The differences between prednisone and prednisolone



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Corticosteroid drugs

Medically reviewed by Femi Aremu, PharmD

Are Prednisone and Prednisolone the same thing?

Although they are very similar, prednisone and prednisolone are not the same.

They are both corticosteroid drugs, also called glucocorticoids, or simply steroids.

Steroids are used to treat inflammation in many autoimmune diseases, such as asthma, rheumatoid arthritis and inflammatory bowel disease.

The list of available corticosteroids is long and there are many different dosage forms available.

Prednisone and prednisolone are similar but have some critical differences discussed in this article.



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Corticosteroid drugs

What are prednisone and prednisolone used for?

Steroids such as prednisolone and prednisone are used to treat a number of medical conditions that cause the following:

Some common uses for prednisone include the following:

How do prednisolone and prednisone work?

Prednisolone and prednisone are both synthetic (manufactured) versions of the hormone cortisol.

Cortisol is a steroid hormone produced by the two adrenal glands that sit above the kidneys.

Prednisone and prednisolone are very similar, but prednisone is a prodrug.

This means that after you ingest it, your liver slightly alters the chemical structure to turn it into prednisolone.

Prednisolone causes the following effects.

  • Decreases inflammation: Blocks the production of certain substances that cause inflammation, such as prostaglandins, resulting in less swelling, redness and pain.

  • Suppresses the immune system: Suppresses your immune system when it attacks your cells by decreasing the number of T cells (a specific type of white blood cell) it produces.

  • Constricts blood vessels: Tightens dilated blood vessels which can contribute to symptoms such as congestion, redness, warmth, and swelling.

How do the dosages for prednisolone and prednisone compare?

Prednisone

Prednisolone

Other oral tablets available

Delayed release, brand Rayos

Orally disintegrating tablet (ODT), brand name Orapred ODT

Oral liquid brands

Prednisone Intensol

Millipred, Orapred, Pediapred

Other dosage forms available

N/A

Eyedrops (Pred Strong)

Typical dosage

5 to 10 milligrams (mg) depending on the condition and severity

Same dosage as prednisone

What other things can I do to help manage inflammation in the body?

Inflammation is essential in the body for some purposes and for short periods. Examples include the following:

  • Respond to injury

  • Fighting infections

However, chronic inflammation is not beneficial.

But you can help prevent it by maintaining certain lifestyle habits like the following:

  • Get at least 20 minutes of moderate exercise a day

  • Stop smoking

  • Maintain a healthy weight

  • Follow an anti-inflammatory diet

Finally, there are other medications besides steroids that reduce inflammation and include the following:

Depending on your condition and medical history, your doctor may recommend one or more of these options in place of or in addition to steroid medications.

Side effects and precautions

Prednisone and prednisolone cause side effects similar to many other corticosteroid medications.

Side effects are dose-related, meaning they are more likely to occur if you take a higher dose.

They are also more likely if you take steroids long term.

It’s good practice to take the lowest dose you need for the shortest amount of time.

Side effects can include:

  • Edema (swelling caused by fluid buildup)

  • Hypertension (high blood pressure)

  • High blood sugar levels

  • Stomach ache

  • Insomnia (trouble sleeping)

  • Mood changes

  • Heachache

  • Acne

  • Weight gain

When taken long-term, over months or years, prednisone or prednisolone can potentially cause more serious side effects.

If you are experiencing any of the following side effects, tell your doctor right away:

  • Eye problems (such as glaucoma or cataracts)

  • Osteoporosis (weaker bones)

  • Infection, possibly due to suppression of the immune system by drugs

  • Severe stomach problems, including stomach ulcers or gastritis

  • Adrenal gland problems, such as excessive tiredness or muscle weakness

Interactions for prednisolone and prednisone

Prednisolone and prednisone have very similar drug interactions. Some of these include:

  • Jantoven (warfarin) it is a blood thinner. When taken with steroids, the blood may become too thin or not thin enough. In this case, specific laboratories, such as international normalized ratio (INR), should be monitored more closely.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen) or Mobic (meloxicam), they can also cause bleeding problems when taken with steroids.

  • Diabetes medications such as Glucophage (metformin) or Diabeta (glyburide) which may need to raise your blood sugar. Steroids can cause blood sugar levels to rise.

  • Diuretics, or water pills, such as Lasix (furosemide) and Microzide (hydrochlorothiazide), can decrease your potassium level, which steroids can do as well. Your potassium level should be monitored closely for hypokalemia (low levels of potassium in the body).

  • Live vaccines, such as the measles, mumps, and rubella (MMR) vaccine, may not work as well in people taking steroids. It is best to wait to receive these vaccines until the steroids are stopped.

If you’ve been prescribed prednisolone or prednisone, make sure your doctor and pharmacist are aware of all the medications and supplements you take, as some changes may need to be made.

Summary

Prednisone and prednisolone are corticosteroid drugs that mimic the action of the hormone cortisol, which is produced by the adrenal glands.

They are very similar, although prednisone is converted by the liver into prednisolone after ingestion.

The drugs have anti-inflammatory and immunosuppressive effects, which help treat many autoimmune diseases.

The list of possible side effects is quite long, so the ideal is to use the lowest possible dose for the shortest time possible.

Frequent questions

Why use prednisolone versus prednisone?

Prednisolone may be a preferred option if you have moderate to severe liver disease. This is because your liver is required to convert prednisone into its working form, prednisolone.

Can you take prednisolone and prednisone together?

There is no reason to take prednisolone and prednisone together, as prednisone is converted to prednisolone in the body. Also, taking two steroids together can increase the likelihood of side effects usually caused by steroids.

How strong are prednisolone and prednisone compared to other steroids?

Prednisone and prednisolone are medium-strength steroids, similar in potency to methylprednisolone. They are stronger than cortisone and hydrocortisone and weaker than dexamethasone.

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