Prednisone alternatives: What can I take instead of prednisone?

In this article:

• What can I take instead of prednisone?
• Top 5 prednisone alternatives
• Over-the-counter NSAIDs
• Biologic agents
• Natural alternatives to prednisone
• How to switch to a prednisone alternative
• How to choose the right treatment

In this article

• What can I take instead of prednisone?
• Top 5 prednisone alternatives
• Over-the-counter NSAIDs
• Biologic agents
• Natural alternatives to prednisone
• How to switch to a prednisone alternative
• How to choose the right treatment

Prednisone is a generic prescription drug approved by the FDA to treat a broad range of conditions by suppressing the body’s immune response. Common conditions that arise from improper immune activity include inflammatory and autoimmune diseases, such as psoriasis or rheumatoid arthritis. While prednisone is effective for many people, it may not be the best option for everyone due to side effects, drug interactions, or lack of effect. In some cases, a healthcare provider may add another agent alongside prednisone to reduce the dose or duration needed, or switch to a different treatment altogether.

What can I take instead of prednisone?

Prednisone belongs to a class of drugs called corticosteroids. Other corticosteroids, such as dexamethasone, treat similar inflammatory conditions. Other drug classes, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic agents, are also FDA-approved for some of the same conditions as prednisone.

The right alternative depends on the condition being treated. Consult your healthcare provider to determine which option is most appropriate for you. The table below covers the most common prednisone alternatives.

Prednisone alternatives cost comparison
Drug name	Price without insurance	SingleCare price	Savings options
Prednisone	$155 for 10, 20 mg tablets	$3 for 10, 20 mg tablets for generic prednisone at Walmart	See latest prices
Dexamethasone	$28 for 10, 4 mg tablets	$5 for 10, 4 mg tablets of generic dexamethasone at Walmart	See latest prices
Methotrexate	$104 for 24, 2.5 mg tablets	$15 for 24, 2.5 mg tablets of generic methotrexate at Food Lion	See latest prices
CellCept (mycophenolate)	$1,344 for 60, 500 mg tablets	$22 for 60, 500 mg tablets of generic mycophenolate at Food Lion	See latest prices
Mercaptopurine	$310 for 30, 50 mg tablets	$31 for 30, 50 mg tablets of generic mercaptopurine at CVS Pharmacy	See latest prices
Imuran (azathioprine)	$328 for 30, 50 mg tablets	$8 for 30, 50 mg tablets of generic Imuran at Walmart	See latest prices

Top 5 prednisone alternatives

1. Dexamethasone

Dexamethasone is a suitable alternative to prednisone for the treatment of acute asthma. In general, it is better tolerated and requires a shorter course of therapy, five days of prednisone compared to one to five days of dexamethasone. Dexamethasone is approximately six times as potent as prednisone and is longer acting, so fewer doses are needed.

A 2009 study showed that two days of dexamethasone had similar effectiveness to five days of prednisone, with better patient compliance and fewer side effects. A 2017 study found the same in children with asthma exacerbation admitted to the emergency department. A 2019 meta-analysis also found that dexamethasone was associated with less vomiting than prednisone for asthma exacerbations.

RELATED: Dexamethasone side effects | Dexamethasone vs. prednisone

2. Methotrexate

Methotrexate belongs to a class of drugs called disease-modifying antirheumatic drugs (DMARDs), which can allow healthcare providers to reduce prednisone doses and avoid long-term corticosteroid use. It is commonly used as a steroid-sparing agent for many forms of arthritis, including giant cell arteritis (inflammation of the blood vessels in the head and scalp), juvenile idiopathic arthritis, rheumatoid arthritis, and systemic lupus erythematosus (a chronic autoimmune disease affecting multiple organs). It is also used for uveitis (inflammation of the middle layer of the eye).

Methotrexate may also be a viable steroid-sparing agent for myasthenia gravis (a condition that causes muscle weakness), though azathioprine is more commonly used for this purpose. A 2021 study found that people with myasthenia gravis treated with methotrexate had significant improvement in disease activity and reduced prednisone dosages.

RELATED: Methotrexate side effects and how to avoid them

3. Mycophenolate

Mycophenolate is an important treatment for systemic lupus. Two studies demonstrated that people with lupus taking mycophenolate and voclosporin (an immunosuppressant) could achieve clinical response while using much lower doses of prednisone. 

Mycophenolate can also reduce steroid use in other inflammatory and immune diseases. A 2023 study found it has similar steroid-sparing effects as methotrexate for uveitis. In a systematic review of 18 studies, 89% of patients with idiopathic inflammatory myopathies (inflammatory muscle diseases) decreased their steroid dose after starting mycophenolate, and 88% showed improvement in disease activity. In a head-to-head study comparing mycophenolate and azathioprine for pemphigus (a rare autoimmune skin condition), patients taking mycophenolate required significantly lower steroid doses to achieve remission.

4. Mercaptopurine

Mercaptopurine may help reduce prednisone doses in people with inflammatory bowel disease (IBD). According to the Crohn’s & Colitis Foundation, mercaptopurine can help maintain remission of Crohn’s disease and reduce the long-term need for steroids. While steroids are effective at achieving remission, they should be used at the lowest effective dose and for the shortest duration necessary to avoid serious long-term side effects. Multiple studies have shown that people taking mercaptopurine alongside steroids can maintain remission of Crohn’s disease while lessening the need for steroids.

RELATED: IBD vs IBS: Which one do I have?

5. Azathioprine

Azathioprine is FDA approved to treat active rheumatoid arthritis in people who haven’t had success with other medications. It can be used alongside a corticosteroid or NSAID. It is also an immunosuppressant that can reduce steroid doses in people with inflammatory bowel disease, often used alongside infliximab for this purpose.

Azathioprine may also help reduce steroid use in people with myasthenia gravis. A study comparing methotrexate and azathioprine in people with myasthenia gravis found that both drugs had a similar degree of steroid-sparing effects.

Azathioprine may also be effective at reducing steroid doses in people with giant cell arteritis, though data are mostly limited to case studies. It may also lower the need for steroids in people with recurrent pericarditis (recurring inflammation around the heart). In one study, 84.7% of people responded to azathioprine treatment and were able to stop steroid treatment entirely after 4 to 12 months.

Over-the-counter NSAIDs

People with arthritis may be able to use NSAIDs instead of prednisone if their disease activity is not too severe. NSAIDs are not as effective as steroids for arthritis, but if symptoms are adequately controlled, oral corticosteroids may not be needed. Over-the-counter options include ibuprofen, naproxen, and diclofenac gel. Always consult a pharmacist or healthcare provider before combining over-the-counter treatments with prescription medications, as drug interactions may occur.

Biologic agents

Biologic agents, such as Humira and Enbrel, play a significant role in treating autoimmune conditions and can be used as a steroid-sparing treatment. Given by subcutaneous injection, these drugs block an inflammatory protein called tumor necrosis factor (TNF). As DMARDs, biologic agents can limit the damaging effects of diseases like rheumatoid arthritis while sparing people the long-term consequences of taking prednisone or other corticosteroids. They are generally more effective than older treatments but carry a higher risk of side effects. The immune suppression they cause can be considerable, requiring careful testing before starting treatment and frequent monitoring during therapy.

Natural alternatives to prednisone

Antioxidants and anti-inflammatory supplements

Natural remedies are not replacements for prednisone, but some may help reduce inflammation when used alongside it. Anti-inflammatory supplements such as omega-3 fatty acids, zinc, and turmeric (curcumin) help fight existing inflammation by supporting the body’s natural anti-inflammatory processes.

RELATED: 14 health benefits of turmeric

Eliminate inflammatory foods

Certain foods are known to promote inflammation, including margarine, corn oil, deep-fried foods, refined sugar, simple carbohydrates like white flour and white rice, and high-fructose corn syrup. Replacing these with plant-based, high-fiber foods such as fruits, vegetables, and whole grains may help reduce chronic inflammation.

Drink more water

Staying hydrated helps the body clear out metabolic waste products that can contribute to inflammation. For example, dehydration can lead to higher concentrations of uric acid, which may trigger a gout flare.

Exercise smart

Research suggests that long-endurance exercise can contribute to chronic inflammation. Instead, opt for moderately intense exercise with frequent rest periods. A 2017 study found that just 20 minutes of moderate exercise is sufficient to produce an anti-inflammatory response.

RELATED: Can I exercise while on prednisone?

Manage stress

Stress can contribute to inflammation and a range of health problems. Rest and relaxation are key. Not sleeping enough has immediate pro-inflammatory effects. Aim for eight hours of sleep each night. To combat chronic stress, try yoga, meditation, journaling, talking with a friend, or taking a nature walk.

RELATED: How to get to sleep when you’re in survival mode

How to switch to a prednisone alternative

Never stop taking prednisone abruptly or without medical guidance. Doing so can lead to dangerous side effects. A healthcare provider will gradually reduce the dose through a process called tapering, the length of which depends on how long and at what dose prednisone was taken.

RELATED: Prednisone dosage

A healthcare provider will also assess whether the underlying condition is adequately controlled on lower doses. The steroid-sparing agents discussed above can help manage symptoms so that less prednisone is needed. In some cases, lowering the dose may not be safe.

The lifestyle modifications above may also help manage symptoms and support a lower prednisone dose. Talk to your healthcare provider about the alternatives in this article. A free SingleCare prescription discount card can help lower the cost of alternative prescriptions.

Choosing the right path for treatment of inflammatory and autoimmune conditions

There are no perfect alternatives to prednisone. Every option has advantages and disadvantages, and the right choice depends on your condition, health history, and other medications. Always discuss any changes with your healthcare provider, who can review potential drug interactions and help develop a treatment plan that works best for you, which may or may not include continuing prednisone.