Prednisone and alcohol: can you mix them?

“Can I drink alcohol while taking this medication?” 

That should be one of your first questions when starting on any new medication, and prednisone is no exception. 

The good news is prednisone and alcohol are generally okay to mix—so long as you’re just having a drink or two. Drinking frequently or heavily, though? It’s best to avoid that while on this medication. Read on to find out why. 

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Prednisone is a type of drug known as a glucocorticoid (GC). The reason for the name is glucocorticoids help regulate glucose metabolism, are manufactured in the adrenal cortex, and are steroids. When you take prednisone, your liver converts it to prednisolone, which suppresses the immune system and has anti-inflammatory effects (Puckett, 2020). 

Your healthcare provider may also prescribe prednisolone itself or methylprednisolone, related medications. 

The FDA approves prednisone for treating several conditions, including, but not limited to (UpToDate, n.d.):

• Adrenal insufficiency (Addison’s disease)

• Acute allergic reactions

• Acute asthma attacks

• Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis

• Multiple sclerosis

• Rheumatic disorders, such as rheumatoid arthritis and gout

Healthcare providers may also prescribe prednisone off-label as a treatment option for other conditions, including (UpToDate, n.d.):

• Bell’s palsy

• Chronic obstructive pulmonary disease (COPD)

• Autoimmune hepatitis

• Certain types of cancer, including prostate cancer and multiple myeloma

Prednisone can have many side effects from long-term use. Healthcare providers typically prescribe it short-term for acute (temporary) conditions or flare-ups of chronic disorders. 

Is alcohol use safe while taking prednisone? In most cases, it’s okay to drink alcohol in moderation while taking prednisone. 

While there’s no specific contraindication for drinking alcohol while on prednisone, mixing prednisone with heavy drinking, binge drinking, or alcohol addiction may carry an increased risk of health problems. The more you drink, the more likely you are to experience negative side effects of alcohol, and many of those side effects coincide with the potential side effects of taking prednisone. 

Any type of steroid use has a high risk of side effects. A survey of over 2,000 people taking glucocorticoids long-term (over 60 days) found 90% reported at least one adverse effect. The most common side effects were, in order (Curtis, 2006):

• Weight gain

• Easily wounded skin

• Sleep troubles

• Mood swings

• Cataracts

• Acne

• Bone fractures

• High blood sugar levels in people without diabetes.

Many of these side effects are similar to those of heavy drinking, which may compound some of these side effects. Here are the biggest causes for concern: 

Blood sugar

Alcohol and prednisone can both affect blood sugar levels. Even with short-term users, prednisone increases fasting glucose levels on the first day it is taken (Kauh, 2012). Light to moderate alcohol use, one drink a day or so, doesn’t significantly affect this. But heavy drinking has been shown to correlate with elevated glucose, so adding on the glucose-raising effects of prednisone could be especially problematic (Leggio, 2009). People watching their glucose levels, such as people with type 2 diabetes, may wish to be extra cautious about alcohol intake while using prednisone.

Mood

We all know alcohol affects mood. That’s the reason some people drink it. Even short-term prednisone use can trigger mood changes in some people (Ou, 2018). For this reason alone, one might want to wait to see how prednisone affects them before even considering popping open a bottle of wine with dinner while taking the steroid. 

Sleep

Even light drinking affects one’s sleep (Ebrahim, 2013). At the same time, 30–60% of glucocorticoid users report some sleep disturbance, depending on dose (Curtis, 2006). If you’re having trouble falling or staying asleep, combining alcohol with prednisone could make problems worse.

Prednisone, alcohol, and bone health

Prednisone and alcohol may both affect bone health. Fractures are a significant risk with long-term or high-dose corticosteroid use, especially for elderly people. It doesn’t happen overnight, but prednisone increases the risk of osteoporosis and vertebral fracture (UpToDate, n.d.).

It appears that alcohol use also affects bone density, though in inconsistent ways. Light to moderate alcohol use could be beneficial. Studies have suggested that a bit of alcohol now and then may, in fact, slow down age-related bone loss. Heavy drinking and binge drinking, though, correlate with a significant decrease in bone density. Some studies have found the risk factor more profound in men than in women (Gaddini, 2016).

While not every study may agree regarding alcohol and bone mass, there’s still a self-evident reason not to mix prednisone with heavy drinking. We know that high cumulative prednisone affects bone density negatively. As anyone who has consumed enough alcohol can tell you, alcohol can make you clumsy. Risking a fall when your bones may not be their strongest is probably not the best idea.

Prednisone and alcohol both affect corticosteroid levels. Studies have shown that alcohol consumption increases cortisol, and regular heavy consumption may impact the HPA (hypothalamic-pituitary-adrenal) axis. This system regulates natural cortisol production from the adrenal glands (Badrick, 2007).

An overabundance of glucocorticoids like cortisol can lead to Cushing syndrome, a rare but potentially fatal condition if left untreated. Even alcohol abuse on its own can lead to what researchers call a pseudo-Cushing state, with many of the same potential health risks (Besemer, 2011).

Alcohol at concentrations of 10% or more (which would include most wines and nearly all hard drinks) can cause stomach upset and even gastrointestinal bleeding (Stermer, 2002). Prednisone carries a risk of peptic ulcers, though research shows this is seen most when prednisone is combined with NSAIDs like ibuprofen or naproxen (Liu, 2013). That aside, if you’re taking prednisone for gastrointestinal conditions, putting alcohol through your digestive tract could be counterproductive.

If you’ve been passing on the drinks while taking prednisone, you may be looking forward to a celebratory cocktail after you’ve finished treatment. You might want to wait a little bit longer, though. It is possible to experience some withdrawal symptoms after stopping a longer-term course of steroids. These can include nausea, vomiting, and lethargy, which may be exacerbated by drinking (Margolin, 2007).

If you’re taking prednisone, talk to your healthcare provider about alcohol use and your condition. Follow their medical advice before reintroducing alcohol to your system. Most prednisone prescriptions are short, and going without alcohol for a week or two may be a small sacrifice to make for your health.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

March 17, 2021

Written by

Seth Gordon

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.