Prednisone is a corticosteroid used for its anti-inflammatory effects. Its ability to target many pathways in the inflammation process makes it the standard treatment for a wide variety of diseases. But, prednisone use can cause severe side effects. Read on to learn more and discover natural alternatives.
Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. Please discuss your medications with your doctor.

What is Prednisone?

Immunosuppressant

Prednisone is a corticosteroid drug that suppresses the immune system and decreases inflammation. It can be taken alone or as part of a treatment plan with other drugs. The available forms include [1]:

  • Rayos, extended-release tablet (lasts for a longer time)
  • Delayed-release tablet (starts to act only after 4-6 hours) 
  • Deltasone
  • Intensol (prednisone solution)
  • Generic tablets
  • Generic solution

Prednisone should not be confused with methylprednisolone or prednisolone. Although all 3 are similar, the dosing and bioavailability differ [23].

Prednisone is a corticosteroid drug that suppresses the immune response and inflammation. It’s available as oral tablets and solutions.

Snapshot

PROs:

  • Suppresses inflammation
  • Treats rheumatoid arthritis and IBD
  • May relieve lupus and other autoimmune conditions
  • Helps with severe asthma, purpura, and leukemia

CONs:

  • Not suitable for long-term use
  • Treatment must be tapered down
  • Increases the risk of fractures, diabetes, and infections
  • May cause mood swings, muscle cramps, and menstrual disorders
  • May cause or worsen adrenal insufficiency in the long run
  • Interacts with antibiotics and anti-seizure drugs

How It Works

Prednisone mimics the action of cortisol, a naturally occurring steroid hormone produced by the adrenal cortex. Before activating glucocorticoid receptors, prednisone travels from the gut to the liver, where it becomes prednisolone — the active form [2, 4].

As a corticosteroid, prednisone weakens the immune system’s inflammatory response by:

  • Blocking leukocyte response at the site of inflammation [5, 6]
  • Blocking inflammatory compounds (such as cytokines, prostaglandins, leukotrienes, NF-κB, and AP-1) [7, 8]
  • Reducing the activity of genes that code for inflammatory compounds [7]
  • Activating anti-inflammatory genes (such as SLPI, MKP-1, IkB-a, GILZ) [7]
Prednisone mimics cortisol and activates glucocorticoid receptors. It suppresses inflammatory and activates anti-inflammatory pathways.

Are You More Prone to Inflammation?

Since inflammation and the effects of prednisone are influenced by your genes. If you’ve gotten your genes sequenced, SelfDecode can help you determine if you are more prone to inflammation as a result of your genes, and then pinpoint what you can do about it.

If you’re sick and tired of guessing about your health, SelfDecode can help you find specific answers that conventional doctors/diagnostics may never uncover.

Uses of Prednisone

1) Rheumatoid Arthritis

In 81 patients with rheumatoid arthritis (RA), 10 mg per day prednisone improved arthritic symptoms, reduced the need for other drugs, and reduced joint damage after 6 months. However, most effects weaned off at 12 and 24 months [9].

In a study of 350 patients with RA, modified-release prednisone (5 mg/day) in addition to standard treatment improved arthritic symptoms, reduced severity of the disease, and increased physical function compared to placebo [10].  

2) Inflammatory Bowel Disease

In an uncontrolled study of 89 patients with acute ulcerative colitis, treatment with 40-80 mg prednisone completely resolved symptoms in 47% of severe, 80% of moderate, and 84% of mild cases [11].

In 205 patients with ulcerative colitis, 40 mg/day prednisolone improved symptoms faster than 20 mg/day fluticasone propionate (another corticosteroid) within 2 weeks [12].

3) Respiratory Problems

In two studies of 175 children with acute asthma attacks, prednisone (2 mg/kg) reduced hospitalization rates and improved breathing [13, 14].

The use of alternate-day prednisone therapy (1 mg/kg for 24 months) helped 285 children with mild to moderate symptoms of cystic fibrosis, a genetic disorder that affects the lungs [15].

In a study of 785 pneumonia patients, prednisone therapy (50 mg/day for 1 week) resulted in quicker improvement [16].

Prednisone can reduce the symptoms of respiratory conditions such as pneumonia, asthma attacks, and cystic fibrosis.

4) Purpura

People with purpura experience bleeding under the skin, skin spotting or discoloration. The immune system attacks platelets, causing a low platelet count and reduced blood clotting [17].

In a pilot study of 4 mg/kg/day prednisone, 22 out of 25 children with purpura improved, with an increase in platelet count. The same treatment was as effective as an initial therapy in another 53 children with purpura [18, 19].

In 171 patients with purpura, prednisone (1 mg/kg/day) was given for 2 weeks, followed by a weaning period of 2 weeks. It reduced stomach and joint pain, and improved kidney symptoms [20].

Prednisone can improve platelet count and reduce the symptoms of purpura, an autoimmune condition that causes bleeding under the skin.

5) Leukemia

Prednisone is currently part of the standard treatment for lymphocytic leukemia, usually combined with other drugs. Lymphocytic leukemia is a type of cancer that affects white blood cells (lymphocytes) in the bone marrow.  

In a study of 96 patients with chronic lymphocytic leukemia, the combination of prednisone + monthly chemotherapy (chlorambucil) showed the greatest reduction in disease severity [21].

Recently, studies compared prednisone with another steroid, dexamethasone, for lymphocytic leukemia and got mixed results. In some, dexamethasone was more effective, while in others there was no difference [222324].

Along with other drugs, prednisone can slow the progression and reduce the severity of chronic lymphocytic leukemia, a type of blood cancer.

6) Lupus

Lupus is an autoimmune disease, and the goal of treatment is to reduce an overactive immune response. Since prednisone suppresses the immune system, it is one of the main treatment options for lupus, in combination with other drugs [25].

In a study of 111 patients with lupus and active kidney inflammation, a combination of prednisone and another immunosuppressant, cyclophosphamide, protected the kidneys better than prednisone alone [26].

7) Autoimmune Hepatitis

Prednisone is one of the main treatment options for autoimmune hepatitis (AIH). In AIH, the immune system attacks liver cells and causes inflammation [27].

In a review of 11 clinical trials, prednisone (alone and in combination with azathioprine) was effective in reducing symptoms, liver inflammation, and liver enzymes. The combination achieved better results [27].

8) Inflammatory Diseases

Polymyalgia Rheumatica (PMR) is an inflammatory condition that causes muscle pain and stiffness in the neck, shoulders, and hips. In 62 patients with PMR, modified-release prednisone reduced overall pain, shoulder pain, fatigue, and stiffness [28].

In a review of various glucocorticoid treatments for patients with PMR, an initial dose of 15 mg/day prednisone was effective in reducing the symptoms [29].

Doctors use prednisone to treat lupus, autoimmune hepatitis, and other inflammatory and autoimmune conditions.
 

Prednisone Side Effects and Precautions

Side Effects

1) Increases the Risk of Bone Fractures

In 74 postmenopausal women with rheumatoid arthritis, long-term prednisone treatment (10 mg/day) increased the frequency of spine deformities.

In a large study of 244,235 patients (with 244,235 matched controls), oral corticosteroids like prednisone increased fracture frequency, especially in higher dosesWhen patients stopped taking these drugs, the risk of fractures rapidly returned to normal [30].

Prednisone (10 mg) decreased bone mineral density in 40 rheumatoid arthritis patients [31].

In a study of 539 lupus patients, prednisone (10 mg/day for 10 years) was associated with a 2.5-fold increase in the risk of osteoporotic fractures [32].

There is strong clinical evidence that long-term use of prednisone and other corticosteroids weakens the bones and increases the risk of fractures.
 

2) Can Cause Mood Disorders

Out of 80 patients on at least 20 mg/day prednisone, 42 experienced mood disorders – anxiety, irritability, euphoria, hyperactivity, depression, or manic episodes – with 5 cases requiring hospitalization [33].

In a case study of 20 patients taking 7.5 mg/day prednisone, there was a 60% higher risk of mood or anxiety disorder [34].

Out of 12 patients in one study, 9 reported behavioral changes that resembled hypomania – feelings of irritability, feeling high, talkativeness – when taking 80 mg prednisone [35].

Prednisone can cause mood disorders such as anxiety, depression, irritability, hyperactivity, and mania.
 

3) Increases the Risk of Infections

Prednisone use was associated with serious infections in 6,290 patients with Crohn’s disease [36].

In a study of 697 patients with acute lymphoblastic leukemia, prednisone treatment (max 60 mg/day) during the incubation period of the chickenpox virus (varicella) increased the severity of infection [37].   

Prednisone use of ≥ 40 mg/day had a 5-fold increase in infection frequency in 233 patients with lupus [38].

By suppressing the immune system, prednisone makes you more prone to serious infections.
 

4) May Cause Cataracts

Out of 58 children receiving prednisone for IBD, 12 developed cataracts (no cataracts in 58 controls) [39].

In a study of 539 lupus patients, prednisone (10 mg/day for 10 years) was associated with almost a 2-fold increase in cataracts [32].

5) Increases the Risk of Cardiovascular Disease

In the above study of lupus patients, prednisone use was associated with a 1.7-fold increase in chest pain, heart attack, and artery bypass procedures. High-dose prednisone was associated with a 1.2-fold increase in stroke due to low blood supply [32].

Out of 80 patients on at least 20 mg/day prednisone, seven developed high blood pressure [33].

6) Increases Blood Glucose Levels

In a 785 patient study of prednisone for pneumonia, 19% of patients got increased glucose levels that required insulin treatment (compared to 11% of placebo-patients) [16]  

7) May Cause Skin Changes

Out of 80 patients on at least 20 mg/day prednisone, 37  experienced skin disorders such as unwanted hair growth, thinning skin, bruising, and delayed wound healing [33].

8) May Increase Muscle Cramping And Weakness

In the above study, 32.5% of patients reported muscle cramps and 15% of patients reported muscle weakness [33].  

9) May Cause Menstrual Disorders

39% of women (premenopausal) experienced menstrual disorders such as irregular or shorter periods and less menstrual bleeding in the study mentioned above [33].  

10) May Cause Stomach Problems

In a study of 101 patients taking 5 – 60 mg prednisone, 22 patients reported stomach and gut problems such as heartburn and changes in bowel movements [40].

11) May Increase Fluid Retention

In a study of 101 patients taking 5 – 60 mg prednisone, 33 patients experienced fluid retention [40].

12) May Cause Insomnia

Insomnia occurred in 13 patients in the above study [40].

Contraindications

Prednisone should not be taken by anyone who has experienced a hypersensitivity to the drug or any of its other components.

Pregnancy and Breastfeeding

Prednisone should not be used if you are pregnant. The exception are certain circumstances where the benefits outweigh the potential risk to the fetus [41].

Prednisone can cross into breast milk and it is not recommended to take the drug if you are breastfeeding. Again, there might be some exceptions to this rule [41].

Drug Interactions

Drugs that alter the activity of liver enzymes that metabolize prednisone (CYP3A4 inhibitors and inducers) may affect prednisone metabolism [2, 41]:

  • Estrogen increases the effect of prednisone
  • Anti-seizure and sedating drugs (barbiturates, phenytoin, carbamazepine) decrease the effect of prednisone
  • Antibiotics (ketoconazole, macrolides) increase the effect of prednisone

Prednisone may also increase blood glucose levels, which may reduce the effectiveness of diabetes drugs [16].

Other drugs that may interact with prednisone include [41]:

  • Aminoglutehimide
  • Amphotericin B
  • Anticholinesterase Agents
  • Anticoagulants (warfarin)
  • Cholestyramine
  • Cyclosporine
  • Digoxin
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Prednisone interacts with estrogen, drugs for seizures, and certain antibiotics. It may also reduce the effectiveness of glucose-lowering drugs.

Prednisone and Vaccines

Some studies show that prednisone treatment can be unsafe or reduce the effectiveness of vaccines, but others show no difference.

In a study of 30 nephrotic patients, high-dose prednisone therapy showed no difference in pneumonia vaccine response compared to controls [42].

Prednisone treatment (2 mg/kg/day for 5 days) showed no significant difference in influenza vaccine response in 50 asthmatic patients [43].

However, in 24 patients with lupus (with 24 age-matched controls), prednisone treatment decreased immune response to the influenza vaccine [44].

The Center for Disease Control (CDC) recommends that individuals with suppressed immune systems should not get live vaccines. The CDC defines an immunosuppressive steroid dose at ≥ 20mg /day prednisone for over 2 weeks [45].

The effects of prednisone on vaccine-induced immune response are mixed. People taking high doses may want to avoid live vaccines.

Forms and Dosage of Prednisone

Prednisone is available as immediate- and delayed-release tablets and as a solution.

Prednisone dosing varies widely from 1-80 mg depending on the disease being treated, whether the condition is acute or chronic, and the response to treatment.

One of the main challenges is finding the right dose and duration of treatment while minimizing the risk of side effects.

Slowly decreasing the dose rather than immediately stopping prednisone — tapering — is often used and is linked to better treatment outcomes and fewer side effects [29].

Prednisone is available as immediate- and delayed-release tablets and as a solution. The dosage varies from 1-80 mg, and it’s usually tapered down.

Natural Alternatives to Prednisone

There are many natural alternatives to prednisone – herbs, mushrooms, minerals, and vitamins – all can help lower inflammation and pain in the body.

This list is not comprehensive, but it’s a breakdown of the top ones that act most similarly, have fewer side effects, and can help with similar diseases.

Note: these alternatives are for informational purposes. It’s important to speak to your doctor and see if any of these make sense for you. Do not stop taking any medications without the guidance of your doctor.

1) Boswellia

Boswellia, also known as frankincense, is an extract taken from the Boswellia serrata tree. It reduces inflammation by blocking 5-lipoxygenase, similar to corticosteroids. Boswellia has been used in traditional medicine to treat a wide range of disease that include chronic inflammation [4647].

In a meta-analysis of 260 patients with rheumatoid arthritis400 mg of boswellia extract reduced swelling, pain, and stiffness. Patients were also able to reduce painkiller (NSAIDs) intake and required fewer emergency treatments [48].

In 102 patients with Crohn’s disease, 400 mg of boswellia extract was comparable to the standard treatment for IBD (mesalazine) [47].

70% of patients with asthma showed improvement when taking 300 mg boswellia extract, compared to only 27% in the placebo group [49].

Boswellia is available as a capsule, tablet, or its bark decoction orally [50].

Boswellia (frankincense) is a tree raisin that naturally reduces inflammation. It can help with rheumatoid arthritis, IBD, asthma, and other inflammatory conditions.

2) Cat’s Claw

Cat’s claw (Uncaria tomentosa) is a vine found in tropical areas of South and Central America.

It reduces inflammation similar to prednisone (by inhibiting NF-kB) and blocks other inflammatory compounds (TNF-alpha and IL-1alpha, IL-1beta, IL-17,  and IL-4) [51, 52, 53].  

In a study of 45 patients with osteoarthritis, cat’s claw reduced pain with no significant side effects [54].

It decreased inflammation and pain in rats with arthritis [55].

Cat’s claw is available as capsules, extracts, tinctures, decoctions, and teas [53].

Cat’s claw reduces inflammation in a similar way as prednisone and helps combat pain and inflammation. It’s available as capsules, tincture, or tea.

3) Resveratrol

Resveratrol is a compound found in many foods, most notably in grape skins and red wine [56].

It reduces inflammation by:

In mice with asthma and airway inflammation, resveratrol decreased airway over-sensitivity, high eosinophils, and mucus production [57].

In rabbits and rats with arthritis, resveratrol decreased cartilage destruction, joint inflammation, swelling, and inflammatory cell infiltration [58, 59].

It improved survival, diarrhea, rectal bleeding, and disease activity in mice with ulcerative colitis [60].

Resveratrol cannot be obtained in therapeutic doses through foods. As a supplement, it is available in creams, tablets, capsules, and tinctures [61].

Resveratrol, which is abundant in grape skin and red wine, can help with a range of inflammatory conditions.

4) Bromelain

Bromelain is an enzyme found in pineapples. It blocks inflammatory compounds during excessive inflammation (COX-2, PGE-2, IL-1beta, INF-alpha, IL-6, and TNF-alpha) [62].

However, bromelain also activates these compounds in a healthy immune response, which makes is an immunomodulator [62]

In 77 patients with rheumatoid or osteoarthritis, bromelain (400 mg) improved overall symptoms, reduced stiffness, and improved physical function [63].

In mice with acute asthma, bromelain decreased eosinophils, leukocytes, and autoimmune response  [64].

Bromelain is available as tablets, capsules, creams, powders, and tinctures [65].

Bromelain is an enzyme from pineapple that can silence an over-active inflammatory response, such as in asthma or arthritis.

5) Ginger

Ginger is a potent anti-inflammatory herb. It acts by blocking:

  • The production of inflammatory components (COX-1, COX-2, 5- lipoxygenase, NF-κB, prostaglandin, and leukocytes) [66R, R6667]
  • Immune cells from arriving at the site of inflammation [66]

In two studies of 267 patients with osteoarthritis, ginger extract (250 and 255 mg) reduced knee pain [6869].

However, in another study of 75 osteoarthritic patients, 170 mg ginger extract had no benefits compared to placebo [70].

The conflicting results in human studies may be due to different types of ginger extracts used, dosing, and duration of treatment.

You can use fresh or ground ginger in cooking or take a supplement (pills or tinctures) [66].

Ginger may help with pain and inflammation; it has mild effects but acts in a similar way as prednisone. You can use it fresh or ground in cooking or take supplements.

6) Curcumin

Curcumin is an anti-inflammatory component of turmeric that can improve a range of autoimmune and inflammatory diseases.

In a study of 89 patients with ulcerative colitis, 1 g of curcumin in addition to typical drugs (sulfasalazine or mesalamine) reduced relapse rates [71].

In 45 patients with rheumatoid arthritis, 500 mg of curcumin improved tenderness, joint swelling, and disease activity better than diclofenac sodium (50 mg) [72].

It improved kidney function in23 patients with lupus and kidney inflammation [73].

Curcumin is available as emulsions, tablets, capsules, powders, nanoparticles, and liposomal encapsulations.

It has limited bioavailability due to poor absorption and rapid breakdown. Combining curcumin and piperine (from black pepper) can increase curcumin’s bioavailability, and many supplements contain both substances [74, 75].

Curcumin the active compound in turmeric that can improve a range of inflammatory diseases. It’s often combined with piperine.

7) Green Tea

One of the main anti-inflammatory components of green tea is epigallocatechin-3-gallate (EGCG).

In an animal study, EGCG blocked neutrophils from traveling to the inflamed sites, blocked the formation of new blood vessels, and stopped lung scarring. In rats with rheumatoid arthritis, green tea extract reduced levels of an inflammatory compound (PGE2) [76, 77].

Although cell studies of EGCG herald its antioxidant and anti-inflammatory effects, the results from human studies are conflicting. The reason could be EGCG’s poor bioavailability and breakdown in the body [78].

EGCG is available as standardized green tea extract capsules, powders, or as green tea. To get the most EGCG out of your green tea, steep in 80°C water for 5-15 min [79].

EGCG from green tea may block inflammation, but our bodies can’t use it well. You can get it by drinking green tea, steeped in 80°C water for 5-15 min.

User Experiences with Natural Alternatives

Boswellia

  • 262 mg of boswellia supplement reduced pain and swelling in hands.
  • Taking boswellia with turmeric reduced arthritic pain with no side effects.

Cat’s Claw

  • 485 mg of cat’s claw supplement was comparable to taking minocycline for rheumatoid arthritis in relieving pain.
  • 500 mg of cat’s claw used in combination with iodoral reduced severe brain inflammation.

Resveratrol

  • Resveratrol improved colon bleeding and inflammation.
  • One user reported severe dizziness when taking resveratrol.
  • One user combines resveratrol and ginger for reducing inflammation.

Bromelain

  • A 67-year-old woman with ulcerative proctitis reported improvement in bowel movement without blood or urgency by taking 2 tablets/day bromelain.  
  • Taking  500 mg bromelain twice a day before meals improved digestion and inflammation.
  • Taking 500 mg bromelain 1-3 times a day on an empty stomach improved inflammation and joint pain without any of the side effects associated with NSAIDs or acetaminophen.

Ginger

  • Multiple users report that ginger root extract was useful in treating inflammation and digestive problems such as nausea.
  • Ginger tea was effective in reducing anxiety, improving digestion, and decreasing inflammation.

Curcumin

  • Users report that supplements labeled as “ turmeric root powder” only contained a low percentage of curcumin.
  • A standardized turmeric supplement that contains 95% curcumin was effective in relieving joint pain and inflammation.

Green Tea (EGCG)

  • EGCG (green tea extract) was effective in reducing chronic inflammation.
  • Users also reported weight loss and increased concentration. They preferred EGCG extract to green tea because EGCG extract had less caffeine.

User experiences with natural prednisone alternatives are mostly positive, as they were able to relieve various inflammatory and autoimmune conditions.

Genetics

Prednisone must be converted to prednisolone by the liver to become active. Therefore, liver disease may decrease prednisone metabolism and its anti-inflammatory effects [2].

Mutations in the NR3C1 gene, which encodes the glucocorticoid receptor, may also affect response to prednisone treatment. Depending on the nature of the mutation, it may increase or decrease the sensitivity of glucocorticoids like prednisone [80].

Takeaway

Prednisone is a corticosteroid drug that suppresses the immune response and inflammation. It mimics cortisol, thus blocking inflammatory and increasing anti-inflammatory pathways.

Doctors use prednisone, alone or in different combinations, to treat rheumatoid arthritis, severe respiratory conditions, IBD, lupus, and some types of leukemia. Long-term use can cause osteoporosis, diabetes, mood swings, infections, and menstrual disorders.

To reduce the risk of side effects, you shouldn’t use prednisone for more than two weeks straight. Your doctor will gradually reduce the dosage.

Prednisone can interact with many drugs. Pregnant and breastfeeding women should avoid it.

Natural options for reducing inflammation include boswellia, cat’s claw, resveratrol, ginger, curcumin, green tea, and bromelain.

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