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

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

Prednisolone and prednisone are each synthetic glucocorticoids used in a variety of disorders involving inflammatory and autoimmune processes. Prednisolone is the active metabolite of prednisone. Prednisone is processed in the liver to prednisolone which is then able to cross the cellular membrane. Once inside the cell, prednisolone has a high affinity for cytoplasmic receptors, and by binding, it inhibits protein synthesis. Ultimately, the steroid’s intended action is inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, and suppression of humoral immune responses.

What are the main differences between prednisolone and prednisone?

Prednisolone is a prescription medication used in inflammatory and autoimmune disorders. It is the active metabolite of prednisone.  Once it crosses the cell membrane, it inhibits the infiltration of inflammatory and immune response markers.

Prednisolone may also be called by some it’s brand name formulations such as Prelone, Pediapred, Millipred, Orapred ODT, or Pred-Forte. Prednisolone is available in ophthalmic drops (suspension and solution) and an injectable solution. Oral formulations include solutions and suspensions in a 5 mg/ml, 10 mg/ml, and 15 mg/ml concentration. Prednisolone is also available in 5 mg oral tablets, as well as orally disintegrating tablets in 10 mg, 15 mg, and 30 mg strengths.

Prednisone is a prescription medication that is also used in a variety of inflammatory and immune disorders. Prednisone is a cortisone derivative and must be metabolized by the liver into its active form, prednisolone, in order to cross the cellular membrane.

Prednisone may also be called by its brand names Deltasone or Rayos. It is available in 2.5 mg, 5 mg, 10 mg, 20 mg, and 50 mg oral tablets. It is also available in an oral solution.

Conditions treated by prednisolone and prednisone

Prednisolone is used to treat a wide range of inflammatory and autoimmune disorders. These include rheumatic, respiratory, allergic, endocrine, collagen, hematologic, gastrointestinal, and ophthalmic disorders. Prednisone is metabolized to prednisolone, therefore, its list of intended treatment disorders is similar.

These corticosteroids have been proven effective in seasonal allergic rhinitis, allergic reactions, and bronchial asthma, helping to reduce airway inflammation and ease the process of breathing. Prednisolone and prednisone are also effective in allergic corneal marginal ulcers, herpes zoster ophthalmicus, and anterior segment inflammation of the eye. Prednisolone’s topical ophthalmic preparations may prove especially useful in disorders of the eye.

The following table, while extensive, may not list every use of these two medications. Please consult with your healthcare provider for more information on indications of use.

Is prednisolone or prednisone more effective?

When comparing the efficacy of prednisolone and prednisone, it is important to remember that prednisone is the precursor to the active metabolite, prednisolone. When evaluating the efficacy of either drug, the first and most important consideration is the patient’s ability to convert prednisone to its active metabolite. Prednisone is metabolized in the liver to prednisolone, and the speed and extent of conversion is dependent upon hepatic function.

Researchers compared the conversion of prednisone in patients who showed hepatic impairment to patients with normal liver function. The plasma concentration of prednisolone was markedly variable in patients with hepatic disease, with some patients showing almost no conversion of the drug. Researchers concluded that there was a great deal of variation of prednisone conversion, and therefore patients with hepatic disease may not be able to dependably convert prednisone to its active metabolite.

Patients with healthy liver function would expect that either prednisolone or prednisone would be effective. Prednisolone is comparable to prednisone on an mg to mg basis. Prednisone is available in higher dose tablets, making the administration of higher doses less complicated. Prednisolone formulations would be preferred in someone with impaired liver function to eliminate the concern over prednisone conversion.

Coverage and cost comparison of prednisolone vs. prednisone

Prednisolone is a prescription medication that is typically covered by commercial and Medicare plans. The average retail price of prednisolone 15 mg/5ml can be over $36 for eight fluid ounces. With a coupon from SingleCare, this price drops to as low as $27.85.

Prednisone is also a prescription medication typically covered by both commercial insurance plans and Medicare. The average retail price of prednisone is around $22 for ten tablets of 20 mg. You may be able to get this prescription for under $4 with a SingleCare coupon.

It is important to note that for certain disease states, corticosteroids may not be covered under the Medicare drug benefit, but may be covered under Medicare Part B. Your pharmacist can provide more information on coverage.

Common side effects of prednisolone vs. prednisone

Prednisone is metabolized to its active metabolite prednisolone by the liver, therefore the potential side effects of each drug closely mirror each other.

Glucocorticoids are known to cause fluid and electrolyte imbalances, which may lead to sodium and fluid retention, high blood pressure, and in some cases, congestive heart failure. Weight gain is a common side effect of corticosteroids.

Prolonged use of steroids may slow the growth of children, and for this reason, their use should be limited to as short of a duration as possible to achieve remission of symptoms.

Glucocorticoids may interfere with the body’s response to insulin. Patients who depend on injectable insulin or other antidiabetic drugs may have to adjust their dose while on steroids. Diabetics may see a rise in their blood sugar even on a very short-term dose of steroids. Non-diabetic patients on long-term steroid therapy may be up to four times more likely to develop diabetes.

The following table is not intended to be a comprehensive list of possible side effects of prednisone and prednisolone. Please consult your pharmacist or physician for a complete list of all side effects.

Source: Prednisolone (DailyMed) Prednisone (DailyMed)

Drug interactions of prednisolone and prednisone

Prednisolone and prednisone are both substrates of the cytochrome P450 enzyme 3A4. This raises the possibility of drug interactions because numerous other drugs are also metabolized by the P450 system.

Itraconazole and ketoconazole are common antifungal agents. They are also potent inhibitors of CYP 3A4 enzymes. These drugs, therefore, slow the metabolism of the active drug, prednisolone. This leads to increased serum concentrations of prednisolone. While the drugs may be administered together on a short term basis, patients should be monitored for increased incidence of glucocorticoid-related side effects.

Corticosteroids are commonly used in patients who are also on other immunosuppressant agents. One agent may affect the actions of another, but they may still be used together if monitored appropriately. For instance, Prolia (denosumab), which is an immunosuppressant and bone modifying agent used in immune disorders and osteoporosis, may increase the risk of severe infection for patients on corticosteroids. Their concurrent use is sometimes necessary, and patients should be monitored closely for signs of infection.

Loop diuretics help manage fluid status in the body by filtering potassium. When given with prednisolone or prednisone, however, there is the potential for the body to lose a large amount of potassium. This could have negative effects on cardiac function. Patients who must take these together should have their electrolyte status monitored closely.

The following table is not a list of all possible serious side effects. Please consult your healthcare provider for a complete list.

Warnings of prednisolone and prednisone

There have been no well-controlled studies of corticosteroids in pregnant women, therefore their use in pregnancy should only occur when it is clear the benefit outweighs any risks. Infants born to mothers who used corticosteroids during pregnancy should be observed for hypoadrenalism. Symptoms may include low appetite, weight loss, irritability, and low blood sugar.

Corticosteroids, especially in higher doses, will inhibit the body’s ability to produce antibodies when vaccinations are given. Vaccines may not be effective in patients receiving steroids. Live vaccines, such as smallpox, should not be given to patients undergoing corticosteroid therapy. Patients taking immunosuppressive agents are at an increased risk of infection from live vaccines.

Corticosteroids may mask signs of infection and may slow the discovery of new infections. Prolonged use of prednisolone and prednisone may lead to cataracts and glaucoma.

Prednisolone and prednisone may alter the results of skin tests or other allergy testing. For the most accurate results, steroid therapy should be stopped days prior to administering these tests.

Steroids should only be administered for as short a duration as possible to achieve the desired effects. If long-term use of steroids is medically necessary, they should be kept at the lowest effective dose.

Frequently asked questions about prednisolone vs. prednisone

What is prednisolone?

Prednisolone is a synthetic glucocorticoid used to treat a variety of inflammatory and autoimmune disorders. It is available as an eye drop, injectable solution, oral liquid, dissolvable tablet, and oral tablet. The most common treatment duration is three to ten days of oral therapy.

What is prednisone?

Prednisone is a glucocorticoid that is metabolized by the liver to its active form, prednisolone. It is also used in many inflammatory and autoimmune diseases. Prednisone is available in oral tablets and oral solution formulations. Acute use of prednisone is typically a five-day regimen.

Are prednisolone and prednisone the same?

Prednisolone and prednisone are both synthetic glucocorticoids. Prednisone is metabolized in the liver to the active metabolite, prednisolone. Their comparative strengths on a milligram basis are equal, but they are not the same drug.

Is prednisolone or prednisone better?

While both drugs are effective for their indications, prednisolone may be the preferred drug in a patient with impaired liver function. Patients with hepatic disease may not be able to reliably convert prednisone to prednisolone.

Can I use prednisolone or prednisone while pregnant?

Prednisolone and prednisone are pregnancy risk category C. This means that there are no controlled human studies proving the medication is safe in pregnancy. These medications should only be used when the benefit clearly outweighs the risk.

Can I use prednisolone or prednisone with alcohol?

Regular consumption of alcohol may affect the body’s ability to metabolize prednisone into its active form. Alcohol and glucocorticoids can both have negative effects on the gastrointestinal system. Alcohol use is best minimized during courses of steroid treatment.

What is equivalent to prednisone?

Prednisolone and prednisone doses are equivalent in a milligram to milligram comparison. In other words, 5 mg of prednisolone is as strong as 5 mg of prednisone. Prednisolone and prednisone are five times more potent than hydrocortisone, but only one-sixth the potency of dexamethasone.

How long does prednisolone take to work for inflammation?

Prednisolone, when given orally, reaches its peak concentration in one to two hours. While patients may report some relief of symptoms in a few hours, it may take two to three days before symptoms are significantly impacted, depending on the condition and severity.

Is prednisone bad for your heart?

Prednisone is known to cause sodium and fluid retention, which can add stress to the heart. In extreme cases, it can lead to congestive heart failure. Through its interaction with drugs like furosemide, prednisone can cause the loss of large amounts of potassium, causing a patient to become hypokalemic. Cardiac function should be monitored if patients are on longer courses of steroid therapy.