any obvious reason
- Persistent fever (In order to establish that you have fever, take your temperature every six
hours and write down the results.)
- Persistent loss of appetite
- Involuntary weight loss
- Excessive and persistent hair loss
- Recurrent (repeated) nose bleeds
- Sores on the roof of the mouth which burn when spicy foods are eaten
- Unexplained rash anywhere on the body
- Persistent hives
- Skin ulcers
- Recurrent pain in the joints
- Swelling of one or several joints
- Persistent joint stiffness upon wakening in the morning
- Chest pain which increases when breathing in
- Unusual shortness of breath
- Coughing up blood
-Persistent, unusual headache
- Persistent nausea and vomiting
- Recurrent or persistent pain in the abdomen
- Persistent and worsening swelling of the feet and legs
-Persistent swelling of the eyelids
- Blood in the urine or in the stools