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Millions of people are prescribed prednisone each year for conditions that range from psoriasis and eczema to multiple sclerosis and rheumatoid arthritis. Prednisone belongs to a class of drugs called corticosteroids (also sometimes called glucocorticoids)—steroids that reduce inflammation in the body by replacing cortisol, a hormone produced in the adrenal glands, and slowing down an overactive immune system.
For individuals living with an inflammatory illness or condition, corticosteroids such as prednisone can feel like a godsend. Prednisone can reduce the hot, achy sensations that accompany inflammation, which often makes people feel better quickly. The benefits of prednisone also come with risks. Because corticosteroids suppress the immune system, your body may be less able to fight off infections when you’re taking them. Not only that, but the body can become reliant on prednisone for the production of cortisol. That means that there could be withdrawal symptoms when you stop taking the drug.
That doesn’t mean you should be scared of prednisone, though. You can work with your healthcare provider to make sure that you don’t experience adverse effects, like steroid withdrawal, when you stop taking the medication. Here’s what providers had to say about reducing negative side effects when you stop taking this Rx.
Why do you need to taper off prednisone?
The first thing you need to know is that if you’ve been taking prednisone for more than five days and/or in high doses, you must taper off of it. It may seem counterintuitive, but even if you feel better, you can’t just stop taking prednisone. This is so important that the prescribing information recommends a taper.
“When someone takes prednisone for a long time, their body adjusts to this added source and starts making less of its own cortisol,” explains Katura Bullock, Pharm.D., a clinical pharmacologist with St. Luke’s University Health Network in Bethlehem, Pennsylvania.
“Withdrawal symptoms occur as the body tries to rebalance its cortisol production once prednisone is stopped.”
In other words, tapering gives your adrenal glands time to adjust to the reduced levels of cortisol. But because everyone is different, you shouldn’t try to taper off without medical advice. Yes, some tapering regimens are relatively standardized, but only your healthcare provider can ensure that you are tapering off corticosteroids in a way that works best for your body and your situation.
“Establishing a tapering schedule for prednisone is a meticulous process,” says Steven Fiore, MD, an orthopedist in Virginia. “It involves assessing the patient’s specific condition, disease progression, and response to treatment, with the goal of gradually reducing prednisone dosage to prevent flare-ups and minimize potential complications.”
If you don’t taper off prednisone, you’re more likely to experience symptoms of withdrawal or have adverse effects.
Prednisone withdrawal symptoms
Prednisone withdrawal can create symptoms that range from physically uncomfortable to medically risky. Prednisone withdrawal symptoms can include:
- Severe fatigue
- Weakness
- Body aches
- Joint pain
- Nausea
- Loss of appetite
- Lightheadedness
- Irritability
- Mood swings
- Weight loss
- Muscle stiffness
- Low blood pressure
Most of the symptoms of prednisone withdrawal, or glucocorticoid withdrawal, are not life-threatening, but that doesn’t mean they’re not serious. “Monitoring for adverse symptoms, such as extreme fatigue, body aches, fever, abdominal pain, and unusual GI issues, during tapering is essential,” Dr. Bullock says. “Patients should report any such symptoms to their provider promptly to a safe and effective withdrawal process.”
What helps with prednisone withdrawal symptoms?
“Supplemental therapies might be prescribed to manage specific withdrawal symptoms,” says Bullock. However, she points out that this should be tailored to each individual’s needs and medical history. Some over-the-counter medications, such as Advil (ibuprofen) or Tylenol (acetaminophen), may be taken to make the experience more comfortable.
The side effects of going off prednisone can last for varying lengths of time after stopping prednisone, depending on the dosage and the length of time you were taking the medication. “Typically, for those who take higher doses of prednisone or use it for extended periods, the dose needs to be reduced more slowly to minimize withdrawal symptoms,” says Dr. Bullock. In other words, the longer you take prednisone, the longer the tapering process and the potential for adverse effects will last.
Dr. Fiore agrees that tapering must be done under the guidance of a healthcare provider. “Close monitoring and collaboration with patients are crucial during this phase to address these symptoms effectively,” he says.
Prednisone alternatives
The alternatives to prednisone are as varied as the conditions that it is used to treat. For example, in some cases, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in place of prednisone. In other cases, a course of treatment may include other medical modalities or prescription NSAIDs.
Individuals who are taking prednisone for orthopedic conditions—such as arthritis, neuropathy, nerve pain, or sciatica—in particular, may benefit from other kinds of treatment. “We may consider alternative strategies for long-term management of rheumatic conditions, such as recommending disease-modifying antirheumatic drugs (DMARDs) or biologics,” says Dr. Fiore. These alternatives aim to provide effective control of the orthopedic aspects of rheumatic diseases with potentially fewer side effects than long-term corticosteroid use.
Any length of time longer than a month is considered long-term use when it comes to prednisone. Most healthcare providers agree that using prednisone for extended periods can be dangerous, and can lead to high blood pressure, eye problems, osteoporosis, and other problems.
Top alternatives to prednisone
The most common prescription drug alternatives to prednisone are:
- Dexamethasone or methylprednisolone, other corticosteroids used to treat various inflammatory conditions, such as asthma.
- Methotrexate, a DMARD, or disease-modifying antirheumatic drug.
- Mycophenolate, used to prevent rejection after a heart, liver, or kidney transplant.
- Mercaptopurine, used to treat inflammatory bowel disease.
- Azathioprine, a DMARD used to treat severe rheumatoid arthritis, or prevent rejection after a kidney transplant.
- Leflunomide, used in the treatment of rheumatoid arthritis.
Natural alternatives to prednisone
Depending on your overall health, lifestyle, and dietary changes can be used as supplements to your prescription medication(s). In addition, there are many anti-inflammatory supplements on the market, such as:
Again, whether you undergo tapering with the aid of supplements or prescription drugs, it’s crucial to stay in close contact with your healthcare provider to ensure that the process goes as smoothly as possible.
Sources
- Prednisone tablets, Cleveland Clinic (2023)
- Prednisone, NIH (2023)
- Does long-term low-dose corticosteroid therapy cause hypertension?, Clinical Science (1981)
- Prednisone and other corticosteroids, Mayo Clinic (2022)