Can You Take Prednisone for 2 Years? A Guide to Long-Term Use

October 10, 2025 •

4 min read

Studies show that long-term use of corticosteroids like prednisone is associated with a more than doubled mortality risk compared to non-users [1.7.1]. While a doctor might prescribe it, the critical question remains for many patients: can you take prednisone for 2 years safely?

Quick Summary

Taking prednisone for 2 years is possible for certain chronic conditions but carries significant risks. Long-term use requires careful medical supervision to manage side effects like osteoporosis, weight gain, and increased infection risk.

Key Points

Risks vs. Benefits: Taking prednisone for 2 years is reserved for chronic conditions where benefits outweigh significant risks like osteoporosis and increased infection [1.8.1, 1.3.1].
Major Side Effects: Long-term use is linked to bone thinning, weight gain, high blood sugar, increased infection susceptibility, and mood changes [1.2.1, 1.2.2].
Medical Supervision is Crucial: Patients on long-term prednisone require regular monitoring for side effects, including bone density scans and eye exams [1.4.3, 1.9.5].
Lowest Effective Dose: The goal is to use the lowest possible dose for the shortest duration necessary to control the underlying disease [1.3.5].
Never Stop Abruptly: Abruptly stopping prednisone after prolonged use can cause severe withdrawal and a life-threatening adrenal crisis; a doctor must supervise a gradual taper [1.2.4, 1.2.5].
Lifestyle Management: A healthy diet, regular exercise, and avoiding illness are key strategies to help mitigate the side effects of long-term use [1.4.1, 1.4.5].
Increased Mortality Risk: Studies indicate that long-term corticosteroid use is associated with a significantly increased risk of death from causes like sepsis and heart failure [1.7.1].

Prednisone is a powerful corticosteroid used to treat a wide array of conditions by suppressing the immune system and reducing inflammation [1.3.4, 1.2.6]. While highly effective for short-term treatment of issues like severe allergies or asthma flare-ups, some chronic diseases may require prolonged therapy [1.3.1, 1.3.5]. The decision to use prednisone for an extended period, such as two years, involves a careful balance of its life-saving benefits against its substantial long-term risks [1.8.4].

Why Would Someone Need Prednisone for 2+ Years?

Certain chronic inflammatory and autoimmune diseases may necessitate long-term corticosteroid therapy to control symptoms and prevent organ damage. There is no absolute set limit on how long you can take prednisone, as it depends on the condition, the dose, and patient response [1.3.5].

Conditions that may require extended use include:

Autoimmune Diseases: Lupus, rheumatoid arthritis, and multiple sclerosis often involve the immune system attacking the body's own tissues. Prednisone can control this response [1.3.2, 1.3.6].
Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis cause chronic inflammation of the digestive tract [1.3.6].
Chronic Lung Diseases: Some cases of asthma, COPD, pulmonary fibrosis, and sarcoidosis require long-term inflammation control to prevent lung damage [1.3.1].
Organ Transplants: Prednisone helps suppress the immune system to prevent the body from rejecting a transplanted organ [1.3.2].

The Significant Risks of Long-Term Prednisone Use

Taking prednisone for months or years significantly increases the frequency and severity of side effects [1.2.1]. The risk of serious health issues is considerably higher for those on long-term therapy compared to short-term users [1.8.3]. In a study of patients with rheumatoid arthritis, the median duration of prednisone use was 2 years [1.7.2].

Major Health Concerns

Osteoporosis: Prednisone causes bone thinning and increases the risk of fractures. Some patients can lose 10% to 20% of their bone mass within the first six months of treatment [1.9.5, 1.8.1]. This effect can lead to a debilitating condition called avascular necrosis (bone death), most commonly affecting the hip joint [1.8.2, 1.8.4].
Immunosuppression: By design, prednisone weakens the immune system, making you more susceptible to infections from bacteria, viruses, and fungi [1.9.2, 1.2.2]. It can also make symptoms of an infection less obvious, delaying diagnosis and treatment [1.2.6]. The risk of serious infections like sepsis can be five times higher in steroid users [1.7.5].
Metabolic Changes: Long-term use frequently leads to increased appetite, fluid retention, and weight gain [1.2.2, 1.2.6]. Fat may be redistributed to the face (moon face), abdomen, and the back of the neck (buffalo hump) [1.8.4, 1.2.5]. It also increases blood sugar levels, which can trigger or worsen diabetes [1.3.2, 1.8.1].
Cardiovascular Issues: Prednisone can cause or worsen high blood pressure and fluid retention [1.2.2]. It may also accelerate the hardening of the arteries (atherosclerosis), increasing the risk of heart disease, especially with use beyond one year [1.8.2].
Psychological and Mood Effects: Many patients experience mood swings, irritability, anxiety, and trouble sleeping [1.9.1, 1.8.5]. In some cases, it can lead to more severe issues like depression or psychosis [1.9.4, 1.8.4].
Eye Problems: The risk of developing cataracts and glaucoma increases with prolonged use [1.8.1, 1.8.2]. Regular eye exams are crucial for anyone on long-term therapy [1.8.5].

Managing Side Effects: A Proactive Approach

If long-term prednisone is medically necessary, your doctor will prescribe the lowest effective dose for the shortest possible time [1.3.5]. Management is a partnership between you and your healthcare provider.


Side Effect Category	Management Strategy
Bone Health	Regular weight-bearing exercise; adequate intake of calcium and Vitamin D supplements; periodic bone density scans [1.4.1, 1.4.5, 1.9.5].
Infection Risk	Practicing good hygiene; avoiding sick people; keeping vaccinations up-to-date (discussing which vaccines are safe with your doctor); promptly reporting any signs of infection [1.2.2, 1.4.5].
Weight Gain & Metabolism	Following a nutrient-dense, low-sodium, low-sugar diet; monitoring calories; regular exercise to control weight and blood sugar [1.4.4, 1.4.5].
Cardiovascular Health	Regular blood pressure monitoring; adopting a low-sodium, low-cholesterol diet to manage blood pressure and fluid retention [1.4.4, 1.8.2].
Gastrointestinal Issues	Taking prednisone with food to minimize stomach irritation; avoiding NSAIDs like ibuprofen, which increase ulcer risk [1.2.2, 1.4.4].
Mood & Sleep	Taking the daily dose in the morning to reduce insomnia; being aware of potential mood changes and informing family; discussing persistent mood issues with a doctor [1.4.4, 1.2.6].

Tapering Off Prednisone

Never stop taking prednisone abruptly if you have been on it for more than a few weeks [1.2.4]. Your body stops producing its own natural steroid (cortisol) during treatment, and it needs time to recover this function [1.2.6]. Suddenly stopping can cause a life-threatening adrenal crisis [1.2.5]. Symptoms of withdrawal include severe fatigue, body aches, joint pain, nausea, and low blood pressure [1.5.3, 1.5.5]. Your doctor will create a gradual tapering schedule, reducing the dose over weeks or even months, to allow your adrenal glands to resume normal function safely [1.5.4, 1.2.5].

Conclusion

While it is possible to take prednisone for 2 years or longer for certain severe, chronic conditions, it is a decision that requires serious consideration of the risks. Long-term use is associated with a wide range of significant side effects, from osteoporosis and weight gain to a weakened immune system and cardiovascular problems [1.8.2, 1.9.3]. Effective management involves using the lowest possible dose, adopting proactive lifestyle changes to mitigate side effects, and maintaining regular communication with a healthcare provider [1.4.1, 1.4.3]. The goal is always to balance the drug's powerful anti-inflammatory benefits with the potential for serious harm.

For more information on managing steroid side effects, one authoritative resource is the Lupus Foundation of America.

Frequently Asked Questions

The most common side effects of long-term prednisone use include weight gain, fluid retention, mood swings, increased blood sugar, high blood pressure, bone thinning (osteoporosis), and an increased risk of infections [1.2.1, 1.2.6].

Yes, some side effects of long-term prednisone use can be permanent. These include osteoporosis (thinning bones), avascular necrosis (bone death), skin thinning, and eye damage like cataracts or glaucoma [1.9.3, 1.2.5].

To protect your bones, engage in regular weight-bearing exercise, ensure adequate intake of calcium and vitamin D (often through supplements), and talk to your doctor about periodic bone density tests [1.4.1, 1.4.5]. Your doctor may also prescribe medication to help prevent bone loss [1.4.4].

Prednisone affects your metabolism and how your body deposits fat, which can lead to an increased appetite and weight gain. It also causes fluid retention. Fat deposits commonly occur in the abdomen, face, and the back of the neck [1.2.2, 1.2.6].

Because prednisone suppresses your immune system, you should avoid live vaccines. It's important to discuss your vaccination status with your doctor to determine which vaccines, like the annual flu shot or pneumonia vaccines, are safe and recommended for you [1.2.2, 1.9.4].

Long-term prednisone use suppresses your adrenal glands' natural production of cortisol. Stopping suddenly can lead to a state of adrenal insufficiency, causing severe withdrawal symptoms like fatigue, body aches, low blood pressure, and potentially a life-threatening adrenal crisis [1.2.4, 1.2.5].

Yes, depending on the condition, alternatives may include other immunosuppressive drugs like methotrexate, biologics such as Humira or Enbrel, or nonsteroidal anti-inflammatory drugs (NSAIDs). The best alternative must be determined by a doctor [1.6.2].