Prednisone is a generic prescription drug approved by the U.S. Food and Drug Administration (FDA) to treat a broad range of diseases and medical conditions by suppressing the body’s immune response. While the immune system defends our body from infections and cancer, it can also cause health problems if not regulated properly. Common diseases that arise from improper immune activity include inflammatory and autoimmune diseases.
Prednisone may cause troublesome side effects, such as fluid retention, round face (moon face), increased risk of infection, high blood pressure, cortisol insufficiency, and others. When taken for long durations, prednisone may lead to more serious adverse effects such as glaucoma, cataracts, diabetes, thinning of the skin, susceptibility to bruising, Cushing’s syndrome, and osteoporosis.
Although prednisone is an effective treatment for many patients with inflammatory diseases, it may not be the best option for everyone due to side effects, drug interactions, or lack of effect. In some cases, an adjunct agent can be used with prednisone to reduce the strength and duration of prednisone therapy. These are referred to as “steroid-sparing” agents. This article will discuss prednisone alternatives and steroid-sparing treatments that can reduce the dose of prednisone for patients with certain conditions.
What can I take instead of prednisone?
Prednisone is a member of the group of medicines called corticosteroids, also known as glucocorticoids. Other corticosteroids are available that also treat inflammatory diseases. Other types of medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic agents, have FDA-approved indications for some of the same uses as prednisone.
If prednisone is not right for you, there are other oral medications as well as injectable medicines that may help, depending on the medical condition for which you are being treated. It is important to consult with your healthcare professional to determine which anti-inflammatory drug would be the best alternative to prednisone. The table below focuses on the most common alternatives to prednisone.
Top 5 prednisone alternatives
1. Dexamethasone
Dexamethasone is a suitable alternative to prednisone for the treatment of acute asthma. In general, dexamethasone is better tolerated and requires a shorter course of therapy (five days of prednisone versus one to five days of dexamethasone). Dexamethasone is approximately six times as potent as prednisone, and a single dose is longer acting. Therefore, fewer doses are required compared with prednisone.
A study in 2009 showed that two days of dexamethasone had similar efficacy to five days of prednisone, and patients on dexamethasone had better compliance and fewer side effects.
A study in 2017 also demonstrated that two doses of dexamethasone are as effective as five days of prednisone in children with asthma exacerbation admitted to the emergency department.
A meta-analysis in 2019 concluded that dexamethasone is associated with less vomiting compared to prednisone when used for asthma exacerbations.
Finally, dexamethasone is available in more dosage forms than prednisone. While prednisone is only available as an oral tablet, dexamethasone is available as a tablet or solution and can be injected via the intravenous, subcutaneous, or intramuscular route.
RELATED: Dexamethasone side effects | Dexamethasone vs. prednisone
2. Methotrexate
Methotrexate is used as a steroid-sparing agent for many diseases. Methotrexate belongs to a class of drugs called DMARDs, or disease-modifying antirheumatic drugs. It is common to use DMARDs like methotrexate to reduce prednisone doses and allow for earlier discontinuation of prednisone.
Methotrexate is considered a steroid-sparing treatment for many forms of arthritis such as giant cell arteritis, juvenile idiopathic arthritis, rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatica, etc. Methotrexate is also commonly used as a steroid-sparing agent in the treatment of uveitis, or inflammation of the uvea, the middle layer of the eye.
Methotrexate may be a viable steroid-sparing agent for myasthenia gravis, although a second drug, azathioprine, is better studied and more commonly used for this purpose. A 2021 study demonstrated that patients with myasthenia gravis who are treated with methotrexate had significant improvement in disease activity and reduced prednisone dosages.
RELATED: Methotrexate side effects and how to avoid them
3. Mycophenolate
Mycophenolate is one of the most common DMARDs for treating lupus. Two studies demonstrated that lupus patients taking mycophenolate and voclosporin, an immunosuppressant, could achieve clinical response while using much lower doses of oral prednisone. In fact, these two trials had the lowest peak steroid doses and faster steroid tapering than any other lupus nephritis trial. In patients with lupus without renal involvement, mycophenolate was shown to be superior to azathioprine when combined with steroids and thus may be a better option than azathioprine for reducing prednisone doses.
Mycophenolate can be used to reduce steroid use in many different inflammatory and immune diseases other than lupus. Mycophenolate has similar steroid-sparing effects as methotrexate when used for uveitis. In a systematic review of 18 studies, 89% of patients with idiopathic inflammatory myopathies decreased their dose of steroids after starting mycophenolate, and 88% showed improvement in disease activity and experienced mild side effects. In a head-to-head study comparing mycophenolate and azathioprine for the treatment of pemphigus, patients taking mycophenolate required significantly lower steroid doses to achieve clinical remission compared to patients taking azathioprine.
4. Mercaptopurine
Mercaptopurine, which is brand-name Purinethol, may be a great option for reducing prednisone doses in patients with inflammatory bowel disease.
According to the Crohn’s & Colitis Foundation, mercaptopurine can help maintain remission of Crohn’s disease and reduce the long-term need for steroids. While steroids are effective at achieving remission of Crohn’s disease, they should be used at the lowest effective dose and duration needed to induce remission, so that patients can avoid serious side effects of prednisone that can occur with long-term use. Multiple studies have demonstrated that patients taking mercaptopurine in addition to steroids are able to achieve and maintain remission of Crohn’s disease while using lower doses of steroids, compared to patients who only received steroids.
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5. Azathioprine
Azathioprine is another DMARD that can reduce steroid doses in patients with inflammatory bowel disease. It is often used along with infliximab for this purpose.
Azathioprine may also be used to reduce the use of steroids in patients with myasthenia gravis. A study comparing methotrexate and azathioprine in patients with myasthenia gravis demonstrated that both drugs had a similar degree of steroid-sparing effects.
Azathioprine may also be effective at reducing the cumulative steroid dose in patients with giant cell arteritis, although data is mostly limited to case studies. Azathioprine may effectively lower the need for steroids in patients with recurrent pericarditis. In one study, 84.7% of patients responded to treatment with azathioprine and were able to completely suspend steroid treatment after 4-12 months.
Over-the-counter NSAIDs
Patients with arthritis may be able to use NSAIDs instead of prednisone if their disease activity is not too severe. NSAIDs are not as effective as steroids for the treatment of arthritis, but if symptoms are adequately controlled with NSAIDs, patients may not need to take oral corticosteroids. Common over-the-counter anti-inflammatory drugs for arthritis include ibuprofen, naproxen, and diclofenac gel. It is important to seek advice from your pharmacist or healthcare provider when using over-the-counter treatments in conjunction with prescriptions as certain drug interactions may occur.
Biologic agents
Biologic agents, such as Humira and Enbrel, play a significant role in the treatment of autoimmune conditions. Given by intravenous infusion or subcutaneous injection, these drugs block the inflammatory mediator called tumor necrosis factor (TNF). The biologics have great potency as disease-modifying antirheumatic drugs (DMARDs). These medicines limit the damaging effects of diseases like rheumatoid arthritis as well as spare patients the long-term consequences of taking prednisone or other corticosteroids. Biologic agents are usually more effective than older treatments, but are stronger and can have a higher risk of causing side effects. Immune suppression from biologics can be considerable and requires careful testing before initiation and frequent monitoring during therapy.
Natural alternatives to prednisone
Antioxidants and anti-inflammatory supplements
Natural remedies are not a replacement for prednisone, but they may work alongside prednisone to help fight inflammation. Other anti-inflammatory supplements such as omega-3 fatty acids, zinc, and turmeric (curcumin) fight inflammation that is already present. They provide the building blocks of natural molecules our body needs to resolve inflammation.
RELATED: 14 health benefits of turmeric
Eliminate inflammatory foods
Avoid inflammatory foods such as margarine, corn oil, deep-fried foods, and processed food products to reduce inflammation. It is well known that refined sugar and simple carbohydrates like white four, white rice, and high fructose corn syrup contribute to chronic inflammation. Replace these processed items with plant-based foods that are high in fiber, like fruits, vegetables, and whole grains.
Drink more water
Staying hydrated helps our bodies clear out toxins. When metabolic waste products and toxins accumulate in the body, they contribute significantly to inflammation. Thus, it is important to replace the body’s fluids regularly as they become laden with toxins. Perhaps the most obvious example of this effect is when dehydration leads to higher concentrations of uric acid, triggering a gout flare.
Exercise smart
According to a review article, patients aiming to reduce inflammation should avoid long-endurance exercise as it can contribute to chronic inflammation. Instead, opt for moderately intense exercise with frequent resting periods. Another study in 2017 concluded that 20 minutes of moderate exercise is sufficient to produce an anti-inflammatory response.
RELATED: Can I exercise while on prednisone?
Manage stress
It is no secret that stress leads to many health problems. That is why rest and relaxation are key to lowering inflammation. Not sleeping enough has immediate pro-inflammatory effects. A healthy lifestyle should include eight hours of regular sleep each night. See our guide to improving sleep.
To combat chronic stress, practice yoga or some form of meditation. This could be as simple as writing your thoughts down in a journal, discussing your concerns with a friend, or taking a nature walk.
RELATED: How to get to sleep when you’re in survival mode
How to switch to a prednisone alternative
The first step to replacing prednisone is discussing alternatives with a healthcare provider. Prednisone should not be stopped abruptly or without medical advice. A doctor will gradually lower a patient’s dose of prednisone before stopping it altogether. This is called a dose taper. A prescriber will determine how long a taper should last based on the patient’s treatment history. Patients who have been on high doses or long courses of prednisone will need more gradual tapers.
RELATED: Prednisone dosage
Additionally, a healthcare provider will assess whether a patient’s disease is adequately controlled on lower doses of prednisone. The steroid-sparing agents discussed above help treat disease so that less prednisone is required to control symptoms. In some cases, a doctor may determine that it is not safe to lower a patient’s dose of prednisone.
The lifestyle modifications and health information listed above may help mitigate disease symptoms, possibly allowing for lower doses of prednisone. Ask a doctor about the recommendations and alternatives in this article if you are interested in switching to low-dose prednisone or replacing prednisone with a different treatment. SingleCare can provide you with coupons that can help you save up to 80% on many prescriptions available at your local pharmacy.
Choosing the right path for treatment of inflammatory and autoimmune conditions
When considering another prescription or OTC alternative to prednisone, it is important to note that there are no perfect options. Every potential replacement drug or drug class have advantages and disadvantages when compared to prednisone. Before making a change, it is important to discuss any alternative treatment with your healthcare provider. By reviewing your health history and other medications, and looking for drug interactions, you can develop a plan of action that may provide the best outcome for your condition, which may or may not include continuing with prednisone.
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