From the FDA Drug Label
Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection
The use of prednisone in patients with infectious mononucleosis (mono) is not directly addressed in the label. However, considering the immunosuppressive effects of prednisone, it may exacerbate existing infections, including viral infections like mono.
- The label warns that corticosteroids, including prednisone, can increase the risk of infection and reactivation or exacerbation of latent infections.
- It is recommended to monitor for the development of infection and consider prednisone withdrawal or dosage reduction as needed 1. Given the potential risks, it is likely that taking prednisone with mono would not be recommended, but the label does not provide a direct answer to this question.
From the Research
Taking prednisone or other corticosteroids is generally not recommended if you have infectious mononucleosis (mono), except in cases of severe complications such as significant airway obstruction, severe hemolytic anemia, or thrombocytopenia, as stated in the most recent study 2.
Reasons to Avoid Corticosteroids in Mono
- The current evidence points to small and inconsistent benefits when using corticosteroids for symptom relief in children with mono, as noted in the study published in the Canadian family physician Medecin de famille canadien 2.
- There is a concern that corticosteroids might suppress the immune system while it's fighting the Epstein-Barr virus, potentially prolonging the illness or masking important symptoms.
- Additionally, there is a theoretical risk of corticosteroids increasing the likelihood of splenic rupture, which is a rare but serious complication of mono.
Exceptions for Corticosteroid Use
- The only exception where prednisone might be considered is in cases of severe complications from mono, such as:
- Significant airway obstruction from tonsil swelling
- Severe hemolytic anemia
- Thrombocytopenia
- Even in these cases, prednisone should only be prescribed by a physician familiar with the specific case, as supported by the study 2.
Standard Treatment for Mono
- If you have mono, the standard treatment includes:
- Rest
- Adequate hydration
- Over-the-counter pain relievers like acetaminophen or ibuprofen for fever and discomfort
- You should avoid strenuous activity and contact sports for at least 3-4 weeks to reduce the risk of splenic rupture, as generally recommended in the management of mono 2.