5 Alternatives to Prednisone: NSAIDs, Biologics, and More

The immune system is a wonderful thing. While you’re going about your daily life, your immune system is fending off germs and harmful substances. You probably don’t even notice. But sometimes your immune system needs to call in extra troops. This causes inflammation, which prompts other protective cells to help.

Inflammation is a normal response to injury or infection. But when it’s directed at the wrong target or lasts too long, it can cause damage. Prednisone is one of the most common corticosteroids (steroids) prescribed to treat inflammation.

One downside to prednisone is that it may come with unwanted side effects. High blood glucose (sugar) and trouble sleeping are two common concerns. What’s more, high doses or long-term use can cause other issues, such as brittle bones, weight gain, and infection.

If you’ve been prescribed prednisone, you might want to explore other options. Here, we’ll discuss treatments that can lessen inflammation and may be alternatives depending on your condition.

1. Other corticosteroids

Prednisone isn’t the only corticosteroid to choose from. Several other oral steroids are available too. Notable examples include:

• Methylprednisolone (Medrol)

• Prednisolone (Millipred, Orapred ODT)

• Hydrocortisone (Cortef)

• Dexamethasone

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All oral steroids decrease inflammation in a similar way. They also work relatively quickly and tend to be affordable. Importantly, they have the potential to cause side effects similar to prednisone. But some steroids have a stronger anti-inflammatory response (potency) and last longer than others. This may make them better for certain conditions. For example, hydrocortisone stays in the body for up to 12 hours, while dexamethasone lasts as long as 3 days.

Steroids are also available in different dosage forms, such as inhalers, creams, and eye drops. If they’re appropriate for your condition, switching to one of these forms may help minimize side effects.

An alternative steroid may (or may not) be more suitable for you than prednisone. Your prescriber can help you choose a steroid that treats your condition while minimizing side effects.

2. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications that treat inflammation, pain, and fever. Corticosteroids treat inflammation more broadly, but NSAIDs block cyclooxygenase (COX) proteins.

There are several NSAIDs to choose from, including:

• Ibuprofen (Motrin, Advil)

• Naproxen (Naprosyn, Anaprox DS)

• Aspirin

• Meloxicam

• Celecoxib (Celebrex)

• Ketorolac

• Diclofenac (Voltaren)

• Indomethacin (Indocin)

EXPERT PICKS: WHAT TO READ NEXT

• Which one is better? Compare and contrast dexamethasone and prednisone, two common corticosteroids.

• Prednisone drug interactions: Discover the common medications that interact with prednisone and what you can do about them.

• Out-of-pocket costs: Here’s how much you can expect to pay for prednisone without insurance.

One benefit of NSAIDs is that some are available over the counter (OTC). Namely, ibuprofen, aspirin, and naproxen. Topical diclofenac gel is available OTC as well. Like corticosteroids, the NSAID you choose will likely vary based on your condition and side effect tolerance.

Corticosteroids and NSAIDs can both cause stomach upset and bleeding (ulcers). But NSAIDs come with their own risks. If you have kidney problems or heart disease, NSAIDs may not be the best option for you.

3. Methotrexate and other conventional DMARDs

A few types of disease-modifying antirheumatic drugs (DMARDs) are available. DMARDs slow down the inflammatory response and help prevent long-term damage from autoimmune disorders.

Traditional DMARDs

Methotrexate (Rheumatrex, Trexall) is a medication that’s occasionally prescribed to treat autoimmune disorders, such as rheumatoid arthritis and psoriasis. It’s also used for different types of cancer.

Methotrexate is a traditional, nonbiologic (conventional) DMARD. Other conventional nonbiologic DMARDs include:

• Sulfasalazine (Azulfidine)

• Hydroxychloroquine (Plaquenil)

• Leflunomide (Arava)

• Azathioprine (Imuran)

• Apremilast (Otezla)

• Cyclosporine (Neoral)

• Mycophenolate (CellCept)

• Cyclophosphamide (Cytoxan)

Nonbiologic DMARDs are effective overall. But they often take longer to start working than prednisone — 6 to 8 weeks. Like prednisone, nonbiologic DMARDs are typically taken orally. But some may be given as an injection. And because they broadly suppress your immune system, they raise the risk of an infection.

JAK inhibitors

Janus kinase (JAK) inhibitors are a newer class of nonbiologic DMARDs. They can start working more quickly — in days in some cases. But they may still need several months for full effect.

JAK inhibitors target the inflammatory JAK proteins. Common JAK inhibitors include:

• Tofacitinib (Xeljanz)

• Upadacitinib (Rinvoq)

• Baricitinib (Olumiant)

• Ruxolitinib (Opzelura)

• Abrocitinib (Cibinqo)

• Ritlecitinib (Litfulo)

4. Biologics

Biologics are another type of DMARD. Unlike conventional DMARDs, biologics are large compounds made from living sources. Because of this, they need to be given as an injection under the skin or an infusion into your vein. They’re typically prescribed when inflammatory symptoms are more severe.

Biologic DMARDs work in a more precise way than conventional DMARDs and steroids. Each medication targets a specific pathway or protein that contributes to inflammation. Some of these medications and their target are listed below.

Biologics are more difficult to make than steroids and conventional DMARDs, so they generally cost more. You also have to be comfortable giving yourself an injection or receiving an infusion from a healthcare professional.

Each biologic DMARD has its own side effect profile. But common side effects include headache, injection site reactions, and infusion reactions.

5. Dietary supplements

Several dietary supplements claim to treat inflammation. Some of them include:

• Boswellia

• Curcumin (the active ingredient in turmeric)

• Devil’s claw

• Fish oil

• Willow bark

Supplements like these may or may not be beneficial for treating inflammation. There’s not much data available. Supplements can also cause side effects and interact with other medications you take.

Ask a healthcare professional before trying a dietary supplement for inflammation. Also, be sure your pharmacy has a list of all medications and supplements. They can check for interactions.

Good to know: Supplements aren’t as well studied as prescription medications. This is because they aren’t regulated in the same way. Prescription medications must be proven safe and effective before they’re FDA approved. Supplements aren’t subject to this same process.

Can lifestyle changes reduce the need for prednisone?

Yes. Infection, injury, and autoimmune disorders aren’t the only causes of inflammation. Certain foods — such as refined sugar, red meat, and ultraprocessed foods — can also contribute to chronic inflammation. Choosing a diet that prioritizes a variety of fruits, vegetables, and plant-based protein can help reduce inflammation.

Stress, inadequate sleep, and a sedentary lifestyle can also increase your inflammation risk. Try some of the following strategies to help curb stress and inflammation:

• Get 7 to 9 hours of sleep each night

• Practice good sleep hygiene

• Try using a smartphone app dedicated to mindfulness or meditation

• Establish a regular exercise routine that you enjoy

• Limit how much alcohol you drink

These lifestyle habits may not eliminate the need to take a medication like prednisone, but they can help. These healthy habits may enable you to take lower doses of prednisone, which could help decrease side effects.

How and when to switch off prednisone

Even if you aren’t loving prednisone’s side effects, it’s important that you don’t stop it abruptly. If you’ve been taking high doses or have needed prednisone for longer than 2 weeks, you’ll likely need to be tapered off. This involves taking progressively lower doses over several days or weeks. A healthcare professional can help you come up with a taper plan that’s appropriate for you.

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Bailey E. Eason, PharmD, MS, BCPS

Bailey Eason has been licensed for 6 years and has held licenses in three states (North Carolina, Virginia, and Illinois). She has held positions as a health-system pharmacy administration resident, operating room pharmacy manager, pharmacy manager of clinical operations: surgery, neurology and controlled substances, and most recently as program director  of drug diversion for a large academic health system.

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