Is it safe to smoke while taking prednisone?

Smoking while taking prednisone is generally not considered safe, and it can make several steroid‑related risks worse. Prednisone weakens the immune system and affects bones, blood sugar, and wound healing; smoking adds independent harm to the lungs, blood vessels, and tissues, so the two together can compound problems. While smoking doesn’t seem to change how your body processes prednisone, it can increase the chance of infections, slow healing, and worsen bone health. ^{[1] [2]}

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How smoking interacts with prednisone

• Immune system and infections: Prednisone increases the risk of infections because it suppresses your immune response. Smoking independently raises the risk and severity of respiratory and other infections, so the combination can reasonably be expected to further increase infection risk. ^{[3] [4]}
  Prednisone can also mask signs of infection, which may delay recognition and treatment. ^{[5] [6]}

• Bone health and osteonecrosis (bone death): Long‑term or high‑dose steroids are linked to bone thinning (osteoporosis) and fractures. Smoking also harms bone health and is discouraged in conditions where blood supply to bone is at risk. Avoiding smoking is specifically advised to reduce the risk of avascular necrosis (osteonecrosis), because smoking narrows blood vessels and reduces blood flow to bone. ^{[3] [7]}

• Wound healing and surgery: Prednisone slows wound healing; smoking further delays healing and increases wound infection and breakdown. Smokers who stop even temporarily can reduce these risks. ^{[3] [8]}

• Blood sugar and cardiovascular risk: Prednisone can raise blood sugar and worsen diabetes control; smokers often have higher cardiometabolic risk factors, so combined effects may be additive. ^{[3] [9]}

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What smoking does not seem to change

• Drug levels of prednisone: Available human data suggest cigarette smoking does not significantly alter the pharmacokinetics (absorption, clearance, or conversion to prednisolone) of prednisone or dexamethasone. This means dosing isn’t typically adjusted just because someone smokes, but the clinical risks from smoking still matter. ^[1]

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Practical guidance if you are on prednisone

• Strongly consider quitting or pausing smoking: Because prednisone already raises infection and bone risks, stopping smoking can help reduce complications, especially respiratory infections, poor wound healing, and bone problems. Quitting even for a short period during recovery or a steroid course can be beneficial. ^{[8] [3]}

• Monitor for signs of infection: Watch for fever, new cough, chest pain, shortness of breath, painful or red wounds, or worsening fatigue; prednisone can blunt typical symptoms, so seek medical attention promptly if concerned. ^{[5] [6]}

• Protect bone health: Ask about calcium and vitamin D, weight‑bearing exercise, and bone density monitoring if you require repeated or long courses of prednisone; not smoking is part of bone‑safety measures. ^{[3] [10]}

• Support blood sugar and cardiovascular health: If you have diabetes or prediabetes, monitor glucose more closely while on prednisone, and reduce other risks like smoking that may compound metabolic stress. ^{[3] [9]}

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Summary table: Smoking + Prednisone risk areas

Risk area	Prednisone effect	Smoking effect	Combined concern
Infections	Increases risk; can mask symptoms	Increases risk, especially respiratory	Higher overall infection risk and delayed recognition [3] [5] [6] [4]
Bone health	Osteoporosis/fractures risk	Worsens bone health	Additive bone risk; avoid smoking to protect bone [3] [10]
Osteonecrosis	Steroids are a known risk factor	Smoking narrows vessels, reduces blood flow	Smoking discouraged to reduce osteonecrosis risk [7]
Wound healing	Slows healing	Delays healing, raises infection risk	Significantly worse healing outcomes; stopping helps [3] [8]
Blood sugar	Raises glucose	Associated with adverse cardiometabolic profile	Potentially additive metabolic strain [3] [9]
Drug levels	No major change	No major change	Dosing generally unchanged; clinical risks remain [1]

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Bottom line

It’s not considered safe to smoke while taking prednisone, mainly because smoking amplifies several steroid‑related complications, including infections, poor wound healing, and bone problems. Even if smoking doesn’t change prednisone’s drug levels, avoiding tobacco during steroid treatment is a prudent step to lower risks. ^{[1] [3] [8] [7]}