Prednisone is a prescription corticosteroid that works by lowering inflammation in the body and suppressing the immune system. Prednisone treats several conditions such as skin problems, allergies, arthritis, lupus, leukemia and other forms of cancer, gastrointestinal diseases such as ulcerative colitis, flares of multiple sclerosis and lung problems such as asthma.
The U.S. Food and Drug Administration first approved prednisone in 1955 for treating rheumatoid arthritis. Since then, health care providers have prescribed it to millions of Americans.
Prednisone is available as an oral tablet in delayed-release and regular forms. It’s also available in an oral liquid. The drug is available in generic form and under the following brand names: Deltasone, PredniSONE Intensol and Rayos.
Prednisone is a synthetic version of glucocorticoid, which is a natural hormone produced in the adrenal glands. It replaces low levels of steroids in the body. Glucocorticoids are potent anti-inflammatories that reduce redness and swelling. They also suppress the immune system.
The most common prednisone side effects include alteration in glucose tolerance (high blood sugar), fluid retention, rise in blood pressure, increased appetite, behavioral and mood changes and weight gain. These are more common in patients receiving larger doses or who are on long-term therapy.
What Does Prednisone Treat?
Health care providers use prednisone to treat a wide variety of conditions caused by inflammation and overactive immune systems. The drug may not cure a condition, but it can help manage symptoms.
For example, in clinical trials on patients with rheumatoid arthritis, patients who took delayed-release prednisone saw a decrease in duration of morning stiffness. Patients who took prednisone had 46 minutes of morning stiffness versus 85 minutes in people who took a placebo, according to the Rayos drug label.
People with severe asthma may also benefit from taking prednisone. The Global Initiative for Asthma recommends short-term steroids (for a few days) during an asthma flare when symptoms are not controlled by other therapies. Long-term steroids are less commonly used because of the risk of side effects.
- Acquired (autoimmune) hemolytic anemia
- Acute exacerbations of chronic obstructive pulmonary disease (COPD) (delayed-release tablets only)
- Acute gouty arthritis
- Acute leukemia
- Acute or chronic solid organ rejection
- Aggressive lymphomas
- Allergic conjunctivitis
- Atopic dermatitis
- Contact dermatitis
- Crohn’s disease
- Drug sensitivity reactions
- Fulminating or disseminated pulmonary tuberculosis
- Herpes zoster ophthalmicus (painful rash in the eye)
- Multiple sclerosis
- Nonsuppurative thyroiditis
- Post-traumatic osteoarthritis
- Psoriatic arthritis
- Rheumatoid arthritis
- Seasonal or perennial allergic rhinitis (inflammation of mucous membranes in the nose)
- Severe erythema multiforme (Stevens-Johnson syndrome)
- Systemic lupus erythematosus
- Tuberculous meningitis
- Ulcerative colitis
The FDA approved prednisone to treat many of these conditions, but sometimes health care providers prescribe it for off-label uses not approved by the FDA.
How to Use This Medication
Prednisone immediate-release tablets are available in six strengths: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg and 50 mg. Delayed-release tablets are available in three strengths: 1 mg, 2 mg and 5 mg. Prednisone oral liquid is available in one strength: 5 mg/5 mL.
Each person’s prednisone dosage varies depending on the condition being treated and how the patient responds to the dose. There are no set dosages on the drug label because they have to be tailored to each patient. The initial dose varies from 5 mg to 60 mg once a day.
Immediate-release forms (tablets and oral liquid) of prednisone work best when taken in the morning before 9 am with food or milk. Delayed-release tablets may be taken at different times of the day by different people depending on what they are taking prednisone for. Some patients may need antacids between meals to avoid stomach ulcers when taking large doses.
Patients should swallow delayed-release tablets whole and shouldn’t chew, break or divide them.
The immediate-release tablet and oral liquid drug label provides one recommended dosage to treat acute exacerbations of multiple sclerosis. Patients may take 200 mg per day for one week followed by 80 mg every other day for one month.
Health care providers may increase or lower the dose based on response. After the health care provider finds a dose that works, they will lower it by small increments until the lowest effective dose is reached.
In some cases, providers may recommend taking larger doses every other morning. Patients should not do this without a provider’s recommendation.
When patients are ready to stop therapy, providers slowly wean them off the drug. Stopping the drug suddenly can lead to withdrawal.
How Long Does Prednisone Stay in Your System?
Prednisone has a half-life of about 2 to 3 hours, according to the Rayos drug label, though other studies place its half-life closer to 3 to 4 hours. Half-life is the amount of time it takes for the drug level in the body to decrease to 50 percent of what it was when a person first took it.
For example, if a person took 5 mg of prednisone, the dose remaining in the body after three hours would be about 2.5 mg.
It takes about seven half-lives for a drug to leave the body. So based on a half-life time of 2 to 3 hours, it would take 14 to 21 hours for prednisone to leave the body. This is just an average and may be different depending on a person’s age, weight and general health.
The chance of dying from prednisone overdose is low and some people may have no symptoms, but others may have life-threatening symptoms. People have died from an overdose.
- Abdominal pain
- Nystagmus (involuntary movements of the eyes)
- Ringing in the ears
Who Shouldn’t Use Prednisone
People who are allergic to prednisone or have a systemic fungal infection should not use this drug.
Patients receiving immunosuppressive doses of prednisone should not receive live or live-attenuated vaccines. Inactivated vaccines may be used, but the patient’s response to these vaccines is unpredictable.
Doctors should monitor patients for allergic reactions and adverse events.
Pregnancy and Breastfeeding
Human and animal studies have shown that steroids, including prednisone, can harm an unborn baby when taken during pregnancy, according to the drug’s label.
Some studies have shown a small increase in the risk of cleft palate and other orofacial clefts when prednisone is taken during the first trimester. There are also reports of decreased birth weight and intrauterine growth restriction — a condition where the baby doesn’t grow at the right rate during pregnancy.
Prednisone can travel to the baby through breast milk, but there haven’t been any reports of adverse events. But high doses of prednisone used for long periods could potentially cause growth problems in breastfed infants.
Drug Interactions and Warnings
Prednisone interacts with a long list of drugs and substances. This isn’t a complete list of all possible drug interactions. Patients should tell their health care provider about all the medicines they take and may start taking.
Prednisone and Alcohol
There are no specific warnings about drinking alcohol with prednisone listed on the drug’s label. But according to the UK’s National Health Service, drinking alcohol with prednisone may increase the risk of upsetting the stomach.
Abelcet and Ambisome (amphotericin B injection)
There have been reports that using these drugs with hydrocortisone, a corticosteroid similar to prednisone, may increase risk of heart failure and cardiac enlargement.
Aricept (donepezil), Razadyne (galantamine), Exelon (rivastigmine) and Other Anticholinesterase Agents
Using these drugs with prednisone may cause severe weakness in patients with myasthenia gravis. Providers should have patients stop anticholinesterase therapy at least 24 hours before starting prednisone, if possible.
Using warfarin with prednisone may cause warfarin not to work as well. Providers should monitor patients frequently to make sure the anticoagulation effect is working.
Prednisone can increase blood sugar levels. People taking diabetes medications may need increased doses.
Aplenzin, Forfivo XL, Wellbutrin (Bupropion)
Both bupropion and corticosteroids can make people more susceptible to seizures, so using them together may increase the risk of seizures.
Antibiotics for Tuberculosis
Isoniazid may not work as well when taken with prednisone.
Phenytoin, Barbiturates, Rifampin, Carbamazepine and other Cytochrome (CYP) 3A4 Enzyme Inducers
These drugs may enhance prednisone metabolism. Providers may need to increase the dose of prednisone.
Macrolide Antibiotics, Ketoconazole and other CYP 3A4 Enzyme Inhibitors
Ketoconazole may cause certain corticosteroids to linger in the body longer. Ketoconazole can decrease drug metabolism by as much as 60 percent. This can increase the risk of corticosteroid side effects.
A certain type of antibiotic called fluoroquinolones can cause damage to tendons. People who take corticosteroids while also taking fluroquinolones, or after taking fluoroquinolones, may be at higher risk for tendon damage.
Clearance of corticosteroids — the rate at which the drug is processed and leaves the body — is increased with cholestyramine.
Gengraf, Neoral, Sandimmune (Cyclosporine)
Using prednisone with cyclosporine may cause convulsions.
Patients on digoxin — a drug used for heart failure — may be at increased risk of low potassium levels or hypokalemia. This can lead to heart rhythm problems.
Estrogen Drugs and Oral Contraceptives
Drugs with estrogens such as birth control pills (oral contraceptives) may decrease the metabolism of the drug in the liver and increase the effect of corticosteroids.
Certain Pain Relievers
Using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and salicylates such as aspirin may increase the risk of toxicity and gastrointestinal side effects when taken with corticosteroids.
Diuretics and other Potassium-Depleting Agents
Using corticosteroids with diuretics and other potassium-depleting medications may increase the risk of low potassium levels, or hypokalemia.
Taking prednisone may decrease the effect of quetiapine, so higher quetiapine doses may be needed.
Taking prednisone while having a skin test may suppress reactions to the test.
Taking thalidomide with prednisone can lead to a serious skin reaction (toxic epidermal necrolysis).
Live or Live-Attenuated Vaccines
People taking prednisone should stop taking the drug before receiving a live or live-attenuated vaccine. Prednisone may increase the replication of some organisms in live-attenuated vaccines. Patients receiving immunosuppressive doses of prednisone should not use live or live-attenuated vaccines.
Prednisolone vs. Prednisone
Prednisolone and prednisone are both corticosteroids. They work the same way in the body, treat the same health conditions and have similar side effects.
Prednisone is converted into prednisolone in the liver. Prednisolone is the form of prednisone that works in the body. Prednisolone’s half-life is also slightly shorter, meaning it is eliminated from the body a little more quickly.
Prednisone is slightly less bioavailable (about 20 percent less) than prednisolone, which means it is slightly less absorbable into the body than prednisolone. Researchers think this is because some people may absorb it differently than others, especially since prednisone must be converted to prednisolone in the liver. For this reason, some researchers recommend using prednisolone rather than prednisone in people with active liver disease.
Prednisolone’s half-life changes with age. Children process the drug more quickly than adults.
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