Highlights
- Prednisone is a pre-drug, meaning the body breaks it down into prednisolone, the active medication.
- Both medications are related to cortisol, a stress hormone released by the adrenal gland.
- They are both glucocorticoid steroids, which help in the management of inflammation.
- These medications are not the anabolic steroids that act like testosterone or other banned athletic substances.
- Online purchases of prescriptions often offer the lowest price for steroid medications.
Introduction
Prednisone and prednisolone are steroid medications called glucocorticoids, or corticosteroids. Both work to inhibit inflammation. They decrease the response of your immune system, which can sometimes overshoot and cause injury when it’s overactive. Both are important treatment options for symptoms that result from exaggerated inflammatory processes.
But there are also important differences between these two medications.
Prednisone vs Prednisolone: What’s the Difference?
Both prednisone and prednisolone are similar to cortisol, a natural hormone your body makes when you’re stressed. Prednisone is a prodrug, meaning it’s inactive on its own. The body metabolizes it in the liver, turning it into prednisolone — the active medication.
Here’s how it works: The body takes cholesterol (a type of fat in the blood) and changes it into cortisol. Cortisol is important because it helps the body manage stress and keeps things in balance. To keep the body from being in a constant state of high alert (the “fight or flight” response), the body turns cortisol into another hormone called cortisone. It can then turn it back into cortisol when needed.
In simple terms, both prednisone and prednisolone are made to act like cortisol to help with inflammation and other body responses to illness or injury. Prednisolone is just one step closer to what your body makes naturally.
In the 1950s, researchers figured out the exact makeup of both prednisone and prednisolone. Prednisolone can now be made in a lab or in your body from a man-made version of prednisone.
About Cortisol
To fully understand the difference between the two prescription corticosteroids prednisone and prednisolone, you first must appreciate what cortisol does.
Cortisol is released as needed as part of the body’s flight-or-fight response discussed above. Along with other stress hormones, adrenaline and norepinephrine, it has figured prominently in our survival as a species.
For the purpose of illustration, let’s consider the caveman who is ready to start his hunter-gathering day. Let’s imagine that when he strolls out of his cave he is confronted by a hungry tiger.
His adrenal glands pump out cortisol immediately to:
- Stimulate the sympathetic nervous system. A complex combination of effects — hormonal and physiologic — kicks in for the right response to a stressful situation. The wrong response, regrettably, is not very forgiving when it comes to tigers. Along with adrenaline and norepinephrine, the processing of fear, arousal, and even emotions is crucial to flip the switch from fight to flight and vice versa.
- Increase glucose in the blood. Glucose is the sugar we use as fuel, important to this caveman as it goes to his brain to help him outthink the tiger. Glucose as fuel also goes to his muscles to give them the energy spike needed to engage in flight or fight.
- Alter circulation. Our caveman does not need to digest a trendy paleo diet right now. His circulation is better used to oxygenate his muscles than his gastrointestinal tract.
- Prepare the body for repair. Cortisol also increases the body’s ability to repair injured tissues by adapting the inflammatory process from inflammation to healing.
Side Effects
Prednisone and prednisolone are bioequivalent, meaning that they have roughly the same effects at the same dosage. For this reason, the two medications have similar side effects and can provoke similar allergies (though some people may be allergic to the inactive ingredients of over-the-counter topical products, such as cortisone creams used to treat a rash).
Side effects of both medications can include:
- Increased appetite
- Mood changes, such as feeling irritable or anxious
- Difficulty sleeping
- Digestive issues like stomach pain or indigestion
- Increased risk of infections
- High blood pressure
- Changes in blood sugar levels
- Weight gain, particularly around the abdomen, face, and neck
Long-term use of either drug can lead to more serious side effects, such as:
- Osteoporosis (weakening of the bones)
- Eye problems like glaucoma or cataracts
- Thin skin that bruises easily
- Muscle weakness
The specific side effects and their intensity can vary from person to person, and other factors such as dosage, duration of treatment, and your overall health can also influence the side effects experienced.
Discuss potential side effects with your doctor, who can provide guidance tailored to your personal health situation.
Drug Interactions
The two medications also have similar drug interactions, including:
- Blood thinners (anticoagulants): Prednisone and prednisolone can increase the risk of bleeding when taken with blood thinners.
- Antidiabetic drugs: Prednisone and prednisolone can reduce the effectiveness of insulin and oral diabetes medications, leading to higher blood sugar levels. This is a concern for both short-term and long-term use.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Using NSAIDs with prednisone or prednisolone can increase the risk of gastrointestinal ulcers or bleeding, especially for people with a history of stomach ulcers.
- Vaccines: All live vaccines may be less effective and can cause more side effects if taken with prednisone or prednisolone.
- Antifungal medications: Certain antifungal medications, such as ketoconazole and itraconazole, can increase the levels of prednisone or prednisolone in the blood, potentially leading to increased side effects.
- Epilepsy drugs (anticonvulsants): Some epilepsy drugs, such as phenytoin and carbamazepine, can decrease the effectiveness of prednisone or prednisolone.
- Cyclosporine: Cyclosporine can have increased side effects if used with prednisone or prednisolone. This is a concern for all side effects of cyclosporine, not just specific ones.
- Diuretics: All diuretics can cause potassium levels to drop, and the combination with steroids can exacerbate this effect.
- Heart medications: Certain heart medications, such as digoxin, may have increased side effects when used with prednisone or prednisolone.
- HIV medications: There can be interactions with HIV medications that affect how these drugs work in the body. These interactions are complex and vary depending on the specific HIV medications involved.
Though the interactions are largely the same for both medications, key exceptions to this list include:
- Rifampin may be less likely to interact with prednisolone.
- Phenytoin may be less likely to interact with prednisolone.
- Prednisone may be difficult to metabolize for people with liver disease, so prednisolone is usually preferred.
If you take any of the medications on these lists, be sure your providers know about them before you start a course of prednisone or prednisolone.
Prednisone vs. Prednisolone: Which Is the Better Choice?
Prednisone and prednisolone differ in their activity, as prednisone won’t work until prednisolone is produced from it. However, because they are bioequivalent, they are nearly interchangeable for most people.
There are two factors, however, that can help determine if one is a better choice for you than the other: cost and your medical conditions.
Cost
Prednisone is less expensive than prednisolone, because the making of prednisolone requires extra steps.
Medical Conditions
If you have any of the following conditions, prednisolone might be the safer choice for you:
- Liver disease: To process prednisone, you need a healthy liver. If you have liver impairment, such as hepatitis, cirrhosis, or fatty liver, your body’s conversion of prednisone to prednisolone isn’t reliable.
- Diabetes: Both prednisone and prednisolone can raise blood sugar levels. However, prednisone is more likely to cause this complication.
- Gastrointestinal issues: If you have a history of gastrointestinal problems, such as ulcers, your provider might prescribe prednisolone because it’s less likely to irritate the stomach lining.
- Rheumatologic diseases: In conditions like lupus or rheumatoid arthritis, the decision might depend on the severity of your disease and your overall health profile, including your ability to metabolize prednisone effectively.
- Adrenal insufficiency: In conditions like adrenoleukodystrophy, where the adrenal glands don’t produce enough steroid hormones, your doctor might prefer the direct use of prednisolone.
- Pediatric patients and those who have difficulty swallowing pills: Prednisolone is available in a liquid form, which is easier to administer.
It’s important to note that the decision between prednisone and prednisolone should be made by a healthcare provider based on your complete medical history and specific circumstances.
Conclusion
Prednisone and prednisolone are synthetic glucocorticoids that work by managing inflammation, which can sometimes overshoot into a destructive process. This action makes them an important part of modern medicine, especially for autoimmune diseases, which exaggerate the effects of the immune system.
Steroid medications have revolutionized the prevention of injury from many diseases, such as asthma, bowel disease, and painful arthritis. However, like all medications, prednisone and prednisolone are associated with side effects and drug interactions — particularly with long-term use — that you should know about before beginning treatment.
Always talk to your doctor about the risks and benefits of a new medication, and be sure they know about all other drugs and over-the-counter products you take.
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This information is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication.
