Is Prednisone Good for Altitude Sickness? A Guide to Its Use and Alternatives

October 8, 2025 •

4 min read

According to a 2002 study published in PubMed, low-dose prednisolone was shown to significantly reduce the daily symptoms of acute mountain sickness (AMS) compared to a placebo group. However, with other options available, is prednisone good for altitude sickness? This article explores its role, its effectiveness compared to alternatives, and the critical risks to consider before use.

Quick Summary

This article explains the use of prednisone for altitude sickness, examining its effectiveness for prophylaxis and comparing it with first-line medications like acetazolamide and other steroids such as dexamethasone.

Key Points

Not First-Line Treatment: Prednisone is not the primary medication for preventing or treating altitude sickness; acetazolamide (Diamox) is the preferred choice for AMS prophylaxis.
Effective for AMS Prophylaxis: Studies show prednisolone can significantly reduce symptoms of mild Acute Mountain Sickness (AMS) during rapid ascent.
Used as an Alternative: Prednisone may be considered for AMS prevention if acetazolamide is contraindicated, for example, due to a sulfa allergy.
Masks Symptoms, Doesn't Acclimatize: Unlike acetazolamide, prednisone suppresses the body's inflammatory response rather than speeding up the physiological process of acclimatization.
Dexamethasone is Preferred for Severe Cases: For treating severe altitude illness like High-Altitude Cerebral Edema (HACE), dexamethasone is the standard corticosteroid used, not prednisone.
Potential for Rebound Effect: Discontinuing prednisone at a high altitude before acclimatization is complete can cause a rebound of symptoms.
Notable Side Effect Profile: Prednisone carries significant risks, including mood changes, gastrointestinal issues, and adrenal suppression with prolonged use.

Understanding Altitude Sickness and Corticosteroids

Altitude sickness, or Acute Mountain Sickness (AMS), affects individuals who ascend to high altitudes too quickly, preventing proper acclimatization. Symptoms, including headache, nausea, fatigue, and dizziness, can range from mild to severe. For many years, certain corticosteroids have been used to manage and prevent these symptoms, primarily due to their strong anti-inflammatory properties. Prednisone is one such glucocorticoid, but its use for altitude sickness is not as straightforward as using first-line medications.

How Prednisone Functions for Altitude Sickness

Prednisone, and its active metabolite prednisolone, works by suppressing the body's inflammatory and immune responses. This mechanism is believed to counteract the inflammatory processes that contribute to the swelling (edema) of the brain and lungs that characterize severe altitude sickness. By reducing this swelling, prednisone can alleviate symptoms such as headache and nausea. Unlike acetazolamide, which promotes the physiological process of acclimatization by increasing breathing rate and altering blood chemistry, prednisone primarily masks the symptoms of altitude illness. This difference is crucial, as it means prednisone treats the symptoms without addressing the underlying cause of the body's struggle to adapt to low oxygen levels.

Prednisone's Efficacy for Preventing Acute Mountain Sickness (AMS)

Clinical research has demonstrated that prednisolone can be effective as a prophylactic agent for AMS, especially in situations of rapid ascent. A study of healthy men exposed to a high altitude environment found that prednisolone significantly reduced AMS scores compared to placebo. This suggests that prednisone can be a useful tool for preventing or mitigating the onset of mild-to-moderate AMS symptoms. However, its use is typically reserved for cases where the first-line medication, acetazolamide, is contraindicated, such as in individuals with a severe sulfa allergy.

Comparison of Medications for Altitude Sickness

For trekkers and climbers, choosing the right medication is vital. Prednisone is not the only option and is often compared to more standard treatments.

Comparison Table: Prednisone vs. Standard Altitude Sickness Medications


Characteristic	Acetazolamide (Diamox)	Dexamethasone	Prednisone (Prednisolone)
Mechanism	Hastens acclimatization by increasing respiratory drive	Reduces cerebral edema and inflammation	Reduces cerebral edema and inflammation
Primary Use	Prevention and treatment of mild to moderate AMS	Treatment of severe AMS, HACE, and HAPE	Prophylaxis for AMS (less common)
Effectiveness	High efficacy for acclimatization	High efficacy for treating severe illness	Moderate efficacy for AMS prophylaxis
Side Effects	Common (paresthesia, increased urination), generally mild	Significant risks (mood changes, GI issues), especially with long-term use	Significant risks (mood changes, GI issues), especially with long-term use
Rebound Effect	No known rebound effect	Potential rebound effect upon cessation at altitude	Potential rebound effect upon cessation at altitude

Treatment of Severe Altitude Illnesses: HACE and HAPE

In the case of severe altitude illnesses—High-Altitude Cerebral Edema (HACE) and High-Altitude Pulmonary Edema (HAPE)—the standard corticosteroid treatment is dexamethasone, not prednisone. Dexamethasone is the medication of choice due to its effectiveness in reducing cerebral edema. While prednisone has a similar mechanism, clinical practice and guidelines favor dexamethasone for these life-threatening conditions, always in conjunction with immediate descent and supplemental oxygen where available. There is insufficient evidence to recommend prednisone as the primary treatment for HAPE.

Important Risks and Side Effects of Prednisone

Prednisone is a powerful medication with a notable side effect profile, especially with higher doses or prolonged use. Side effects can include:

Gastrointestinal issues: Indigestion, nausea, and in more severe cases, gastrointestinal bleeding.
Mood and neurological changes: Irritability, agitation, mood swings, and insomnia.
Fluid retention: Swelling of the hands, feet, or ankles due to water retention.
Metabolic effects: Increased blood sugar levels, which is a particular concern for diabetic individuals.
Adrenal suppression: Long-term use can suppress the body's natural production of steroids, requiring a slow tapering of the dose to prevent withdrawal symptoms.

Unlike acetazolamide, which helps the body acclimatize, corticosteroids like prednisone can cause a rebound of symptoms if discontinued abruptly at a high altitude before full acclimatization has occurred. This makes it a less desirable option for prophylaxis compared to acetazolamide.

Conclusion: When to Consider Prednisone

So, is prednisone good for altitude sickness? The answer is nuanced. While research shows it can be effective for preventing mild AMS, it is not the first-line choice for most situations. Acetazolamide is widely preferred for its ability to promote acclimatization and its generally milder side effect profile. For the treatment of severe AMS and HACE, dexamethasone is the standard corticosteroid used. Prednisone might be considered as an alternative for AMS prophylaxis if acetazolamide is contraindicated or unavailable, but this decision should always be made in consultation with a healthcare professional. Ultimately, the best strategy is a slow, gradual ascent to allow for natural acclimatization.

The Importance of Proper Acclimatization

The most effective prevention strategy for altitude sickness is a gradual ascent. Key non-pharmacological methods include:

Ascend slowly: Plan your itinerary to ascend to higher elevations gradually, allowing your body time to adapt.
Stay hydrated: Drink plenty of water to counteract the dehydrating effects of high altitude.
Avoid alcohol and sedatives: These substances can suppress breathing and worsen symptoms.
"Climb high, sleep low": This classic mountaineering strategy involves ascending to a higher altitude during the day and descending to a lower altitude to sleep.

For more comprehensive guidelines on high-altitude travel and medication, a highly recommended resource is the CDC's "Yellow Book" section on High-Altitude Travel and Illness.

Final Medical Consultation

Anyone planning a trip to a high-altitude destination should consult their doctor to discuss the risks of altitude sickness and determine the most appropriate prophylaxis strategy. Never self-prescribe medication for altitude illness without professional guidance.

Frequently Asked Questions

Dexamethasone is generally the preferred corticosteroid for the treatment of severe altitude illness like HACE, while prednisone is sometimes considered for the prophylaxis of AMS. Dexamethasone is more potent and often acts faster, making it the standard for severe cases.

No, prednisone does not cure altitude sickness. It helps reduce the severity of symptoms by decreasing inflammation but does not address the underlying issue of poor acclimatization.

The specific dosage and administration schedule must be determined by a qualified healthcare provider. Self-dosing is not recommended.

Common side effects of prednisone include indigestion, nausea, increased appetite, and mood changes. More serious side effects can occur with higher doses or prolonged use.

No, stopping prednisone abruptly at high altitude can lead to a rebound of symptoms. A gradual descent is necessary before discontinuing the medication, and a physician should supervise the tapering if it has been used for more than a few days.

Acetazolamide is the preferred medication because it promotes the body's natural acclimatization process, addressing the root cause of altitude sickness. Prednisone only masks the symptoms and carries a greater risk of side effects and rebound effect.

You should see a doctor before any trip to high altitude, especially if considering medication. A doctor can evaluate your health, discuss your travel plans, and determine if prednisone is an appropriate prophylactic option, especially if you cannot take acetazolamide.