All glucocorticoids have similar side effects, which depend on the dose and duration of treatment.
First and the most common is a suppression of adrenal cortex function. Glucocorticoids suppress the function of the hypothalamic-pituitary-adrenal cortex system. This effect may persist for months after cessation of treatment and depends on the dose used, the frequency of administration and the duration of therapy. The effect on the adrenal cortex can be weakened if short-acting drugs, such as Prednisone or Methylprednisolone in small doses, are used instead of long-acting drugs.
Suppression of immunity. Glucocorticoids, including Prednisone and other drugs from pharmacies, reduce resistance to infections, especially bacterial infections. The risk of infection directly depends on the dose of glucocorticoids and remains the main cause of complications. As a result of treatment with steroids, a local infection can become systemic, a latent infection is active, and non-pathogenic microorganisms can also cause it. On the background of glucocorticoid therapy, infections can occur secretly, but body temperature usually rises.
Changes in appearance include rounding of the face, weight gain, redistribution of fatty deposits, hirsutism, acne, purple striae, bruising with minimal injuries. These changes decrease or disappear after a dose reduction.
Disorders of the psyche range from slight irritability, euphoria, and sleep disturbances to severe depression or psychosis.
Hyperglycemia can occur or build up against glucocorticoids, but, as a rule, does not serve as a contraindication for their appointment. You may need to use insulin. Ketoacidosis develops rarely.
Glucocorticoids are capable of inducing or enhancing arterial hypertension.
Muscle weakness is noted, but there is no soreness. The activity of blood enzymes of muscle origin and electromyographic parameters, in contrast to inflammatory muscle damage, do not change. A muscle biopsy is performed only in rare cases when it is necessary to exclude their inflammation. The possibility of steroid myopathy decreases as the dose of glucocorticoids decreases and a complex of intensive physical exercises is carried out. However, a full recovery may take several months.
Ophthalmic disorders include increased intraocular pressure.
Ischemic necrosis of bones can also occur against a background of steroid therapy. These complications are often multiple, with the defeat of the femoral and humerus, as well as the tibia. The appearance of characteristic X-ray changes indicates a far-reaching process. At an early stage of ischemic necrosis, surgical bone decompression may be effective, but estimates of this method of treatment are inconsistent.
Other side effects of glucocorticoids include hyperlipidemia, menstrual irregularities, increased sweating, especially at night, and benign intracranial hypertension. The presence of thrombophlebitis, necrotizing arteritis, pancreatitis and peptic ulcer is sometimes associated with the action of glucocorticoids, but the evidence for this relationship is not sufficient.