Can You Take Trelegy and Prednisone Together? Understanding Concurrent Treatment

October 11, 2025 •

3 min read

While Trelegy is a daily maintenance medication, an estimated 50% of COPD exacerbations require treatment with a systemic corticosteroid like prednisone. Understanding the proper protocols for how and when you can take Trelegy and prednisone together is essential for effectively managing severe respiratory symptoms and preventing serious side effects.

Quick Summary

Concurrent use of Trelegy and prednisone is common for severe COPD or asthma exacerbations, with Trelegy providing long-term maintenance and prednisone offering short-term relief. This combination requires careful medical supervision, especially when tapering off prednisone, to avoid adrenal insufficiency and manage other potential side effects.

Key Points

Purpose: Trelegy is a daily, long-term maintenance inhaler, while prednisone is a short-term oral steroid for acute respiratory flare-ups like COPD exacerbations.
Adrenal Risk: A primary concern when combining these medications is the risk of adrenal insufficiency when transitioning from long-term oral prednisone to inhaled Trelegy, which requires slow weaning under a doctor's care.
Side Effects: Concurrent use can increase the risk of side effects such as low blood potassium (hypokalemia), high blood sugar (hyperglycemia), decreased bone density (osteoporosis), and weakened immunity.
Not a Rescue Inhaler: Trelegy is not for immediate relief of sudden breathing problems; patients need a separate rescue inhaler for acute symptoms.
Medical Supervision: Due to potential interactions and side effects, the combination of Trelegy and prednisone must be carefully managed by a healthcare provider.

When is the combination used?

Trelegy and prednisone are commonly used together to manage both the chronic and acute symptoms of respiratory conditions such as chronic obstructive pulmonary disease (COPD) and severe asthma. Trelegy Ellipta is a daily maintenance inhaler that combines an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting beta-agonist to reduce inflammation and keep airways open over time, helping to prevent flare-ups. Prednisone, an oral systemic corticosteroid, is typically used for short periods to treat acute exacerbations, providing rapid relief from severe inflammation that Trelegy alone cannot address. Using oral steroids temporarily in addition to a long-term Trelegy regimen is a standard medical practice.

Potential drug interactions and side effects

Combining Trelegy and prednisone, while often necessary, can increase the risk of certain side effects due to their similar actions. A significant risk is adrenal insufficiency when transitioning from long-term oral steroids.

Adrenal suppression and insufficiency

Trelegy's inhaled corticosteroid can suppress adrenal gland function. Long-term oral prednisone also significantly suppresses these glands. Safely stopping oral prednisone requires careful medical management to allow adrenal glands to recover. Abruptly stopping prednisone can lead to a dangerous adrenal crisis, especially during physical stress. Patients transitioning from systemic steroids may need to carry a warning card for emergencies.

Other potential side effects

Hypokalemia: Both medications can lower blood potassium, increasing the risk of arrhythmias.
Hyperglycemia: Prednisone can raise blood sugar. Diabetic patients need close monitoring.
Bone mineral density loss: Long-term use of both types of steroids can reduce bone density, increasing fracture risk.
Cardiovascular effects: The beta-agonist in Trelegy can affect heart rate and blood pressure, risks that may be amplified when combined with oral steroids and existing heart conditions.
Weakened immune system: Both medications suppress the immune system, raising infection risk. Trelegy also carries a risk of oral thrush.

Management and patient guidance

Patients taking both medications must follow their doctor's instructions precisely. Trelegy is for maintenance, and prednisone is for acute control. The dose and duration of prednisone are carefully chosen, especially considering patient risk factors.

How doctors manage combined therapy

Slow tapering: Doctors slowly reduce prednisone doses after starting Trelegy to prevent adrenal insufficiency in patients on long-term oral steroids.
Close monitoring: Patients are watched for adrenal suppression symptoms and side effects like hypokalemia and hyperglycemia.
Patient education: Patients are taught to recognize worsening symptoms and understand when to use their rescue versus maintenance inhaler. Those on oral corticosteroids should carry identification indicating their steroid use.

Trelegy vs. Prednisone: A comparison


Feature	Trelegy (Inhaled)	Prednisone (Oral)
Drug Type	Inhaled Triple Therapy (ICS/LAMA/LABA)	Oral Systemic Corticosteroid
Purpose	Long-term daily maintenance to prevent exacerbations	Short-term treatment for acute exacerbations
Onset of Action	Long-acting, for consistent daily control	Rapid-acting, for immediate systemic relief
Administration	Once-daily oral inhalation via Ellipta device	Oral tablet, typically 5-7 days for exacerbations
Primary Mechanism	Reduces local lung inflammation, dilates airways	Suppresses systemic immune response and inflammation
Adrenal Impact	Localized suppression, especially when transitioning from oral steroids	Significant systemic suppression with long-term use
Common Use	Daily therapy for COPD and severe asthma	Emergency treatment for flare-ups

Conclusion

Taking Trelegy and prednisone together is a safe and medically indicated approach for managing acute respiratory flare-ups in conditions like COPD, provided it is done under close medical supervision. Trelegy provides essential long-term control, while prednisone offers the necessary systemic relief during severe exacerbations. Patients must be aware of potential risks, particularly adrenal suppression when transitioning from oral steroids, and other side effects like hypokalemia and hyperglycemia. Always follow your healthcare provider's instructions for tapering oral steroids and managing your maintenance therapy to ensure the safest and most effective treatment outcomes.

For more information on the proper transition from systemic corticosteroids, refer to the prescribing information provided by the FDA for Trelegy.

Frequently Asked Questions

No, you should never stop taking prednisone suddenly, especially after a long course of treatment. Your doctor must create a specific tapering schedule to prevent adrenal insufficiency and other severe side effects.

Adrenal insufficiency is a condition where the adrenal glands do not produce enough steroid hormones. It can occur when a person stops taking oral steroids and can be severe or even fatal, especially during times of physical stress.

Yes, both Trelegy and prednisone contain corticosteroids that can suppress the immune system. This increases the risk of infections like pneumonia and oral thrush. Patients should report any signs of infection to their doctor immediately.

Your doctor will monitor you for signs of adrenal suppression and potential side effects like hypokalemia and hyperglycemia. They will also adjust your prednisone dosage slowly during the transition period.

No, Trelegy is a maintenance medication for daily use. You should use a short-acting, or rescue, inhaler like albuterol for immediate relief of sudden shortness of breath or other acute symptoms.

Common side effects may include headache, flu-like symptoms, back and joint pain, and infections like oral thrush. More serious, but less common, side effects can include heart rhythm changes, high blood sugar, and low potassium.

You should inform your doctor of any heart conditions. The vilanterol in Trelegy can affect heart rate and blood pressure, and the combined use requires careful monitoring, especially for patients with a history of cardiovascular issues.