Dexamethasone vs. prednisone: Comparing these corticosteroids

In this article:

• Difference between dexamethasone and prednisone
• Uses
• Potency and efficacy
• Dosage
• Side effects
• Interactions
• Warnings
• Insurance coverage and cost comparison

In this article

• Difference between dexamethasone and prednisone
• Uses
• Potency and efficacy
• Dosage
• Side effects
• Interactions
• Warnings
• Insurance coverage and cost comparison

Steroid medications are used in a wide variety of emergency medical situations, as well as for many other acute and chronic inflammatory conditions and disease states. Dexamethasone and prednisone are two prescription steroids that are approved by the 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. 

Difference between dexamethasone and prednisone

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.

What is dexamethasone?

Dexamethasone is a corticosteroid, or steroid, medication. Although dexamethasone is usually sold as a generic drug, some brand names that contain dexamethasone include Decadron, Hemady, and TaperDex. Oral dexamethasone is available as a tablet, oral solution, and injection. It is also available in certain ophthalmic products, such as eye drops. Dexamethasone is a long-acting drug with a half-life of 36 to 72 hours.

What is prednisone?

Prednisone is also a steroid medication. Prednisone may be referred to as Deltasone, but the brand name is no longer available. Prednisone is available as a generic product in the form of a tablet and oral solution. It is an intermediate-acting drug with a half-life of 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.

Dexamethasone vs prednisone: Corticosteroids comparison
	Dexamethasone	Prednisone
Drug class	Corticosteroid (steroid), also known as a glucocorticoid	Corticosteroid (steroid), also known as a glucocorticoid
Brand/generic status	Brand and generic	Generic with a delayed-release brand name available
What is the brand name?	Decadron, Hemady, TaperDex	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; varies
Who typically uses the medication?	Adults, sometimes in children	Adults, sometimes in children

 

What are dexamethasone and prednisone used for?

Dexamethasone and prednisone have similar indications. Both medications are indicated for use in a wide variety of inflammatory conditions for various organ 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 conditions, there are too many to list. Several examples for each category are listed in the chart below. Consult your doctor for more information. Also, some doctors prescribe these medications off-label for certain uses. Off-label prescribing is when a medicine is prescribed for an indication that is not FDA-approved. For example, steroids may be prescribed for certain cancers (in combination with other drugs), nausea and vomiting caused by chemotherapy, carpal tunnel syndrome (in combination with other drugs), and exacerbations of chronic obstructive pulmonary disease (COPD). 

Dexamethasone vs. prednisone uses
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 multiple sclerosis exacerbations, 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

 

Dexamethasone vs. prednisone potency and efficacy

Clinical trials comparing the two drugs head-to-head mostly looked at the use of dexamethasone vs. prednisone in young children with croup or acute asthma. A 2006 study treated children who had mild-to-moderate croup with one single dose of oral dexamethasone or one dose of prednisolone (the active form of prednisone). The study found that prednisolone was less effective than dexamethasone in lowering the number of patients who returned to the hospital. 

Both a 2014 review of studies in Pediatrics and a 2017 study in The Journal of Pediatrics concluded that two doses of dexamethasone are an effective alternative to a five-day prednisone treatment in children with acute asthma. 

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 be determined by your healthcare provider, who can take into account your medical history, other conditions, and other medications you take that could potentially interact with dexamethasone or prednisone.

Dexamethasone vs. prednisone dosage

When taking steroid medication, it is important to take it exactly as directed. Often, the directions will specify that you start with a higher dose and then taper down to a lower dose. Steroids like dexamethasone or prednisone should be taken with food to reduce stomach side effects. The tables below outline standard dosages for some of the conditions that these steroids treat. More detailed information on dosing can be found for dexamethasone and prednisone on our dosing pages.  

Dexamethasone vs. prednisone dosage for adults
Condition	Dexamethasone	Prednisone
General dosage	Initial dose: 0.75 mg to 9 mg per day, depending on the condition being treated	Initial dose: 5 mg to 60 mg per day, depending on the condition being treated
Adrenal insufficiency (Addison’s disease)	0.75 mg to 9 mg per day, given in two to four divided doses	5 mg in the morning and 2.5 mg in the evening
Rheumatic disorders (acute gouty arthritis, ankylosing spondylitis, rheumatoid arthritis, juvenile rheumatoid arthritis, juvenile idiopathic arthritis)	Initially, 0.75 mg to 9 mg per day, given in two to four divided doses, then adjusted according to patient response	5 mg to 30 mg daily
Skin conditions (atopic dermatitis)	Initially, 0.75 mg to 9 mg per day, given in two to four divided doses, then adjusted according to patient response	5 mg to 60 mg per day, given in one to four divided doses (only given when the patient does not respond to topical treatment)
Asthma exacerbation	Initially, 0.75 mg to 9 mg per day, given in two to four divided doses, then adjusted according to patient response	40 mg to 50 mg per day or 1 mg/kg/day(max: 50 mg/day)
Multiple myeloma	20–40 mg by mouth on the specified day of the chemotherapy cycle	Varies (used off-label)

Sources: Dexamethasone, Prednisone

Steroid dosing for children varies by weight and the condition being treated. The healthcare provider will decide the dosage based on the condition being treated, severity of symptoms, the child’s weight, and any other contributing factors. 

Dexamethasone vs. prednisone dosage for children
Condition	Dexamethasone	Prednisone
All conditions that respond to steroids (general dosing)	0.08-0.3 mg/kg/day divided into two to four doses per day	0.05–2 mg/kg/day divided into one to four doses per day

Note: Doses listed in the tables above are standard doses per condition. Initial and maximum doses vary by drug and indication. The tables above are not a complete list of all possible indications or doses for dexamethasone and prednisone. Your healthcare provider will determine the best dosage for you based on your health condition and response to treatment.

COVID-19 Dosage

Patients with mild-to-moderate COVID-19

Systemic corticosteroids, such as dexamethasone and prednisone, are not recommended in patients with mild or moderate COVID-19 who do not require oxygen. Unless the patient requires oxygen, using a steroid does not provide benefit and can cause serious side effects, such as high blood sugar, stomach bleeding, psychosis, infections, and other long-term effects.

Patients who are already taking a corticosteroid for another indication should continue treatment under the supervision of their healthcare provider. 

Patients with severe COVID-19

In patients who are hospitalized, have suspected or confirmed severe COVID-19, and are on oxygen or a ventilator, a steroid may be used if the healthcare provider determines it will be useful. If dexamethasone is used, the dose is usually 6 mg (by mouth or IV) daily. If dexamethasone is not available and prednisone is used, the dosage is usually 40 mg daily. 

 

Dexamethasone and prednisone side effects 

When you are prescribed a steroid medication, it is important to take the medication as directed and taper the dose when instructed to do so by your healthcare provider. 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 events.

Dexamethasone and prednisone side effects
System	Potential side effects
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 a 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 ulcers, perforation of the small and large intestine, ulcerative esophagitis
Musculoskeletal	Loss of muscle mass, muscle weakness, osteoporosis, long bone fractures, tendon ruptures, vertebral compression fractures
Neurological/psychiatric	Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (increased pressure in the skull) usually following discontinuation of treatment, insomnia, mood swings, neuropathy, paresthesia (“pins and needles” feeling), personality changes, vertigo
Ophthalmic	Glaucoma, cataracts, blurred vision
Other	Abnormal fat deposits, increased susceptibility to infectious diseases, hiccups, moon face, weight gain

Sources: Dexamethasone, Prednisone 

Dexamethasone and prednisone interactions

Patients taking an anticoagulant, such as warfarin, should be monitored while taking steroid medications. 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 a dosage adjustment. This is not a full list of drug interactions. Consult your healthcare provider for a full list of drug interactions.

Dexamethasone vs. prednisone 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 inducers	Yes	Yes
Azithromycin Erythromycin Ketoconazole	CYP3A4 inhibitors	Yes	Yes
Aspirin Ibuprofen Meloxicam Naproxen	Nonsteroidal anti-inflammatory drugs (NSAIDs)	Yes	Yes

 

There are also some food interactions to take note of with steroids like dexamethasone and prednisone. These steroids should not be mixed with alcohol. Combining steroid medications with alcohol can lead to a higher risk of stomach ulcers, perforation, and bleeding. 

Dexamethasone, but not prednisone, interacts with grapefruits and grapefruit juices. The combination can lead to higher levels of dexamethasone in the body, which can cause serious side effects from the steroid. Avoid grapefruits and grapefruit juice while taking dexamethasone.

Dexamethasone and prednisone warnings 

Rarely, an allergic or anaphylactic reaction may occur. Seek emergency medical treatment if you experience symptoms of anaphylaxis, such as trouble breathing, swelling of the face, neck, tongue, or lips, or a lack of responsiveness.

Steroids should be used with caution in patients with any of the following conditions:

• Heart failure
• Kidney problems
• High blood pressure
• Recent myocardial infarction
• Gastrointestinal conditions 
• Liver problems

Adrenocortical insufficiency may occur if steroids are stopped too quickly and can persist for months. The risk may be reduced by slowly tapering steroid medications and using the lowest possible dose. Follow the dosing and tapering schedule as prescribed. 

Because steroids suppress the immune system, patients being treated with them have an increased risk of infections, especially with higher doses. Steroids may exacerbate systemic fungal infections and should not be used in these cases unless needed to control a life-threatening drug reaction. Additionally, 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 may cause mood changes, personality changes, insomnia, or psychotic manifestations. Consult your healthcare provider immediately if you notice any changes in mood or behavior.

There is limited data on dexamethasone and prednisone in pregnant women, so they should be avoided during pregnancy unless the benefit outweighs the risk to the fetus. They should only be taken under the close supervision of a healthcare provider. 

Dexamethasone is not recommended for use in breastfeeding women due to a lack of data. Prednisone may be used during breastfeeding if approved by the healthcare provider. Women who take more than 20 mg of prednisone per day should wait at least four hours after taking the medication to breastfeed. 

Insurance coverage and cost comparison

Generic medications are usually covered by insurance, including Medicare and Medicaid. However, the cost of dexamethasone and prednisone with any insurance provider will vary. Cost factors include:

• Whether your plan’s drug formulary covers these drugs and which tier they fall under
• Your coverage stage (whether you’ve hit your deductible or maximum out-of-pocket amount yet)
• The quantity, strength, and form of medication you need
• Which pharmacy you are using to fill your prescription

Note for Medicare consumers: Depending on the diagnosis, Medicare coverage of these steroids may fall under Part B or Part D.

RELATED: Get the SingleCare prescription discount card

Dexamethasone vs. prednisone costs
	Dexamethasone	Prednisone
Cost without insurance	$28 per 10, 4 mg tablets	$187 per 10, 20 mg tablets
SingleCare cost	$5 for 10, 4 mg tablets	$3 for 10, 20 mg tablets
SingleCare coupons	Dexamethasone coupons	Prednisone coupons

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices.

If you’re prescribed dexamethasone or prednisone and have questions, talk to your healthcare provider. They can explain why one corticosteroid may work better than the other for your specific condition.