Can I take hydroxychloroquine with prednisone?

October 8, 2025 •

5 min read

According to the Johns Hopkins Arthritis Center, hydroxychloroquine (Plaquenil) can be taken with other medications, including corticosteroids like prednisone. Taking these two medications together is a common and often necessary treatment strategy for managing various autoimmune diseases, particularly in initial stages or during disease flares.

Quick Summary

Taking hydroxychloroquine and prednisone together is a safe and common strategy for treating autoimmune diseases like lupus and rheumatoid arthritis. This combination helps manage inflammation, with prednisone providing rapid relief and hydroxychloroquine offering long-term disease control while sparing the use of higher steroid doses.

Key Points

Combination is Standard: Combining hydroxychloroquine and prednisone is a common and medically accepted approach for treating autoimmune diseases like lupus and rheumatoid arthritis.
Prednisone for Quick Relief: Prednisone provides rapid, short-term anti-inflammatory effects, effectively controlling acute flare-ups and severe symptoms.
Hydroxychloroquine for Long-Term Control: Hydroxychloroquine works slowly to provide long-term disease control and allows for the eventual tapering down of prednisone.
Minimizing Steroid Side Effects: This combination strategy is often used to achieve a "steroid-sparing" effect, reducing reliance on high-dose, long-term steroid therapy and its associated risks.
Medical Supervision is Essential: All changes to dosage and treatment plans must be managed under a doctor's supervision, and prednisone should never be stopped abruptly.
Regular Monitoring is Required: Patients must be monitored for potential side effects, including regular eye exams for hydroxychloroquine and bone density checks for long-term prednisone use.
No Direct Drug Interaction: Reputable drug interaction checkers indicate no known major interaction between hydroxychloroquine and prednisone, but this does not mean no interactions exist, and doctor consultation is always necessary.

Is it Safe to Combine Hydroxychloroquine and Prednisone?

For individuals with autoimmune conditions such as lupus or rheumatoid arthritis, combining hydroxychloroquine and prednisone is a standard medical approach. The two drugs work differently to combat inflammation and suppress the overactive immune system. Prednisone, a corticosteroid, provides rapid and potent anti-inflammatory relief, especially during a disease flare. Hydroxychloroquine, a slower-acting disease-modifying antirheumatic drug (DMARD), helps control the underlying disease activity over the long term and has a "steroid-sparing" effect, allowing for a gradual reduction of the prednisone dosage to minimize its side effects. Medical experts emphasize that while there are no known direct drug-to-drug interactions that prevent this combination, careful management is essential to balance therapeutic benefits and mitigate risks.

The Complementary Roles of Hydroxychloroquine and Prednisone

How Hydroxychloroquine Works

Hydroxychloroquine is a DMARD that modulates the immune system over time. Its mechanism of action is not fully understood, but it is believed to interfere with communication within the immune system and inhibit endolysosomal functions. This leads to a reduction in pro-inflammatory responses, making it effective for long-term management of conditions like lupus and RA. However, its slow onset of action, which can take up to several months, means it is not suitable for immediately controlling severe symptoms.

How Prednisone Works

Prednisone is a fast-acting corticosteroid that suppresses the immune system and reduces inflammation throughout the body. It is highly effective for rapidly controlling symptoms during a flare-up or for managing severe disease activity. Due to its speed and potency, it is a crucial tool for providing quick relief. However, prolonged or high-dose use is associated with a wide range of significant side effects, necessitating its use for the shortest possible duration at the lowest effective dose.

The Strategic Combination

Combining the two medications allows clinicians to use each drug for its specific strengths. A typical strategy involves starting both drugs together to quickly bring inflammation under control with prednisone. As the hydroxychloroquine begins to take effect over weeks and months, the prednisone dosage is slowly and carefully tapered down. The goal is to eventually manage the condition with a low, long-term maintenance dose of prednisone or, if possible, to stop it altogether. This minimizes the patient's exposure to the more severe, long-term side effects of steroids while maintaining disease control.

Potential Risks and Monitoring with Combination Therapy

While the combination is safe, it is not without risks. The side effects of each medication must be managed, and some effects can be amplified when used concurrently. Regular monitoring is crucial for patient safety.

Monitoring Side Effects

Prednisone: Long-term use can lead to side effects such as weight gain, bone loss (osteoporosis), increased risk of infection, elevated blood sugar, and mood changes.
Hydroxychloroquine: The most notable risk is potential retinal toxicity, which is rare but serious. Regular eye exams are recommended to screen for any visual changes, with guidelines suggesting an initial baseline exam and subsequent annual screenings. Other side effects include gastrointestinal issues, skin rashes, and hair changes.

Importance of Tapering Prednisone

Abruptly stopping prednisone can be dangerous and lead to withdrawal symptoms or a disease flare. The gradual reduction, or tapering, of the dose allows the body's natural adrenal function to recover. This process must always be done under a doctor's supervision. In patients with lupus, for example, studies have shown that tapering hydroxychloroquine while on prednisone can increase the risk of poor outcomes, highlighting the need for careful management.

Comparison of Hydroxychloroquine vs. Prednisone


Feature	Hydroxychloroquine (Plaquenil)	Prednisone (Corticosteroid)
Drug Class	Disease-Modifying Antirheumatic Drug (DMARD)	Corticosteroid
Speed of Action	Slow (takes weeks to months to be fully effective)	Fast (provides rapid relief, often within hours or days)
Mechanism	Modulates the immune system and reduces pro-inflammatory cytokines over time	Potently suppresses the immune system and reduces inflammation system-wide
Primary Use	Long-term disease control and maintenance in conditions like lupus and RA	Short-term management of acute flare-ups and severe disease activity
Long-Term Safety	Generally well-tolerated with careful monitoring for retinal toxicity	Significant side effects with long-term or high-dose use (bone loss, infections, etc.)
Combination Strategy	Used to reduce the reliance on high-dose steroids (steroid-sparing)	Used to bridge the gap until hydroxychloroquine becomes fully effective

Clinical Applications of the Combination

Systemic Lupus Erythematosus (SLE)

In lupus treatment, hydroxychloroquine is considered a cornerstone therapy, while corticosteroids are used to manage flares. Combination therapy is standard, with the goal of minimizing steroid dosage over time. Studies have supported treatment schemes using prednisone, combined with hydroxychloroquine, followed by a rapid taper to a low maintenance dose.

Rheumatoid Arthritis (RA)

For RA, hydroxychloroquine is often used with other DMARDs or corticosteroids. Combining it with prednisone helps manage symptoms during the initial weeks until the DMARD's effects are established. The combination is a way to control joint pain, stiffness, and swelling more effectively and prevent joint damage.

Conclusion

Combining hydroxychloroquine and prednisone is a well-established and effective therapeutic strategy for managing inflammatory and autoimmune conditions such as lupus and rheumatoid arthritis. The combination leverages the rapid anti-inflammatory effects of prednisone for acute symptom control while harnessing hydroxychloroquine for long-term disease management, thereby minimizing prolonged exposure to high-dose steroids. While generally safe, the regimen requires close medical supervision to monitor for and manage the potential side effects of both medications, especially the long-term risks associated with corticosteroids and the rare risk of retinal toxicity from hydroxychloroquine. Patients should always consult their healthcare provider before starting, stopping, or altering their medication dosages to ensure the treatment plan is safe and tailored to their specific needs. It's also important to have regular check-ups, including periodic eye examinations, as recommended by the rheumatologist. For more detailed information on specific autoimmune conditions, consult the resources provided by the American College of Rheumatology.

Important Considerations

Adherence: Consistency in taking hydroxychloroquine is crucial, as it builds up in the system slowly.
Monitoring: Regular doctor visits and eye exams are essential.
Steroid Taper: Never stop prednisone abruptly due to the risk of withdrawal.
Reporting Symptoms: Patients should report any new or worsening symptoms to their doctor immediately.
Individualized Treatment: Treatment plans are highly personalized based on the severity of the disease and individual patient response.

Final Takeaway

The combination of hydroxychloroquine and prednisone is a safe and common strategy when managed appropriately by a healthcare provider. It effectively controls autoimmune diseases by providing both fast-acting and long-term inflammation management, ultimately helping to minimize the risks associated with prolonged high-dose steroid use.

Frequently Asked Questions

The primary reason for combining these medications is to manage autoimmune conditions effectively. Prednisone offers rapid, powerful anti-inflammatory effects to control acute flare-ups, while hydroxychloroquine provides long-term disease-modifying benefits, allowing the dose of prednisone to be gradually reduced over time.

Major drug interaction databases, like those on Drugs.com, report no direct interactions between hydroxychloroquine and prednisone. However, this does not eliminate the need for medical supervision, as combining any medications carries risks, and your doctor must monitor your overall health.

The duration of prednisone use varies by individual and disease severity. A doctor typically starts both medications simultaneously, then slowly tapers the prednisone dose as the hydroxychloroquine takes effect. The goal is to be on the lowest possible dose of prednisone for the shortest time, or to stop it completely.

Potential side effects are largely related to each drug individually. Prednisone side effects include weight gain, elevated blood sugar, and bone loss with long-term use. Hydroxychloroquine's most serious, though rare, side effect is retinal damage, requiring regular eye exams. Monitoring by your doctor is essential.

Yes, many patients can eventually taper off prednisone entirely or reduce it to a very low maintenance dose. The ability to do so depends on the disease state and how well hydroxychloroquine is managing symptoms. This process must be carefully guided by a rheumatologist to avoid withdrawal effects or a disease flare.

No, you should never stop taking prednisone abruptly. Abrupt discontinuation can cause adrenal insufficiency and lead to severe health issues. Your doctor will provide a specific tapering schedule to safely reduce the dosage over time, allowing your adrenal glands to resume normal function.

While the combination is generally safe, it may not be suitable for everyone. Individuals with a history of heart problems, severe liver or kidney disease, or certain infections may require closer monitoring or alternative treatments. You should always inform your doctor about all of your medical conditions before starting this regimen.