As with any other medication, there is a risk of prednisone negatively interacting with other medications and substances, even when used correctly. Always consult with a physician before taking prednisone with any other prescription drug, over-the-counter medication, or substance like alcohol.
Some of the following information comes from DailyMed, the official FDA label information provider for drugs.
According to The Food and Drug Administration, drugs that may interact with prednisone include the following.
|Drugs that May Interact with Prednisone||Examples|
|Aminoglutehimide||– Aminoglutethimide may lead to loss of corticosteroid-induced adrenal suppression.|
|Amphotericin B Injection||– There have been cases reported in which concomitant use |
of Amphotericin B and hydrocortisone was followed by
cardiac enlargement and congestive heart failure.
|Anticholinesterase Agents||– Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. |
If possible, anticholinesterase agents (galantamine, donepezil, ngeostigmine, pyridostigmine) should be withdrawn at least 24 hours before initiating corticosteroid therapy.
|Anticoagulant Agents||– Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.|
|Antidiabetic Agents||– Because corticosteroids may increase blood glucose (sugar) concentrations, dosage adjustments of antidiabetic agents may be required.|
|Antitubercular Drugs||– Serum concentrations of isoniazid may be decreased.|
|CYP 3A4 Inducers (e.g., Barbiturates, Phenytoin, Carbamazepine, and Rifampin)||– Drugs such as barbiturates, phenytoin, ephedrine, and rifampin, which induce hepatic microsomal drug metabolizing enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased.|
|CYP 3A4 Inhibitors (e.g., Ketoconazole, Macrolide Antibiotics)||– Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60% leading to increased risk of corticosteroid side effects.|
|Cholestyramine||– Cholestyramine may increase the clearance of corticosteroids.|
|Cyclosporine||– Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use.|
|Digitalis||– Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.|
|Estrogens, Including Oral Contraceptives||– Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.|
|Non-steroidal Anti-Inflammatory Drugs (NSAIDS) Including Aspirin and Salicylates||– Concomitant use of aspirin or other nonsteroidal anti-inflammatory drugs and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids; this could lead to decreased salicylate serum levels or increase the risk of salicylate toxicity when corticosteroid is withdrawn.|
|Potassium-Depleting Agents (e.g., Diuretics, Amphotericin B)||– When corticosteroids are administered concomitantly with potassium-depleting agents, patients should be observed closely for development of hypokalemia.|
|Skin Tests||– Corticosteroids may suppress reactions to skin tests.|
|Toxoids and Live or Attenuated Vaccines||– Patients on corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible.|
Please note that this list may not be complete, and other interactions with drugs not listed here may occur. To learn more about some of these interactions, keep reading.
Prednisone and COVID-19
In the midst of the current COVID-19 crisis, it’s important to understand whether or not Prednisone puts you at risk for infection. Although Prednisone is an immunosuppressant, the way you take it may influence your infection risk. Those who take prednisone orally or via injection typically have a higher risk of developing immune system side effects compared to those who take the drug topically.
As for your risk for COVID-19, while taking prednisone, it all depends on the current state of your immune system. However, more research is needed on how taking Prednisone specifically affects risks related to COVID-19. To learn more about how to protect yourself and others, visit the Center for Disease Control.
Prednisone and Alcohol
When you mix prednisone with alcohol, it can lead to long-term and serious side effects. Although it would be best to completely avoid alcohol while on this corticosteroid, the effects depend on the dosage of prednisone. When mixing alcohol and prednisone, the patient is at risk for the following side effects:
- Gastrointestinal Problems
- Weakened Immune System
Prednisone and Tylenol
Currently, there are no interactions found when taking prednisone and Tylenol. This doesn’t necessarily mean no interactions exist, which is why it’s crucial to consult your healthcare provider.
Prednisone and Anxiety
Some medicines may cause or increase anxiety, including prednisone. But, the way in which prednisone affects a patient’s anxiety depends on their current state of anxiety as well as the dosage of prednisone. Be sure to contact your healthcare provider if you experience a development of anxiety or it worsens.
Prednisone and Diabetes
If Prednisone is used long-term, it can increase the risk of developing Type 2 diabetes mellitus in a patient who is already at risk of developing Type 2 diabetes mellitus.. The higher the dose of Prednisone, the higher likelihood that the blood glucose level will rise, therefore increasing the risk of diabetes. Other factors that contribute to diabetes are obesity and a genetic background that includes diabetes.
Prednisone and Potassium
Prednisone may cause low potassium levels (hypokalemia), which may be increased by other drugs that also cause hypokalemia (like furosemide, hydrochlorothiazide, etc.). If you find that your potassium levels dramatically decrease from taking prednisone, contact your healthcare consultant.
Prednisone and Advil
Taking prednisone with Advil may increase your risk of side effects in the gastrointestinal tract such as ulceration, inflammation, or bleeding.
Prednisone and Pregnancy
While the risks of taking prednisone during pregnancy appear small, there are still some side effects such as cleft lip or palate, premature delivery, or low birth weight. To learn more about prednisone and pregnancy, visit our pregnancy page.