Can Prednisone Cause Oral Thrush?
Yes, prednisone can cause oral candidiasis (thrush) by suppressing the immune system and creating conditions favorable for fungal overgrowth. 1
Mechanism and Risk
Prednisone increases susceptibility to oral thrush through immunosuppression:
- The FDA label explicitly warns that corticosteroids, including prednisone, suppress the immune system and increase the risk of fungal infections, including oral candidiasis. 1
- Corticosteroids can exacerbate systemic fungal infections and enhance the establishment of secondary infections due to fungi. 1
- The rate of infectious complications, including fungal infections, increases with increasing corticosteroid dosages. 1
Evidence from Clinical Studies
Research confirms the association between corticosteroid use and oral candidiasis:
- Concomitant use of oral prednisone with topical corticosteroids (such as inhaled beclomethasone) may increase the risk of developing oral candidiasis. 2
- In experimental models, prednisolone combined with antibiotics successfully induced oral candidiasis with characteristic whitish, curd-like patches on the tongue. 3
- Oral candidiasis is commonly caused by overgrowth of Candida albicans in the mouth, particularly in immunosuppressed patients. 4
Clinical Implications
When prescribing prednisone, consider the following:
- Monitor patients on chronic prednisone therapy for signs of oral thrush, including white patches on the tongue, inner cheeks, or throat. 1, 4
- The risk is dose-dependent—higher doses and longer duration of therapy increase susceptibility to fungal infections. 1
- For patients who develop systemic fungal infections while on prednisone, withdrawal or dosage reduction is recommended. 1
- Prednisone is contraindicated in patients with systemic fungal infections. 1
Prevention and Management
To minimize thrush risk in patients requiring prednisone:
- Maintain good oral hygiene practices. 4
- Consider prophylactic antifungal therapy in high-risk patients on prolonged high-dose corticosteroids. 1
- If oral thrush develops, treat with appropriate topical or systemic antifungal agents while reassessing the need for continued corticosteroid therapy. 4
- Use the lowest effective dose of prednisone for the shortest duration necessary. 1