Prednisone alternatives: What can I take instead of prednisone?

Creator: SingleCare
Published: 2022-07-25T14:18:51-04:00

Prednisone doesn't work for everyone. Dexamethasone, methotrexate, mycophenolate, mercaptopurine, azathioprine, and leflunomide are some prednisone alternatives. Get the full list here.

By Daniel Cardin, Pharm.D. | Jul. 25, 2022

Prednisone is a generic prescription drug that treats a broad range of diseases and medical conditions by suppressing the body’s immune response. While the immune system defends our body from infections and cancer, it can also cause health problems if not regulated properly. Common diseases that arise from improper immune activity include inflammatory and autoimmune diseases.

Prednisone can cause troublesome side effects in the short term, such as fluid retention, round face (moon face), increased risk of infection, high blood pressure, cortisol insufficiency, and others. When taken for long durations, prednisone can cause more serious adverse effects such as glaucoma, cataracts, diabetes, thinning of the skin, susceptibility to bruising, Cushing’s syndrome, and osteoporosis. These side effects may be particularly problematic for patients who have pre-existing risks or health conditions such as osteoporosis, heart failure, hypertension, diabetes, glaucoma, or cataracts.

Despite its side effects, prednisone is an effective treatment for many diseases and might not always have a suitable replacement. In many cases, however, an adjunct agent can be used with prednisone to reduce the strength and duration of prednisone therapy. These are referred to as “steroid-sparing” agents. This article will discuss prednisone alternatives and steroid-sparing treatments that can reduce the dose of prednisone for patients with specific conditions.

What can I take in place of prednisone?

The table below lists common therapies that can replace prednisone or can be used as an adjunct therapy to reduce the cumulative dose of prednisone. Some common uses, side effects, and dosing regimens are listed for each agent.

Compare prednisone alternatives
Drug name	Uses	Dosage	Savings options
Prednisone	Asthma COPD exacerbation Adrenal insufficiency Multiple sclerosis Rheumatic conditions Dermatitis Sarcoidosis Allergic reactions Idiopathic pulmonary fibrosis Multiple myeloma Hodgkin’s lymphoma Systemic lupus erythematosus Lupus nephritis Leukemia Organ transplant rejection Others	COPD exacerbation: 40 mg daily for 5 days Asthma exacerbation: 1-2 mg/kg daily for 5 days MS: 1250 mg daily for 3-5 days Adrenal insufficiency: 4-5 mg /m2 daily Other corticosteroid-responsive diseases: 5-60 mg daily	Prednisone coupons
Dexamethasone	Adrenal insufficiency Asthma exacerbation Multiple myeloma Myasthenia gravis Inflammatory bowel disease (IBD) Hodgkin’s lymphoma Non-Hodgkin’s lymphoma Leukemia Multiple sclerosis Chemotherapy-related nausea/vomiting Allergic disorders Anaphylactic shock Cerebral edema Kidney transplant rejection Graft-versus-host disease (GVHD) Rheumatic disorders Dermatitis T-cell lymphoma Psoriasis Immune thrombocytopenic purpura (ITP) Others	Adrenal insufficiency: 0.03-0.15 mg/kg orally daily Other corticosteroid-responsive conditions: 0.75-9 mg orally daily Asthma exacerbation: 0.3-0.6 mg/kg daily for 1-5 days Multiple myeloma: 20-40 mg daily on specified cycle days Anaphylactic shock: 1 -6 mg/kg IV or 40 mg IV every 4-6 hours Transplant rejection: 0.5-9 mg IV or IM daily in divided doses Rheumatic disorders: 0.75-9 mg by mouth daily in divided doses	Dexamethasone coupons
Methotrexate	Leukemia T-cell lymphoma Non-Hodgkin’s lymphoma CNS lymphoma Osteosarcoma Breast cancer Squamous cell head/neck cancer Lung cancer Rheumatoid arthritis Psoriasis Polyarticular juvenile idiopathic arthritis Crohn’s disease SLE Others	Acute lymphocytic leukemia: 10-5000 mg/m2 IV on specified cycle days T-cell lymphoma: 25-75 mg by mouth every week Non-Hodgkin’s lymphoma – 1000 mg/m2 IV on specific cycle days CNS lymphoma: 8000 mg/m2 IV on specific cycle days Breast cancer: 40 mg/m2 IV on days 1 and 8 of a 28-day cycle Head/neck cancer: 40-60 mg/m2 IV or IM on specified cycle days Rheumatoid arthritis: 7.5-25 mg weekly Psoriasis: 7.5-25 mg weekly Crohn’s disease: 15 mg subcutaneously or intramuscularly each week	Methotrexate coupons
Mycophenolate	Prevention of kidney, liver, or heart transplant rejection Rheumatoid arthritis GVHD Lupus nephritis Atopic dermatitis Myasthenia gravis Uveitis Pemphigus Psoriasis Systemic lupus erythematosus (SLE) Others	Kidney transplant: 1 g by mouth or IV twice daily Heart or liver transplant: 1.5 g by mouth or IV twice daily Lupus nephritis: 2-3 gram orally daily SLE: 0.5 – 2 g orally daily Psoriasis: 1 – 1.5 g orally twice daily Rheumatoid arthritis: 2 g orally daily Atopic dermatitis, pemphigus, myasthenia gravis, and psoriasis: 1 gram orally twice daily	Mycophenolate coupons
Mercaptopurine	Leukemia IBD (Crohn’s disease and ulcerative colitis)	Acute lymphocytic leukemia: 2.5-5 mg/kg daily Crohn’s disease and ulcerative colitis: Start at 50 mg daily with a max of 1.5 mg/kg daily	Mercaptopurine coupons
Azathioprine	Prevention of kidney transplant rejection Rheumatoid arthritis IBD (Crohn’s disease and ulcerative colitis) Behcet’s syndrome Lupus nephritis SLE Myasthenia gravis Dermatomyositis Autoimmune hepatitis Idiopathic pulmonary fibrosis Atopic dermatitis Psoriasis Thiopurine methyltransferase (TPMT) Others	Prevention of kidney transplant rejection: 1-3 mg/kg daily Rheumatoid arthritis: 1-2.5 mg/kg daily Crohn’s disease and ulcerative colitis: 100-250 mg by mouth daily Lupus nephritis: 2 mg/kg by mouth daily SLE: 2-3.5 mg/kg by mouth daily	Azathioprine coupons
Leflunomide	Rheumatoid arthritis Juvenile idiopathic arthritis	Rheumatoid arthritis: 10-20 mg by mouth daily. Loading dose of 100 mg by mouth daily x 3 days Juvenile idiopathic arthritis: 10-20 mg by mouth once daily based on weight	Leflunomide coupons

Other alternatives to prednisone

Remicade (infliximab)
Enbrel (etanercept)
Humira (adalimumab)
Tocilizumab
Dupixent (dupilumab) for severe asthma
Fasenra (benralizumab)
Cinqair (reslizumab)
Xolair (omalizumab)
Lupkynis (voclosporin)

NSAIDs

Patients 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 the treatment of arthritis, but if symptoms are adequately controlled with NSAIDs, patients may not need to take oral corticosteroids. Common over-the-counter anti-inflammatory drugs for arthritis include ibuprofen, naproxen, and diclofenac gel. It is important to seek advice from your pharmacist or healthcare provider when using over-the-counter treatments in conjunction with prescriptions as certain drug interactions may occur.

Top 6 prednisone alternatives

1. Dexamethasone

Dexamethasone is a suitable alternative to prednisone for the treatment of acute asthma. In general, dexamethasone is better tolerated and requires a shorter course of therapy (five days of prednisone versus one to five days of dexamethasone). Dexamethasone is approximately six times as potent as prednisone, and a single dose is longer acting. Therefore, fewer doses are required compared with prednisone.

A study in 2009 showed that two days of dexamethasone had similar efficacy to five days of prednisone and patients on dexamethasone had better compliance and fewer side effects.

A study in 2017 also demonstrated that two doses of dexamethasone are as effective as five days of prednisone in children with asthma exacerbation admitted to the emergency department.

A meta-analysis in 2019 concludes that dexamethasone is associated with less vomiting compared to prednisone when used for asthma exacerbations.

Finally, dexamethasone is available in more dosage forms than prednisone. While prednisone is only available as an oral tablet, dexamethasone is available as a tablet or solution, and can be injected via the intravenous, subcutaneous, or intramuscular route.

2. Methotrexate

Methotrexate is used as a steroid-sparing agent for many diseases. Methotrexate belongs to a class of drugs called DMARDs, or disease-modifying antirheumatic drugs. It is common to use DMARDs like methotrexate to reduce prednisone doses and allow for earlier discontinuation of prednisone.

Methotrexate is considered a steroid-sparing treatment for many forms of arthritis such as giant cell arteritis, juvenile idiopathic arthritis, rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatica, etc. Methotrexate is also commonly used as a steroid-sparing agent in the treatment of uveitis.

Methotrexate may be a viable steroid-sparing agent for myasthenia gravis, although azathioprine is better studied and more commonly used for this purpose. A 2021 study demonstrated that patients with myasthenia gravis who are treated with methotrexate had significant improvement in disease activity and reduced prednisone dosages.

3. Mycophenolate

Mycophenolate is one of the most common DMARDs for treating lupus. Two studies demonstrated that lupus patients taking mycophenolate and voclosporin could achieve clinical response while using much lower doses of oral prednisone. In fact, these two trials had the lowest peak steroid doses and faster steroid tapering than any other lupus nephritis trial. In patients with lupus without renal involvement, mycophenolate was shown to be superior to azathioprine when combined with steroids, and thus may be a better option than azathioprine for reducing prednisone doses.

Mycophenolate can be used to reduce steroid use in many different inflammatory and immune diseases other than lupus. Mycophenolate has similar steroid-sparing effects as methotrexate when used for uveitis. In a systematic review of 18 studies, 89% of patients with idiopathic inflammatory myopathies decreased their dose of steroids after starting mycophenolate and 88% showed improvement in disease activity and experienced mild side effects. In a head-to-head study comparing mycophenolate and azathioprine for the treatment of pemphigus, patients taking mycophenolate required significantly lower steroid dose to achieve clinical remission compared to patients taking azathioprine.

4. Mercaptopurine

Mercaptopurine may be a great option to reduce prednisone doses in patients with inflammatory bowel disease. The brand name of mercaptopurine is Purinethol.

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 of Crohn’s disease, they should be used at the lowest effective dose and duration needed to induce remission, so that patients can avoid serious side effects of prednisone that can occur with long-term use. Multiple studies have demonstrated that patients taking mercaptopurine in addition to steroids are able to achieve and maintain remission of Crohn’s disease while using lower doses of steroids, compared to patients who only received steroids.

5. Azathioprine

Azathioprine is another DMARD that can reduce steroid doses in patients with inflammatory bowel disease. It is often used along with infliximab for this purpose.

Azathioprine may also be used to reduce the use of steroids in patients with myasthenia gravis. A study comparing methotrexate and azathioprine in patients with myasthenia gravis demonstrated that both drugs had a similar degree of steroid-sparing effects.

Azathioprine may also be effective at reducing the cumulative steroid dose in patients with giant cell arteritis, although data is mostly limited to case studies. Azathioprine may effectively lower the need for steroids in patients with recurrent pericarditis. In one study, 84.7% of patients responded to treatment with azathioprine and were able to completely suspend steroid treatment after 4-12 months.

6. Leflunomide

Leflunomide is an effective steroid-sparing agent for various kinds of arthritis. In a small 2013 study, lower steroid doses were required in patients with polymyalgia rheumatica and giant cell arteritis after taking leflunomide. Leflunomide is also an effective steroid-sparing option for patients with pulmonary sarcoidosis.

Another lung disease, chronic hypersensitivity pneumonitis (cHP), may be treated with leflunomide in some cases. A 2020 study showed that leflunomide had a significant steroid-sparing effect—half of the patients discontinued prednisone entirely.

In patients with inflammatory diseases related to IgG4 antibodies (collectively known as IgG4-related disease), leflunomide can lower the cumulative dose of steroids needed to achieve and maintain remission. Adding leflunomide to steroid therapy can also shorten the time to complete response and maintain a longer duration of remission compared to steroids alone.

Natural alternatives to prednisone

Antioxidants and anti-inflammatory supplements

Natural remedies are not a replacement for prednisone, but they may work alongside prednisone to help fight inflammation. Antioxidants such as flavonoids and carotenoids protect tissue from damage by reactive oxygen species and other free radicals. They may have an even stronger effect when taken together. By preventing tissue damage, these antioxidants prevent unwanted inflammatory responses from occurring. Other anti-inflammatory supplements such as omega-3 fatty acids, zinc, and turmeric (curcumin) fight inflammation that is already present. They provide the building blocks of natural molecules our body needs to resolve inflammation.

Eliminate inflammatory foods

Avoid inflammatory foods such as margarine, corn oil, deep-fried foods, and processed food products to reduce inflammation. It is well known that refined sugar and simple carbohydrates like white four, white rice, and high fructose corn syrup contribute to chronic inflammation. Replace these processed items with plant-based foods that are high in fiber, like fruits, vegetables, and whole grains.

Drink more water

Staying hydrated helps our bodies clear out toxins. When metabolic waste products and toxins accumulate in the body, they contribute significantly to inflammation. Thus, it is important to replace the body’s fluids regularly as they become laden with toxins. Perhaps the most obvious example of this effect is when dehydration leads to higher concentrations of uric acid, triggering a gout flare.

Water also has a lubricating effect on joints. Synovial fluid provides a cushion at the joints to prevent bones from coming into contact. When we become dehydrated our synovial fluid does not provide as much lubrication. A deficiency of synovial fluid can lead to damage and inflammation of the joints.

Exercise smart

According to a recent study, patients aiming to reduce inflammation should avoid long endurance exercise as it can contribute to chronic inflammation. Instead, opt for moderately intense exercise with frequent resting periods. Another study in 2017 concluded that 20 minutes of moderate exercise is sufficient to produce an anti-inflammatory response.

Manage stress

It is no secret that stress leads to many health problems. That is why rest and relaxation are key to lowering inflammation. Not sleeping enough has immediate pro-inflammatory effects. A healthy lifestyle should include eight hours of regular sleep each night. See our guide to improving sleep.

Chronic stress contributes to chronic diseases by contributing to inflammation. When we are emotionally or psychologically stressed, we go into the “fight-or-flight” response. During this state, the body releases stress hormones cortisol and adrenaline. It also releases pro-inflammatory molecules called cytokines. These molecules plan an important role in fighting off different forms of danger, but when they are chronically released into the body, they can wreak havoc.

To combat chronic stress, practice yoga or some form of meditation. This could be as simple as writing your thoughts down in a journal, discussing your concerns with a friend, or taking a nature walk.

How to switch to a prednisone alternative

The first step to replacing prednisone is discussing alternatives with a healthcare provider. Prednisone should not be stopped abruptly or without medical advice. A doctor will gradually lower a patient’s dose of prednisone before stopping it altogether. This is called a dose taper. A prescriber will determine how long a taper should last based on the patient’s treatment history. Patients who have been on high doses or long courses of prednisone will need more gradual tapers.

RELATED: Prednisone dosage

Additionally, a doctor will assess whether a patient’s disease is adequately controlled on lower doses of prednisone. The steroid-sparing agents discussed above help treat disease so that less prednisone is required to control symptoms. In some cases, a doctor may determine that it is not safe to lower a patient’s dose of prednisone.

The lifestyle modifications and health information listed above may help mitigate disease systems, possibly allowing for lower doses of prednisone. Ask a doctor about the recommendations and alternatives in this article if you are interested in switching to a low dose prednisone or replacing prednisone with a different treatment. SingleCare can provide you with coupons that can help save up to 80% off on many prescriptions available at your local pharmacy.