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Prednisone & Alcohol: Does it Mix?

Prednisone & Alcohol: Does it Mix?

What’s your drink of choice? If your drink of choice is alcohol, you might’ve wondered if it’s safe to drink alcohol while you’re on prednisone?

Today, I am going to share with you how prednisone and alcohol might interact.

Can You Drink Alcohol While on Prednisone?

A Prednisone Warrior approached me this week and was wondering if prednisone alone was enough to cause the terrible consequences he was having or was it the combination of prednisone and alcohol? Here’s his story. He took just 3 days worth of prednisone and it put his adrenal system into craziness. Then a few days later he coped by drinking alcohol, and not just a little but a lot, with his friends! So he was wondering if the way he was still feeling a month later was because of the prednisone. So that’s what we’ll explore today and answer the question, “Can I drink alcohol while I’m taking prednisone?”

Prednisone + Alcohol

First, we will discuss prednisone and how it works, and what that has to do with alcohol. Next, we will discuss alcohol and how it might interact with prednisone. Finally, we will talk about how you can cope with these complications. Prednisone is mimicking a hormone in our body called cortisol. Cortisol is our stress hormone. It is what’s helping us cope with stress in life, whether that’s it being too cold outside, or whether that’s a tiger chasing us, cortisol is helping us deal with stress.

An article I read about alcohol said both very high and very low levels of basal plasma cortisol and associated blunted cortisol response are associated with elevated anxiety. What does that mean? It means either when your prednisone or your cortisol is really high or your cortisol is really low, either of those things can lead to anxiety, or aggression, or depression, or other ways that make you feel pretty miserable. This young man who was asking about the prednisone, he was having anxiety a long time after stopping prednisone. It’s because there was interference in his normal rhythm. What is that normal rhythm?

HPA axis, Prednisone

It is the HPA axis. You don’t need to know the names of these organs inside your body. You don’t need to memorize the chart. Don’t feel overwhelmed. I just wanted you to see where in your body this is all happening. We’ve got our brain, and part of our brain is the hypothalamus. That sends a signal right next to it called the anterior pituitary, and that sends a signal down there at the bottom, those little red spots called your adrenal glands, and that is what releases cortisol normally.

But when you’re on prednisone, that’s not happening. The prednisone is stopping that signal right there because it’s mimicking the cortisol. It is interfering and saying, “I’m cortisol now,” and so that signal back, do you see a little arrow back up, never happens. So your pituitary gland doesn’t kick into gear, which means your hypothalamus doesn’t kick back into gear. All of that happened after taking prednisone, and that has a lot to do with how alcohol affects you. Because guess what? Alcohol does the same thing.

Alcohol affects your hypothalamus

prednisone affects hypothalamus

It affects your hypothalamus. It feels like stress to your body, and so it is messing up this whole rhythm too. That is what I wanted to show you as far as how prednisone and alcohol might interact with each other. So the many ways include the following, and these are all hypothetical. There’s actually no study that’s been done that says, if you’re taking high-dose prednisone and then you take alcohol, this is what happens. I looked. I couldn’t find any studies that said prednisone and alcohol does this. This is all based on what prednisone does, and what alcohol does, and then how they might interact with each other.

Prednisone is a glucocorticoid

Prednisone is a glucocorticoid. It’s messing with glucose or sugar in our body, so it causes high blood sugars. Why do we care about high blood sugars? Because that leads to diabetes, that leads to weight gain, that leads to bloating and misery. Alcohol also leads to high blood sugars, taking alcohol. So that’s why you’ve heard of the term beer belly because it’s depositing these sugars as fat in the belly, and leading to alcoholic liver, and all sorts of things. The combination of them can lead to diabetes and weight gain.

All right. Moving on to the immune system. Prednisone is often used because it causes immunosuppression. It’s turning off a lot of parts of the immune system. When that happens, it can make my bleeding disorder go away. It can make people’s asthma chill out. It can make people stop attacking their cool new transplant of an organ, like a new liver, or a new kidney, or a new heart. That’s a really good thing that it does, but alcohol is also lowering your immune system, and so the combination can lead to a lower ability to fight infections. Next, the stomach. Many people know how alcohol makes them feel as far as feeling nauseated, throwing up, it can damage the gut, but prednisone also can lead to peptic ulcers. That’s like a hole in your gut that can bleed, and the combination of them can make things worse.

One of the ways that these things are happening is that alcohol is interfering with the glucocorticoid receptors. There’s this little thing sitting on cells, and normally the cortisol goes there and it turns all of this whole system on that helps you deal with stress. Well, guess what is happening to these little receptors? Prednisone is sitting on them, and so they’re being used up. But guess what alcohol does? It either moves them away from where they’re supposed to be. It makes there to be too many, or it could be too few glucocorticoid receptors. And it’s very unique.

So some people might get too many receptors, some people might get two few receptors, and so there’s really not a great way to predict all of this. That’s the real thing about alcohol, is some people can tolerate it, some people can’t, in just normal people. Whereas when you’re on prednisone, the alcohol is moving around your glucocorticoid receptors, the place where the prednisone is working, and then where the cortisol will work when you stop taking the prednisone. So it can get all sorts of messed up in certain people, but maybe not in others.

Then other things that people have mentioned in support groups, that they’ll get red burning cheeks. Now, lots of Asian people get this when they drink alcohol just because they don’t have a great ability genetically to break down the alcohol. Other people say they feel hot. Others say they can’t hold down as much alcohol as they normally could while they’re on prednisone. Other people say, like another way of saying that is, it’s like drinking water. They can drink, and drink, and drink, and it’s not doing anything for them. Others say if they do a few drinks too many, the next day they get really swollen moon-face cheeks. So it’s very individual. Some people have no problems, some people have lots of problems, and it’s really impossible to predict.

Should you drink Alcohol?

Finally, we’re going to conclude with the number one concern that you need to consider when you are trying to decide, should I drink alcohol with prednisone, and it is osteoporosis. Prednisone is the number one drug that causes osteoporosis. It literally steals calcium from the bones so that your bones get really thin and fragile, and can break and rot. Alcohol is associated with bone loss as well. An article I read said that heavy drinking compromises bone quality. It decreases bone density and weakens the mechanical properties of the bone so it’s just not as strong.

And heavy drinking in the young years, like a teen and young adult, that bone loss caused by the alcohol cannot be reversed. Yikes. So even if you don’t take prednisone, heavy drinking can still lead to osteoporosis, and you can’t get rid of that loss. So consider maybe not drinking alcohol in general, and then definitely not while you’re on prednisone. If you’re concerned about osteoporosis, both alcohol and prednisone lead to malnourishment, specifically of vitamin D, calcium from the bones, and B vitamins, especially with the alcohol. So you need to be aware of these possibilities when you’re considering drinking alcohol with prednisone.

What can you do about this?

The number one thing you need to know is, there’s no black and white here. This is all gray area. There’s no, you should not take prednisone with alcohol. There’s no, you should. It’s completely individualized. So you need to talk to your doctor. Okay? You need to talk to your doctor about this. Have a clear go-ahead from your doctor before you ever drink alcohol with prednisone. The theoretical ways that you can cope are one, to exercise to build up the bone strength to cope with the high blood sugars to strengthen your immune system. Exercise is wonderful. Theoretically, you break down and metabolize both prednisone and alcohol in a 24-hour period each.

So if you are about to start prednisone, you can drink 24 hours before your first dose or the other way around. Once you stop taking prednisone, theoretically, you can drink alcohol. But not if you’re like this young man who’s like, “I was on this prednisone and it messed up my adrenals, and I needed to give adrenal glands time to come back, to become sufficient. And what did I do? I went and got drunk.” That was probably the worst thing he could do to help his adrenal glands recover. This is all theoretical, just using bits and pieces of information and trying to tie them together. With prednisone, you should never, ever stop taking it suddenly. It can kill you. It can lead to an adrenal crisis, in which you have to go to the hospital and you could die of shock.

Then, it’s probably a really good idea to take calcium and vitamin D while you’re taking prednisone. According to the rheumatologists who prescribe it at the most, they recommend that for everybody who’s on prednisone for three months or more. So because of this, I created the Nutranize® Zone™ . It is a dietary supplement just for people on prednisone. I am Dr. Megan, your Prednisone Pharmacist, and I used my specialized training to create this with just the nutrients that people on prednisone need. It has special herbs and other ingredients that are clean, and sourced responsibly, and help you to reduce your suffering so that you can replenish your nutrients and recover from prednisone. You can find it at


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