What pain reliever can I take on prednisone?

In this article:

• Pain relief on prednisone
• Safe options
• Risks and considerations
• Dosing schedule
• The bottom line

In this article

• Pain relief on prednisone
• Safe options
• Risks and considerations
• Dosing schedule
• The bottom line

Prednisone, an FDA-approved corticosteroid, works in two ways. As a glucocorticoid, it reduces inflammation for people with conditions like rashes, asthma, and rheumatoid arthritis. For those with autoimmune diseases like lupus or multiple sclerosis, prednisone suppresses the immune system from attacking healthy tissues.

If you are prescribed prednisone, you may find that it helps to relieve pain. Numerous studies have demonstrated its role in chronic pain management, reducing post-operative pain, and alleviating general joint pain.

However, prednisone might not be able to relieve all the discomfort you experience. If you still find yourself in pain, acetaminophen is considered the safest over-the-counter drug to take, though there are several other medications that may be used with caution.

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Navigating pain relief while taking prednisone

Prednisone reduces inflammation and may give you some pain relief, but it doesn’t always do the trick for everyone. That’s because prednisone isn’t a true pain reliever like the ones you probably have in your medicine cabinet right now. Prednisone doesn’t work like regular painkillers such as ibuprofen or Tylenol. Instead of blocking pain signals directly, it eases pain by calming down the body’s inflammation process, which also reduces some of the chemicals (like prostaglandins) that cause pain.

Therefore, if you have tissue damage or nerve pain, or even if you’re on a lower dose of prednisone, you might reach for a pain reliever. But which do you choose?

“When I counsel patients, I alert them to medication combinations that can worsen the side effects of a particular medication,” says Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics.com.

To find a pain reliever that has limited drug interactions with prednisone, you first need to understand the different types:

• Analgesics and antipyretics: These are drugs like Tylenol (acetaminophen), which inhibit prostaglandins to lessen mild to moderate pain, but do not target inflammation.
• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are also analgesics in that they inhibit prostaglandins, but they have the added benefit of targeting inflammation. These include Advil (ibuprofen), Motrin (ibuprofen), and Aleve (naproxen).   
• Opioids: These are the most powerful pain relievers and require a prescription; they include hydrocodone, oxycodone, and morphine, and they work by blocking pain messages from being sent to the brain. 

Prednisone does not have known interactions with acetaminophen or opioids, but it is known for having interactions with NSAIDs. If you take NSAIDs while on prednisone, you may put yourself at risk for kidney issues as well as gastrointestinal toxicity that can lead to upper GI bleeding or peptic ulcer disease.

However, several factors could elevate the risk of interactions with any of these medications, such as pre-existing health conditions, including heart, kidney, and stomach issues. Therefore, if you’re currently taking prednisone, it’s imperative to talk to your healthcare provider about any additional medication you wish to take.

Safe pain relievers to use with prednisone

You may be relieved to find out that a common, affordable, and over-the-counter drug is the safest pain medication to combine with prednisone. “The best choice of a pain reliever to use with prednisone would be acetaminophen, as it does not irritate the stomach or increase bleeding risk,” says Dr. Erika Gray.

Acetaminophen coupons

There are several brand-name drugs that contain acetaminophen. The most popular is Tylenol, whose only active ingredient is acetaminophen and is considered safe to take with prednisone. 

Be cautious with drugs that contain acetaminophen but have additional active ingredients. Some are still considered safe to take with prednisone. Tylenol PM has the added antihistamine diphenhydramine HCl, and Midol contains pyrilamine maleate, though neither of these is known to interact with prednisone. 

On the other hand, the common headache medicine Excedrin contains aspirin, which is an NSAID that may have interactions with prednisone. 

As with any other medication, sticking to a prescribed or recommended dose is crucial to avoiding side effects. The typical recommended dose of acetaminophen is 325 to 650 mg every 4 to 6 hours as needed or  1,000 mg every 6 hours for adults. Exceeding the maximum dose of acetaminophen could be problematic. One study found that people who take more than a maximum daily dose of 3,000 mg to 4,000 mg of the drug were at an increased risk of upper gastrointestinal complications. Other consequences could include liver damage.

Pain relievers to use with caution

There are two other classes of drugs that you might be considering while on prednisone. If you’re looking at taking either of these, be sure to discuss your health history as well as potential side effects with your provider.

NSAIDs

Prednisone alone can have a variety of side effects, such as stomach irritation, increased blood pressure, heightened glucose levels, bleeding, and worsening kidney function. The most likely group of pain relievers to amplify prednisone’s adverse effects are NSAIDs like ibuprofen and naproxen, explains Dr. Gray. 

“While there aren’t any pain relievers that have to be avoided on prednisone, caution should be used with NSAIDs, especially high doses taken multiple times a day, chronic NSAID usage, or combination products that contain NSAIDs,” says Dr. Gray. “These medications have a similar side effect profile as prednisone and could increase the risk of stomach bleeding, worsening kidney function, and bruising.”

Other common side effects could include stomach pain and allergic reactions. More seriously, combining the two types of drugs could put you at a heightened risk of gastrointestinal issues like ulcers. 

There are cases in which your healthcare provider may prescribe you NSAIDs while on prednisone, Dr. Gray says, because the provider feels the benefits outweigh the risks. “The key is that the medication combination is being used for a short period of time,” she explains. “Additionally, high-dose aspirin should also be used very cautiously. Prescribers will sometimes prescribe PPIs (proton pump inhibitors) to help protect the stomach if prednisone is being used long-term.”

Another important note: Not all NSAIDs may have strong interactions with prednisone. NSAIDs are also known as cyclooxygenase (COX) inhibitors. NSAIDs that target COX-1 enzymes include aspirin, ibuprofen, and naproxen. NSAIDS that target COX-2 enzymes are drugs like celecoxib. Some evidence suggests that COX-2 NSAIDs are less likely to cause GI issues when combined with corticosteroids like prednisone. 

That doesn’t mean that there is no risk at all with COX-2 NSAIDs. If you have a history of conditions like GI bleeding, heart disease, high blood pressure, platelet defects, or cirrhosis, all NSAIDs could be contraindicated as a pain reliever for you.

Opioids

For some patients, over-the-counter medications may not be enough, and something stronger may be needed to alleviate pain. There are no known interactions between corticosteroids like prednisone and prescription medication opioids like hydrocodone, oxycodone, and morphine. 

“In most cases, an individual can continue chronic pain medication such as hydrocodone or oxycodone while on prednisone, but should exercise caution,” says Elizabeth Hawes, a physician assistant at Burke Primary Care in North Carolina.

However, any time you are prescribed an opioid, experts advise proceeding with caution. As the Centers for Disease Control and Prevention points out, the use of opioids can lead to serious side effects and even fatal consequences, like overdose. “Opiates carry their own significant side effects, and your health care provider should always be consulted before combining medications,” says Dr. Gray.

How soon after taking prednisone can you take a pain reliever?

Always speak with your provider about when you should take your medications. There are some basic guidelines experts recommend, especially when combining prednisone with a pain medication.

“Because prednisone can be energizing, it is best to take it in the morning with some food,” advises Dr. Gray. “If an NSAID is needed, make sure it’s taken with food, and try to separate it from prednisone by at least two hours.”

If you’re taking acetaminophen alongside prednisone, you can generally take them at the same time, unless your provider has directed otherwise. 

“Tylenol can be taken at normally directed intervals while on prednisone and should not exceed the recommended daily maximum dose,” explains Hawes.

The bottom line

Prednisone is a powerful medication that has its own side effects, like weight gain and digestive issues. Combining it with other medications could lead to more drastic complications. If you’ve been prescribed prednisone or any other corticosteroid but still need additional pain relief, the OTC drug acetaminophen is your best bet as long as you avoid high doses. It isn’t known to have any interactions with corticosteroids.

NSAIDs like ibuprofen, aspirin, and naproxen may put you at risk of adverse effects, so approach these medications with caution. If you’re prescribed both opioids and prednisone and are under a healthcare provider’s care, it is considered safe to take those medications at the same time.

Prednisone is known to have interactions with hundreds of drugs, like cyclosporine, anticoagulants, and even some vaccines. Before you take any other medication while on prednisone, be sure to speak with your healthcare provider for medical advice.