• Experts don't yet know all the potential side effects of combining prednisone and alcohol. 
  • Mixing the two may raise your risk of health conditions like osteoporosis and high blood pressure. 
  • Your doctor may recommend limiting alcohol use or avoiding alcohol while taking prednisone.

Prednisone and alcohol can each increase your risk of certain health conditions like osteoporosis, pancreatitis, and high blood pressure. 

Both prednisone and alcohol can also irritate and reduce your stomach's protective lining, which could increase your chances of gastrointestinal (GI) bleeding.

In short, regularly mixing the two isn't going to do your body any favors, and some healthcare professionals may recommend you avoid mixing them altogether.

That said, the little research that exists suggests drinking a small amount of alcohol while taking prednisone may not always have negative health effects. 

Still, an interaction between alcohol and prednisone may not always be obvious. So, if you do drink occasionally while taking prednisone, it's essential to pay attention to your health so you can catch any recurring or worsening issues.

Read on to learn more about the potential side effects of drinking alcohol while taking prednisone and what to do if you notice a reaction.

How might alcohol and prednisone interact?

If you look at your medication's warning label, you probably won't notice alcohol on the list of drugs to avoid. To date, few studies have explored the interactions between prednisone and alcohol, so the actual risk level remains unknown.

Still, some professionals caution against heavy drinking if you've been taking prednisone long-term. They fear combining both drugs could worsen side effects, including the following:

Osteoporosis

Long-term use of prednisone can cause bone loss, most of which occurs during the first three to six months of treatment. Among people who take GCs, 10% eventually get a fracture. 

Heavy alcohol use is also associated with bone loss. Compared to people who don't consume alcohol, those who have at least two drinks a day had 63% more risk of developing osteoporosis, according to a 2019 review.

Therefore, it's likely that if you regularly mix prednisone and alcohol, you could increase your risk of bone loss and osteoporosis. 

Pancreatitis

Pancreatitis refers to inflammation in your pancreas. This organ plays an important role in digestion and helps turn your food into energy. Acute pancreatitis symptoms include abdominal pain, fever, and vomiting.

Up to one in four cases of acute pancreatitis are caused by heavy, chronic alcohol consumption, which can include frequent binge drinking. You may have a higher risk for pancreatitis if you have been drinking four to five drinks per day for at least five years. 

Steroids like prednisone can also contribute to pancreatitis, albeit at much lower rates. Only 2% of pancreatitis cases involve any drug, so prednisone makes up a small fraction of total cases. But if your alcohol usage puts you at risk for pancreatitis, prednisone may increase this risk. 

Immune suppression

GCs like prednisone work by suppressing your immune system so it doesn't attack your own body. But long-term GC use can also lower your defenses against germs. 

The higher your dose, the greater your risk of developing a serious infection. But even doses lower than 5 mg can impact your immunity. 

Alcohol can also sabotage your immune system if you drink heavily. But if you drink in moderation and only need to take prednisone for a brief period, you probably don't have to worry about getting sick.

High blood pressure

While the mechanism is unclear, one of prednisone's more common side effects is raising your blood pressure, possibly by causing you to retain more salt and water. This, in turn, increases the volume of plasma flowing in your system, putting extra pressure on your blood vessels. 

Alcohol's effects on your cardiovascular system are a little more nuanced. Small amounts of alcohol can lower your blood pressure temporarily. But if you drink heavily for an extended period, your risk of high blood pressure goes up.

Osteonecrosis

In extreme cases, high blood pressure can damage the vessels around your bones. Without blood, your bones begin to die in a process called osteonecrosis. This condition is rare, but quite painful for those who develop it. Both prednisone and regular alcohol use have been linked to osteonecrosis. 

But according to the results of the only human trial studying the interaction of steroids and alcohol, people who drank alcohol while taking steroids didn't have a higher risk of osteonecrosis than people who only drank alcohol or only took steroids. The researchers also said the effects of alcohol were "trivial," compared to the impact of steroid use.

Is there a safe amount to drink?

Assuming the side effects of alcohol and prednisone do in fact stack, then the amount of alcohol you can safely drink likely depends on how much prednisone you're taking. That said, your doctor may recommend avoiding alcohol while taking prednisone, just to be on the safe side. 

According to the American Osteopathic College of Dermatology, prednisone dosages are categorized as:

  • Low: Less than 7.5 mg a day
  • Moderate: Between 7.5 mg and 40 mg a day
  • High: Over 40 mg a day

The higher your dose, the greater your chances of experiencing side effects, and — presumably — the less you can safely drink. Long-term use of three months or more also raises your risk of side effects. Research suggests the length of time you've been taking prednisone matters more than the specific dosage.

The American College of Rheumatology (ACR) recommends limiting your alcohol intake to a moderate amount — one to two drinks per day —  if you've taken at least 2.5 mg of prednisone a day for three months or longer. 

However, the ACR emphasizes that these guidelines are conditional and subject to change if more research is published. Until more studies come out, the amount of alcohol you can safely drink depends largely on your particular health situation. 

"Alcohol can cause adverse side effects when used in conjunction with any medication. As such, if you are prescribed prednisone you should consult with your doctor if it is safe to consume alcohol," says Aaron Sternlicht, counselor at the private practice Family Addiction Specialist.

Check with your doctor before stopping prednisone

If you have a condition that requires treatment with prednisone and want to avoid alcohol-related side effects, you may want to consider limiting your alcohol intake. 

When your doctor has prescribed prednisone to treat a medical condition, you'll want to keep taking the medication as prescribed. What's more, it's not always safe to stop taking prednisone abruptly. 

If you've taken this medication for longer than a few days, you may need to lower your dosage gradually. Your doctor will let you know if you need to taper off your dose. 

A tapering regimen is recommended if:

  • You've taken any dose of prednisone for a month or more.
  • You've taken 30 mg of prednisone a day for at least two weeks.

It's essential to follow the tapering regimen your doctor sets out for you. When you take prednisone long-term, your body makes less of its own steroid hormones, content to let the drug do the heavy lifting. Tapering gives your body time to ramp up production again — similar to an employee giving two weeks' notice so their coworkers have time to redistribute the team's workload.

If you quit prednisone too quickly, your body won't make enough steroid hormones to keep itself running. You might feel weak, dizzy, and tired, or even lose consciousness. If you're experiencing prednisone withdrawal, treatment involves slowly reintroducing steroids back into your body until it becomes side effects stop.

Alcohol withdrawal can resemble prednisone side effects

If you've been drinking alcohol heavily for a long time, you may experience alcohol withdrawal when you try to stop. 

This is important to consider if you're taking prednisone, because alcohol withdrawal and prednisone can cause similar clinical effects, including agitation and even psychotic symptoms,  says Dr. Kelly Johnson-Arbor, co-medical director of National Capital Poison Center and medical director of hyperbaric medicine at MedStar Georgetown University Hospital. 

Drug-induced psychosis is rare but serious. 

Dr. Johnson-Arbor says it's important to know whether alcohol or prednisone triggered the episode, because the treatments for psychosis related to prednisone and psychosis related to alcohol withdrawal are quite different: 

"People might be misdiagnosed or not treated correctly if they are not completely honest with their doctor about their alcohol and steroid use," Johnson-Arbor says. 

Your care team can offer more guidance on cutting back or quitting drinking safely. 

What to do if you experience a bad reaction

Prednisone and alcohol can cause many of the same side effects, some more serious than others. You may need urgent medical attention if you or a loved one experience:

  • Slow or irregular breathing
  • Uncontrollable shaking
  • Persistent vomiting 
  • Paranoia or aggression
  • Difficulty staying awake

Always let healthcare professionals know which substances you've taken and how much — mention every medication or drug, not just the alcohol and prednisone. The more information your doctors have, the more effectively they can treat your symptoms.

If you are concerned by your side effects and want to know which steps to take next, consider reaching out to:

Insider's takeaway

To date, there's not much research examining the potential impact of drinking alcohol while taking prednisone. If your prednisone side effects seem to get worse when you drink alcohol, you may want to consider cutting back, or avoiding alcohol while on the medication. 

Don't stop taking prednisone before checking with your doctor, since quitting prednisone can  lead to life-threatening reactions. 

Your doctor can offer more information about drinking alcohol while treating your specific health concerns with prednisone.

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