Prednisone is a powerful corticosteroid used to treat a wide range of inflammatory and autoimmune conditions, from asthma and allergic reactions to arthritis and lupus [1.2.5]. It works by mimicking the hormone cortisol to suppress the immune system and reduce inflammation [1.6.4]. While highly effective, its potency requires careful management to minimize risks. Understanding what to avoid during treatment is a critical part of a successful and safe therapeutic outcome.
Never Stop Prednisone Abruptly
One of the most critical warnings for prednisone users is to never stop taking the medication suddenly, especially after long-term use (more than a few weeks) [1.2.5, 1.6.5]. When you take prednisone, your body's adrenal glands reduce their natural production of cortisol [1.6.1].
Stopping abruptly can lead to a state of adrenal insufficiency, where your body doesn't have enough cortisol to function properly [1.6.4]. This can trigger a range of withdrawal symptoms, including [1.6.1, 1.6.5]:
- Severe fatigue and weakness
- Body and joint pain
- Nausea and loss of appetite
- Lightheadedness or fainting due to low blood pressure
- Mood swings
A sudden stop can also cause a dangerous flare-up of the underlying condition being treated [1.6.1]. In severe cases, it can lead to a life-threatening adrenal crisis, marked by symptoms like severe vomiting, confusion, and loss of consciousness [1.6.3]. Always follow a doctor's instructions for tapering the dose, which allows your adrenal glands time to resume their normal function [1.6.2].
Avoid Live Vaccinations
Prednisone weakens the immune system, which has important implications for vaccinations [1.2.5]. While taking prednisone, especially at high doses (20 mg or more per day for over 14 days), you should not receive any "live" vaccines [1.7.3, 1.7.4].
Live vaccines contain a weakened form of the virus they are meant to protect against [1.7.1]. In a person with a suppressed immune system, these vaccines can potentially cause the very illness they are designed to prevent [1.7.2].
Examples of live vaccines to avoid include [1.7.4]:
- Measles, Mumps, and Rubella (MMR)
- Varicella (chickenpox)
- Rotavirus
- Yellow Fever
- Nasal flu (influenza) vaccine
Inactivated (non-live) vaccines, like the standard flu shot and COVID-19 vaccines, are generally considered safe, although they might be less effective because the immune response is dulled [1.7.1]. Always consult a healthcare provider before any vaccination.
Dietary and Lifestyle Adjustments
Your diet and daily habits can significantly impact how your body handles prednisone and its side effects.
Foods and Drinks to Limit or Avoid
While few foods interact directly with prednisone, certain dietary choices can worsen its side effects like fluid retention, weight gain, and high blood sugar [1.2.1, 1.3.4].
- High-Sodium Foods: Prednisone causes the body to retain sodium and lose potassium, which can lead to fluid retention, swelling, and high blood pressure [1.2.2, 1.3.1]. It is best to avoid highly processed and salty foods like chips, canned soups, pickles, and bacon [1.3.1, 1.3.3].
- Sweets and Simple Carbohydrates: Both prednisone and sugar can elevate blood glucose levels [1.3.4]. Limiting your intake of cookies, cakes, candy, sugary drinks, and honey is crucial to manage this risk, especially for individuals with diabetes [1.3.1].
- High-Fat and High-Cholesterol Foods: Prednisone can increase cholesterol levels [1.2.2]. To manage this, limit fried foods, full-fat dairy, and foods high in saturated fat [1.2.1, 1.3.4].
- Alcohol: It's recommended to avoid alcohol while taking prednisone. Both substances can suppress the immune system, irritate the stomach lining (increasing the risk of ulcers), and worsen side effects like mood swings and high blood pressure [1.2.1, 1.5.2].
- Caffeine: While not a direct interaction, the caffeine in coffee and other beverages can amplify potential side effects like insomnia, anxiety, and heartburn [1.2.1, 1.5.5].
Foods to Emphasize
To counteract some of prednisone's effects, focus on a diet rich in:
- Potassium: To replenish what's lost, include bananas, apricots, baked potatoes, oranges, and spinach [1.2.1, 1.2.2].
- Calcium and Vitamin D: Prednisone can interfere with calcium absorption, increasing the risk of osteoporosis over time [1.2.1, 1.9.2]. Consume calcium-rich foods like dairy, broccoli, and kale, and vitamin D sources like salmon and egg yolks [1.2.1].
- Lean Protein: Prednisone can increase protein breakdown, so a diet high in lean meats, fish, beans, and tofu is important [1.2.1].
Drug Interactions to Be Aware Of
Prednisone can interact with numerous other medications, altering their effectiveness or increasing the risk of adverse effects. It's vital to inform your doctor of all medications you take, including over-the-counter drugs and supplements [1.2.5].
Comparison of Common Drug Interactions
| Interacting Drug Class | Potential Effect When Combined with Prednisone | Management Strategy |
|---|---|---|
| NSAIDs (e.g., Ibuprofen, Naproxen) | Increased risk of gastrointestinal side effects, such as stomach ulcers and bleeding [1.2.1, 1.4.5]. | Avoid taking them together. Acetaminophen (Tylenol) is often a safer alternative for pain relief [1.2.4]. |
| Diuretics ("Water Pills") | Both can decrease potassium levels, increasing the risk of hypokalemia (low potassium) [1.2.1, 1.2.4]. | Your doctor may monitor potassium levels and recommend a supplement if needed [1.2.4]. |
| Blood Thinners (e.g., Warfarin) | The effect can be unpredictable; prednisone may increase or decrease the anticoagulant effect, raising the risk of either bleeding or clots [1.2.4]. | Frequent blood tests (INR checks) are necessary to monitor and adjust dosage [1.4.5]. |
| Diabetes Medications (e.g., Metformin) | Prednisone can raise blood sugar, making diabetes drugs less effective [1.2.4]. | Blood glucose levels should be monitored closely, and the diabetes medication dosage may need to be adjusted [1.2.1]. |
| Certain Antibiotics/Antifungals | Some drugs (like clarithromycin, ketoconazole) can slow the breakdown of prednisone, increasing its levels and side effects. Others (like rifampin) can make prednisone less effective [1.2.4, 1.4.5]. | Your doctor may need to adjust your prednisone dose accordingly [1.2.4]. |
| Other Immunosuppressants | Taking other drugs that suppress the immune system increases the overall risk of infection [1.2.1]. | Close monitoring for signs of infection (fever, cough) is essential [1.2.4]. |
Other Precautions
- Avoid exposure to infections: Because your immune system is suppressed, try to avoid being near people who are sick, especially with contagious illnesses like chickenpox or measles, which can be severe or even fatal for someone on steroids [1.5.2, 1.7.4].
- Inform all healthcare providers: Always wear a medical alert tag or carry an ID card stating that you take prednisone. Any doctor, dentist, or emergency provider who treats you needs to be aware [1.2.5].
Conclusion
Prednisone is a highly beneficial medication, but its use requires significant caution and awareness. The most critical rules are to never stop treatment abruptly and to avoid live vaccines. Beyond these, managing your diet to limit sodium and sugar, avoiding alcohol, and being vigilant about potential drug interactions are key to minimizing side effects. By working closely with your healthcare provider and understanding what you shouldn't do on prednisone, you can navigate your treatment safely and effectively.
For more information, you can consult with your healthcare provider or visit Drugs.com [1.2.5].
