What is prednisone?
Prednisone falls under a class of drugs called corticosteroids, which also includes prednisolone, fluticasone, and budesonide, among others. It is sold under several brand names, including Deltasone, Meticorten, and Sterapred, and is also available as a generic medication.
Corticosteroids are steroid hormones that occur naturally in your body, while synthetic versions (such as prednisone) are used medicinally. Corticosteroids are involved in several processes, including your immune response, inflammation, and metabolism. Corticosteroids can be further categorized, with the main classes being glucocorticoids and mineralocorticoids. Glucocorticoids are the type of corticosteroids that influence your immune response and inflammation.
Prednisone is a glucocorticoid and therefore has anti-inflammatory effects. This is why you may see it referred to as both a corticosteroid and glucocorticoid.
Prednisone is, therefore, usually used to treat conditions that are characterized by inflammation, including different forms of arthritis, allergic conditions (including asthma), and chronic skin conditions (such as psoriasis). A more comprehensive list of conditions prednisone is used to treat can be found in questions 2: What is prednisone used for?
Prednisone is taken orally as a tablet – available in immediate- or delayed-release form – or as a liquid solution. Unlike other corticosteroids, including methylprednisolone and prednisolone, prednisone cannot be taken by injection or applied topically to the skin (as a lotion or cream, for example).
What is prednisone used for?
The anti-inflammatory characteristics of prednisone make it a potential treatment option for a wide range of diseases that are characterized by inflammation.
The use of corticosteroids in treating allergic conditions, including asthma, allergic rhinitis (hay fever), and allergic reactions to other drugs, is usually reserved for severe cases and when conventional treatment has been ineffective.
Prednisone can be used, in addition to long-term therapy, as a short-term treatment for acute episodes or ‘flare-ups’ of several rheumatic disorders. These include rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, among others.
Prednisone may be used to treat endocrine disorders such as Addison’s disease, which is characterized by the adrenal glands not producing enough steroid hormones (primarily cortisol). Prednisone can be used as a treatment, as it mimics cortisol (see question 3: How does prednisone work).
Prednisone can be used to treat autoimmune diseases related to collagen (the main protein in connective tissue), either during an exacerbation or as maintenance therapy. These include lupus, dermatomyositis, and acute rheumatic carditis.
Prednisone can be used to treat several skin conditions, including psoriasis, seborrheic dermatitis, exfoliative dermatitis, bullous dermatitis herpetiformis, mycosis fungoides, pemphigus, and Stevens-Johnson syndrome. As prednisone is one of the more potent corticosteroids, it may be used in particularly severe cases.
Other uses for prednisone include a range of respiratory disorders, hematological disorders, neoplastic diseases, edematous states, gastrointestinal diseases, and nervous diseases. It may also be used ‘off-label’ (in a manner not approved by the FDA or other health agencies) at your doctor’s discretion.
For more details about which conditions prednisone is used to treat and whether it may be a suitable option for you, you can read the FDA label (available in the sources at the bottom of this page) or speak to your doctor.
How does prednisone work?
Corticosteroid drugs, such as prednisone, work by mimicking the effects natural corticosteroid hormones have on your body. In particular, they mimic cortisol, which is the most important glucocorticoid (see question 1: What is prednisone? for a brief explanation of what glucocorticoids are).
One of the primary actions of prednisone is to limit your immune system’s activity, particularly regarding inflammation. Inflammation is an important part of your immune system’s normal response; however, many diseases are characterized by the immune system being overactive or mistakenly attacking healthy parts of the body (such as the joints in people living with rheumatoid arthritis).
By limiting this response, prednisone can reduce inflammation and ease symptoms.
The downside to this mechanism of action is that prednisone can weaken your immune system and make you more susceptible to infections. Cortisol, the hormone prednisone mimics, also plays a role in a variety of other functions within your body. Prednisone can, therefore, cause several side effects related to these other functions, particularly when taken at high doses. You can read more about the side effects of prednisone in the following question.
The mechanisms of corticosteroids are markedly different from non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and meloxicam. NSAIDs block enzymes that promote pain and inflammation, rather than limiting the response of your immune system.
What are the side effects of taking prednisone?
Prednisone can cause a wide range of side effects, whether you are taking immediate-release tablets, delayed-release tablets, or oral solution form. Some side effects do not usually require medical attention, unless they are severe, do not go away, or worsen. These include:
- Dry scalp
- Thinning of hair
- Swelling of the stomach area
- Lightening skin color
- Red face
- Red or purple lines on your arm, face, legs, or groin
- Increased sweating
- Thin or fragile skin
Some serious side effects can also occur, which require immediate medical attention. These include:
- Blurred vision
- Decreased amount of urine
- Mood changes, aggression, or irritability
- Slow, fast, or irregular heartbeat
- Difficulty swallowing
- Trouble breathing
- Numbness or tingling in your arms or legs
- Itching or skin rashes
- Eye pain or tearing
- Loss of appetite
- Yellow eyes or skin
- Unexplained weight gain or loss
- Pain in your stomach or abdomen
Allergic reactions to prednisone
Allergic reactions to prednisone are rare but can occur. Signs of a serious allergic reaction should be treated as a medical emergency. They include:
- Skin rash – for example itchy, red, or swollen skin
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
Effects of prednisone on the immune system
The way that prednisone works means it may reduce your immune system’s ability to fight infections. You should, therefore, be aware of any signs of infection and speak to your doctor if you experience symptoms such as fever, chills, a bad cough, or persistent sore throat. You should also speak to your doctor immediately if you are exposed to chickenpox or measles.
Speak to your doctor & read the label
This is not a comprehensive list of side effects that can occur when you take prednisone. Because prednisone is prescribed at different strengths and for different lengths of time, it is important to both speak to your doctor about which side effects that you should be aware of. You should also read the leaflet that comes with your medication.
How long does it take for prednisone to work?
Prednisone usually starts working within a few hours, but it may take up to a week until you notice your symptoms improving. This can vary depending on your dosage and the condition prednisone is being used to treat.
If you do not notice an improvement in symptoms or you are concerned prednisone is not working effectively, continue taking it as prescribed and speak to your doctor. Do not suddenly stop taking prednisone, as this can lead to serious side effects (especially if you have been taking it for two weeks or more).
What is the difference between prednisone, prednisolone, and methylprednisolone?
Prednisone, prednisolone, and methylprednisolone all work in very similar ways and are generally used to treat the same conditions. However, there are some differences:
- Prednisone is a ‘prodrug’. This means it is biologically inactive until it is metabolized. Prednisone is metabolized in the liver, releasing prednisolone, which then acts on the body. Prednisone is taken orally.
- Prednisolone is, therefore, the active metabolite of prednisone. Unlike prednisone, it does not need to be metabolized before it starts having a biological effect. It can be taken orally, with injections, or topically (creams/ointments applied to the skin). Prednisolone and prednisone have been found to have similar potency.
- Methylprednisolone is the most potent of the three; 4mg of methylprednisolone is equivalent to 5mg of prednisone or prednisolone. It can be taken orally, with injections, or topically.
Your doctor will consider the differences between methylprednisolone, prednisone, prednisolone, another corticosteroid, and other treatment options (such as NSAIDs) when deciding the most suitable option.
Can I take painkillers with prednisone?
You should not take non-steroidal anti-inflammatory painkillers (NSAIDs), such as ibuprofen, aspirin, meloxicam, or naproxen while taking prednisone unless explicitly told to do so by your doctor.
The combination can increase your risk of problems in your gut, including gastrointestinal bleeding, stomach ulcers, and inflammation. In rare cases, it can lead to gastrointestinal perforation – a hole right through the stomach or intestine – which can be fatal.
Doctors may, in some circumstances, prescribe prednisone with an NSAID such as ibuprofen if the benefits are deemed to outweigh the risks.
Acetaminophen (also known as paracetamol) is not believed to interact with prednisone, so they can be taken together.
A number of other substances can interact with prednisone. It is important to tell your doctor about prescription medications, over-the-counter medications, and supplements that you take.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.