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Drug vs. Drug

Dexamethasone vs. prednisone: Differences, similarities, and which is better for you

Karen Berger medical writer and reviewer headshot By | Updated on June 30, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

With COVID-19 in the news every day, it is likely you have heard about steroid treatment. Or, if you have ever been an emergency room patient, it is possible you have been treated with steroids. Steroid medications are used in a wide variety of emergency medical situations as well as for many other acute and chronic inflammatory conditions. Dexamethasone and prednisone are two prescription drugs that are approved by the United States Food and Drug Administration (FDA).

Both drugs are corticosteroids, also known as glucocorticoids or steroids. They are used for a wide variety of inflammatory conditions in many organ systems. Corticosteroids work by causing metabolic effects and modifying the body’s immune response to stimuli. Although dexamethasone and prednisone are both steroids, they have some differences, which we will describe below.

What are the main differences between dexamethasone and prednisone?

Dexamethasone is a corticosteroid, or steroid, medication. Although the brand name was known as Decadron, the brand-name product is no longer commercially available. Dexamethasone is available as a generic product, as a tablet, injection, oral solution, and in ophthalmic products. Dexamethasone is known as a long-acting drug. Its half-life is 36-72 hours.

Prednisone is also a steroid medication. The brand name of prednisone may be referred to as Deltasone, but the brand-name is no longer available. Prednisone is available as a generic product, as a tablet, and as an oral solution. Prednisone is known as an intermediate-acting drug. Its half-life is about three to four hours. Oral prednisone is most commonly prescribed as an immediate-release tablet, but there is also a delayed-release prednisone tablet called Rayos.

Main differences between dexamethasone and prednisone
Dexamethasone Prednisone
Drug class Corticosteroid (steroid), also known as a glucocorticoid Corticosteroid (steroid), also known as a glucocorticoid
Brand/generic status Generic Generic, brand (Rayos— delayed-release tablets)
What is the brand name? Decadron (no longer commercially available) Deltasone (no longer  commercially available),
Rayos (delayed-release tablets)
What form(s) does the drug come in? Tablet, injection, oral solution, ophthalmic drops (alone and in combination with other ingredients), ophthalmic ointments (in combination with other ingredients) Tablet, oral solution
What is the standard dosage? Varies by indication and response to treatment Varies by indication and response to treatment
How long is the typical treatment? Short-term; varies Short-term; some patients take long-term under prescriber’s care
Who typically uses the medication? Adults, sometimes in children Adults, sometimes in children

Conditions treated by dexamethasone and prednisone

Dexamethasone and prednisone have similar indications. Both medications are indicated for use in a wide variety of inflammatory conditions for various systems. For example, both medications may be used for allergic conditions, when conventional treatment is not effective. The allergic and dermatologic conditions that dexamethasone and prednisone may treat include acute exacerbations of asthma, atopic or contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, Stevens-Johnson syndrome, and serum sickness.

Because each category has many indications, there are too many to list. In the chart below, we will list several examples for each category. Consult your healthcare provider for more information.

Condition Dexamethasone Prednisone
Allergic and dermatologic conditions (acute asthma exacerbations, dermatitis, rhinitis) Yes Yes
Endocrine disorders (adrenocortical insufficiency—in conjunction with a mineralocorticoid drug such as fludrocortisone, congenital adrenal hyperplasia) Yes Yes
Gastrointestinal diseases (enteritis, ulcerative colitis) Yes Yes
Hematology disorders (certain types of anemia, idiopathic thrombocytopenic purpura) Yes Yes
Neoplastic diseases (leukemia, lymphoma) Yes Yes
Nervous system (acute exacerbation of multiple sclerosis, cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury) Yes Yes
Ophthalmic diseases (temporal arteritis, uveitis) Yes Yes
Renal diseases (idiopathic nephrotic syndrome, lupus) Yes Yes
Respiratory diseases (certain types of tuberculosis or pneumonia) Yes Yes
Rheumatic disorders (certain types of arthritis, lupus) Yes Yes

Is dexamethasone or prednisone more effective?

Studies comparing the two drugs head to head mostly looked at dexamethasone vs. prednisone in young children with acute asthma. One review of studies looked at dexamethasone vs. prednisone in children with acute exacerbation of asthma. It concluded that evidence supports the use of either drug. The review mentioned that dexamethasone may be better tolerated, but that more research is needed.

Because each drug can be used to treat a wide variety of medical conditions, it is difficult to say which drug is more effective. Your healthcare provider may choose dexamethasone if you need something that is longer-acting and more potent, or prednisone if you need something that is shorter-acting. The best drug for you can only be determined by your healthcare provider, who can take into account your medical history and conditions, and other medications you take that could potentially interact with dexamethasone or prednisone.

Coverage and cost comparison of dexamethasone vs. prednisone

Dexamethasone is typically covered by private insurance and Medicare. The out-of-pocket price of 30 4 mg tablets can be $40 or more. With a SingleCare coupon, it is less than $10 at participating pharmacies.

Prednisone is also usually covered by private insurance and Medicare. The out-of-pocket price of 10 20 mg tablets is about $20. Use a SingleCare coupon to get a prescription for less than $5.

Note: Depending on the diagnosis, Medicare coverage may fall under Part B or Part D.

  Dexamethasone Prednisone
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 4 mg 30 tablets 20 mg 10 tablets
Typical Medicare copay $0-$1 $0-$1
SingleCare cost $10 $5

Common side effects of dexamethasone vs. prednisone

When you are prescribed a steroid medication, it is important to take the medication as directed, and taper the dose as directed by your healthcare provider when instructed to do so. Below is a list of potential side effects that may occur with either dexamethasone or prednisone. This is not a full list of side effects. Consult your healthcare provider for a full list of adverse effects.

System Potential side effects of dexamethasone or prednisone
Allergic Allergic reaction, anaphylaxis, angioedema
Cardiovascular Cardiac arrest/arrhythmia, cardiac enlargement, changes in heart rate, circulatory collapse, heart failure, hypertension, edema, syncope, tachycardia, thromboembolism
Dermatologic Acne, allergic dermatitis, dry/scaly skin, erythema (redness), impaired wound healing, increased sweating, rash
Endocrine Decreased carbohydrate/glucose tolerance, development of cushingoid state, hyperglycemia (high blood sugar), hirsutism (excess hair growth), menstrual irregularities, suppression of growth in pediatric patients
Fluid/electrolyte disturbances Congestive heart failure, fluid retention, potassium loss, sodium retention
Gastrointestinal Increased appetite, nausea, pancreatitis, peptic ulcer, perforation of the small and large intestine, ulcerative esophagitis
Musculoskeletal Loss of muscle mass, muscle weakness, osteoporosis, long bones fracture, tendon rupture, vertebral compression fractures
Neurological/psychiatric Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuropathy, paresthesia, personality changes, vertigo
Ophthalmic Glaucoma, cataracts, blurred vision
Other Abnormal fat deposits, increased susceptibility to infectious diseases, hiccups, moon face, weight gain

Source: DailyMed (dexamethasone), DailyMed (prednisone)

Drug interactions of dexamethasone vs. prednisone

Patients taking an anticoagulant, such as warfarin, should be monitored while taking a steroid medication. Medications used for diabetes may need to be adjusted because steroids may affect blood glucose levels. Certain medications that are metabolized by an enzyme called CYP3A4 may affect the metabolism of the steroid, requiring dosage adjustment. This is not a full list of drug interactions. Consult your healthcare provider for a full list of drug interactions.

Drug Drug class Dexamethasone Prednisone
Warfarin Anticoagulant Yes Yes
Digoxin Cardiac glycoside Yes Yes
Glipizide
Glyburide
Insulin
Metformin
Pioglitazone
Antidiabetic agents Yes Yes
Carbamazepine
Phenobarbital
Phenytoin
Rifampin
CYP3A4 enzyme inducers Yes Yes
Azithromycin
Erythromycin
Ketoconazole
CYP3A4 enzyme inhibitors Yes Yes
Aspirin
Ibuprofen
Meloxicam
Naproxen
NSAIDs Yes Yes

Warnings of dexamethasone and prednisone

Warnings of corticosteroid treatment with dexamethasone or prednisone include:

  • Rarely, an allergic or anaphylactic reaction may occur. Seek emergency medical treatment if this occurs.
  • The use of dexamethasone or prednisone may increase blood pressure, causing retention of sodium and water, and loss of potassium. Steroids should be used with caution in patients with heart failure, high blood pressure, and/or kidney problems.
  • Steroids may cause calcium loss. This may lead to slowed growth in children and osteoporosis at any age. Use with caution.
  • There is an association between steroid use and left ventricular free wall rupture after a recent myocardial infarction. Steroids should be avoided or used with extreme caution in these patients.
  • Steroids can cause reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, or adrenal insufficiency, along with potential glucocorticosteroid insufficiency, after treatment. Adrenocortical insufficiency, which may persist for months after discontinuation of the steroid, may occur if steroids are stopped too quickly. The risk may be reduced by slowly tapering the steroid medication. Also, the lowest possible dose should be used.
  • Because steroids suppress the immune system, patients being treated with steroids are more susceptible to infections, especially with higher doses of steroids. Steroids may exacerbate systemic fungal infections and should not be used in these cases unless needed to control a life-threatening drug reaction.
  • Chickenpox and measles can be more serious or even fatal in patients who take steroids, due to a suppressed immune system. Avoid exposure to chickenpox and measles. If you are exposed, seek medical attention right away.
  • Patients receiving immunosuppressive doses of steroids should not receive a live vaccine.
  • Steroids may cause increased intraocular pressure, cataracts, glaucoma, and/or eye infections. Patients who develop eye symptoms, or who use steroids for more than six weeks, should see an ophthalmologist. Oral steroids should not be used to treat optic neuritis or active ocular herpes simplex.
  • Steroids should be used with caution in patients with gastrointestinal conditions and/or liver problems.
  • Steroids may cause mood changes, personality changes, insomnia, or psychotic manifestations. Consult your healthcare provider immediately if you notice any changes in mood or behavior.
  • Follow the dosing and tapering schedule for your corticosteroid therapy. Do not discontinue steroids abruptly or without supervision from your healthcare provider.
  • Steroid use in pregnancy may cause the baby to have a cleft palate or problems with growth/weight gain. Steroids should only be used in pregnancy if benefits outweigh the risks. If you are already taking a steroid medication and find out that you are pregnant, consult your healthcare provider immediately.

Frequently asked questions about dexamethasone vs. prednisone

What is dexamethasone?

Dexamethasone is a steroid drug used in the treatment of a wide variety of inflammatory conditions.

What is prednisone?

Like dexamethasone, prednisone is a steroid drug that is used in many different inflammatory conditions for its anti-inflammatory effects.

Are dexamethasone and prednisone the same?

 

Although they are similar, they are not exactly the same. The information above is a helpful comparison between the two drugs. Other steroid drugs you may have heard of include Medrol (methylprednisolone), prednisolone, and hydrocortisone.

Is dexamethasone or prednisone better? / Is dexamethasone safer than prednisone?

There is not much data comparing the two drugs directly. One review of studies concluded that either drug is acceptable for the treatment of children with acute exacerbation of asthma. Because there are so many different indications for the use of a steroid medication, your healthcare provider will take into account the condition being treated along with your medical history and other medications you take, when deciding which medication is better for you.

In terms of safety, all steroids have the potential for side effects (see Warnings section), and some can be very serious. Your healthcare provider will decide which medication is safer for you and prescribe the shortest course of treatment possible. Often, you will taper off the steroid so that you do not stop suddenly. This helps your adrenal glands return to normal function.

Can I use dexamethasone or prednisone while pregnant?

Corticosteroids such as dexamethasone or prednisone have been shown to harm the fetus in many species when given in doses equivalent to the dose a human would take, causing an increased incidence of cleft palate in the animal offspring. Steroids may also cause growth restriction and decreased birth weight. There have been no adequate, well-controlled studies of dexamethasone or prednisone in pregnant women. Therefore, dexamethasone or prednisone should be used in pregnancy only if the benefit outweighs the risk to the fetus. Infants born to mothers who have received high doses of steroids during pregnancy should be observed for signs of hypoadrenalism.

Can I use dexamethasone or prednisone with alcohol?

Generally, alcohol should not be mixed with steroids. Consult your healthcare provider for medical advice.

Is dexamethasone a strong steroid?

Dexamethasone is long-acting and is considered a potent, or strong, steroid. It is 25 times more potent than hydrocortisone. The initial dosage of dexamethasone may vary from 0.75 to 9 mg a day, depending on the condition being treated. Dosage requirements vary and must be individualized based on the condition being treated and response to treatment.

Are prednisone and Decadron the same?

Prednisone and Decadron (dexamethasone) are both steroids, used in a variety of inflammatory and/or autoimmune conditions, but have some differences, as outlined above. For example, Decadron (dexamethasone) is more potent and longer-acting than prednisone.

How quickly does dexamethasone work?

It depends on how the medication is administered. Given by injection, dexamethasone will begin working quickly. Taken by mouth as a tablet, the effects may take from one hour up to several hours.