When you’re living with a chronic condition like systemic lupus erythematosus (SLE), there are times you may need to take more than one medication. Prednisone and ibuprofen, for example, are common medications for treating lupus. When these two medications are taken together, they can increase your risk of potential side effects.

Members of MyLupusTeam have asked about the interaction between these two drugs. “I just took my prednisone about 10 minutes ago. I’m in pain today; how long should I wait to take ibuprofen?” wrote one member.

Read on to learn more about how prednisone and ibuprofen may interact and how to decrease the risk of unwanted side effects.

What Is Prednisone?

Prednisone is in a class of medications called corticosteroids. It’s the most common corticosteroid used to treat inflammation in lupus. Other corticosteroids include prednisolone (Flo-Pred, Orapred, Pediapred) and methylprednisolone (Medrol).

Is Prednisone an Antibiotic?

As a corticosteroid, prednisone isn’t an antibiotic. It’s designed to help reduce inflammation, whereas antibiotics target bacteria.

MyLupusTeam members often discuss prednisone’s positive impact on their symptoms. “Prednisone has been my only lifesaver,” one member wrote. “I’d be miserable without it.” Another said, “Prednisone definitely helped me.”

How Does Prednisone Work?

Prednisone works similarly to a hormone your body already produces called cortisol. Cortisol is made by your adrenal gland, a hormone gland located on top of your kidneys.

Prednisone decreases inflammation all over the body by lowering the activity of the immune system and blocking production of inflammatory chemicals called cytokines.

In lupus, your body’s immune system becomes overactive. This results in inflammation that damages healthy tissues in your body. Prednisone can help slow the inflammation that causes damage in lupus.

How Do You Take Prednisone?

Prednisone is available as a tablet. Depending on the type and severity of your symptoms, you may take prednisone for a few days, a few months, or indefinitely. Some people with lupus will stay on low-dose steroids long term to control their symptoms of lupus.

The drug comes in different dosages, ranging from 5 milligrams to 50 milligrams. Prednisone can be taken once a day or multiple times per day, according to your doctor’s instructions.

Make sure to closely follow your doctor’s instructions on how to take prednisone.

What Are the Side Effects of Prednisone?

The side effects of prednisone depend on your dose and length of treatment. In general, you’re more likely to have side effects with high doses taken for a longer period of time.

If you take prednisone for a short period of time, you may experience side effects such as:

• Headache
• Dizziness
• Insomnia (trouble falling or staying asleep)
• Mood changes
• Moon face (facial swelling)
• Stomach upset
• Swelling from fluid retention
• Increased appetite and weight gain
• Increased sweating

If you take prednisone for a longer period of time, it can increase your risk of other health problems, such as:

• Increased risk of infection
• Osteoporosis (weakened bones) and bone fractures (breaks)
• Diabetes
• Vision changes
• Adrenal suppression
• Hypertension (high blood pressure)

What Cannot Be Mixed With Prednisone?

Most people are advised to avoid taking prednisone with desmopressin or a live rotavirus vaccine. Desmopressin is a lab-made hormone used to treat frequent bed-wetting and a condition called central diabetes insipidus. It may also be used after head injuries and some brain surgeries. The rotavirus live vaccine is a vaccination to protect against severe diarrhea caused by the rotavirus.

There are dozens of other medications that may not interact well with prednisone, but which your doctor may still recommend depending on your symptoms. Always talk to your doctor before mixing any medications with prednisone.

What Is Ibuprofen?

Ibuprofen is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These can be used to treat pain and fever. Ibuprofen may be sold under brand names such as Advil and Motrin. Studies show that more than 90 percent of people with SLE experience joint pain and inflammation. Almost all MyLupusTeam members also experience painful and swollen joints.

Other common types of NSAIDs include naproxen (Aleve) and diclofenac (Cataflam).

How Does Ibuprofen Work?

As the name of this drug class suggests, ibuprofen is not a steroid drug. Instead, ibuprofen works by blocking your body’s ability to make prostaglandins — chemicals that cause pain and inflammation. When you have fewer prostaglandins in your body, your pain and inflammation are temporarily reduced.

The inflammation and tissue damage caused by lupus can be painful. Ibuprofen can temporarily help relieve this pain.

How Do You Take Ibuprofen?

Ibuprofen is available as a tablet or liquid that you take by mouth. You can buy it over the counter in 200 milligram tablets or in higher doses as a prescription. Talk to your doctor about the appropriate dose for your symptoms. Ibuprofen is usually taken every four to eight hours or as needed for your pain, depending on your dose and your doctor’s instructions.

What Are the Side Effects of Ibuprofen?

Common side effects of ibuprofen include:

• Constipation
• Dizziness
• Stomach pain
• Indigestion (heartburn)
• Gas or bloating
• Swelling of the legs and ankles
• High blood pressure

If you take ibuprofen regularly for an extended period of time, it can increase your risk of potentially life-threatening health problems, such as:

• Kidney problems
• Bleeding in the stomach or bowels
• Heart attack or stroke

People with kidney disease, such as lupus nephritis, shouldn’t take ibuprofen because of the increased risk of kidney damage.

What Are the Possible Side Effects of Taking Prednisone and Ibuprofen Together?

Your rheumatologist may recommend that you take prednisone and ibuprofen. But you should be aware of the possible side effects and warning signs to watch for if you take prednisone with ibuprofen. Taking them at the same time may increase the risk and severity of side effects, especially problems with your gastrointestinal system (stomach and intestines).

One study found that the risk for stomach ulcers was two times greater for people taking corticosteroids alone compared to those not taking corticosteroids. Stomach ulcers are also called peptic ulcer disease (PUD). The risk of PUD was more than four times greater in people taking corticosteroids who had also taken an NSAID.

Taking prednisone and ibuprofen together may also worsen swelling and water retention. Both drugs can cause your body to hold onto salt and water, which can cause edema (swelling) and increased blood pressure. This may be especially problematic if you already have heart disease.

Talk to your rheumatology doctor immediately if you experience any troublesome or serious side effects, particularly those that don’t go away. Look for any of the following warning signs:

• Black, tarry stools
• Red streaks in your stool
• Vomit that looks like coffee grounds
• Swelling in your lower legs, feet, or ankles
• Sudden weight gain
• Loss of appetite

If you’ve accidentally taken prednisone with ibuprofen, pay attention to the warning signs above and call your doctor if you notice any side effects.

How Soon After Taking Prednisone Can You Take Ibuprofen?

You should follow your doctor’s instructions regarding when you should take prednisone and ibuprofen. In general, it may be a good idea to take them a few hours apart to allow your body to process each medication separately.

MyLupusTeam members often discuss their experiences with stomach issues while taking these medications. One member shared, “I learned that lesson the hard way. I had been taking prednisone for two to three weeks, and my stomach started acting up. Never again. Even if it’s a couple of crackers, I make sure I eat something.”

Another member wrote, “I took prednisone and ibuprofen and had a severe stomach reaction.”

What Pain Reliever Can You Take With Prednisone?

Talk to your health care provider or pharmacist about which pain relief medications may be safe to take with prednisone. In general, acetaminophen (Tylenol) isn’t known to have any interactions with prednisone. However, acetaminophen is not an NSAID and may not reduce inflammation as well as NSAIDs do. Also, lupus can cause inflammation of the liver in some people, and in those cases, it might be dangerous to take acetaminophen. This is another reason why you should always speak with your doctor before deciding which medications to take.

Minimizing Side Effects of Prednisone and Ibuprofen

You may not be able to avoid the side effects of these medications, but you can reduce your risk of certain side effects with a few key strategies:

• Take the medication with or just after having food or milk — Food can help decrease stomach upset.
• Avoid alcohol — Alcohol increases your risk of gastrointestinal bleeding while taking NSAIDs.
• Drink more water and eat less salt — Increased salt intake may make swelling worse.

Talk to your doctor about preventing GI problems while taking these medications. Your doctor may prescribe a preventive medication, such as omeprazole (Prilosec), pantoprazole (Protonix), or famotidine (Pepcid), while you’re taking certain drug combinations.

You can also talk to your doctor about other treatment options for lupus that may help improve your joint pain so you can lower your dose of prednisone or ibuprofen. These may include:

• Immunosuppressants, such as methotrexate (Trexall), azathioprine (Imuran), mycophenolate (CellCept), and cyclosporine (Neoral)
• Antimalarial drugs, like hydroxychloroquine (Plaquenil)
• Biologic medications, including belimumab (Benlysta) and rituximab (Rituxan)

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 231,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Have you taken prednisone and ibuprofen for lupus? Share your experience in the comments below, or start a conversation by posting on your Activities page.