Prednisone 💊
Related Subjects:
|Prednisolone
|Methylprednisolone
|Corticosteroids: Uses and Cautions
ℹ️ Prednisone is not used in the UK. It is an inactive prodrug converted in the liver to prednisolone, which UK practice prescribes directly. You will meet prednisone in US/international guidelines, papers and patients who were prescribed abroad.
📖 About
- Dose equivalence: prednisone 5 mg = prednisolone 5 mg (1:1), so doses quoted in US literature translate directly.
- Hepatic conversion is efficient in most people, so there is no clinical advantage over prednisolone; in severe liver disease conversion may be less reliable, which is one reason to use prednisolone.
- For UK prescribing, use the BNF prednisolone monograph and the Prednisolone topic.
⚙️ Mode of Action
- Prednisone → (11β-hydroxysteroid dehydrogenase type 1, liver) → prednisolone.
- Prednisolone binds the intracellular glucocorticoid receptor → alters gene transcription → anti-inflammatory and immunosuppressive effects (↓ cytokines, ↓ leucocyte migration, ↓ prostaglandin/leukotriene synthesis).
- Moderate mineralocorticoid activity (less than hydrocortisone).
🔁 Glucocorticoid Equivalent Doses (approximate anti-inflammatory potency)
| Drug | Equivalent to prednisolone 5 mg |
|---|
| Prednisone | 5 mg |
| Hydrocortisone | 20 mg |
| Methylprednisolone | 4 mg |
| Dexamethasone | 750 micrograms |
🎯 Where You Will See It
- US/international regimens - e.g. "prednisone 40 mg for 5 days" for COPD exacerbation (UK equivalent: prednisolone 30–40 mg).
- Some chemotherapy protocols (e.g. CHOP-type regimens) written with prednisone; UK units usually substitute prednisolone.
- Patients transferring care from abroad - convert 1:1 to prednisolone.
⚠️ Steroid Safety (applies to prednisolone)
- Issue a steroid treatment card; consider an NHS Steroid Emergency Card if there is adrenal-insufficiency risk (≥5 mg prednisolone daily for ≥4 weeks, among other criteria).
- Do not stop abruptly after more than 3 weeks of treatment or repeated courses - taper.
- Sick-day rules: double the dose during intercurrent illness (follow the endocrine guidance) and seek help if vomiting.
- Bone protection if ≥3 months of treatment is expected (≥7.5 mg prednisolone daily) - assess and offer bisphosphonate per guidance.
- Monitor glucose and BP; consider PPI if there are GI risks (e.g. with NSAIDs).
💥 Main Adverse Effects
- Hyperglycaemia, hypertension, fluid retention, weight gain.
- Osteoporosis, myopathy, avascular necrosis.
- Infection risk, impaired healing, skin thinning, bruising.
- Mood change, insomnia, steroid psychosis.
- Cataract, glaucoma; adrenal suppression.
📚 References
