Methylprednisolone vs Prednisone - What's the difference between them?

Both methylprednisolone and prednisone belong to the class of medicines called corticosteroids.

The main difference between them is that methylprednisolone is available in an injectable form which makes it useful if a person’s inflammation is severe and requires reducing quickly. Injectable forms allow larger dosages to be given quickly. Some forms of methylprednisolone can also be directly injected into a joint to provide localized, relief of pain and inflammation within 24 to 36 hours.

The main difference between oral methylprednisolone and oral prednisone is that methylprednisolone is slightly stronger than prednisone, so a lower dosage is used (4mg of methylprednisolone is equivalent to approximately 5mg of prednisone). Oral prednisone is also available as a liquid, so it is more likely to be prescribed to children than oral methylprednisolone.

Other differences include:

• Brand names of methylprednisolone include Medrol, Depo-Medrol, and Solu-Medrol. Brand names of prednisone include Rayos
• Methylprednisolone is available as an oral tablet and an injectable preparation (injectable form can only be administered by health care professionals). Prednisone is available as an oral tablet and an oral solution
• Because methylprednisolone is available in an injectable form it can be administered directly into the bloodstream or directly into a muscle, joint, or small area of soft tissue
• Prednisone was FDA approved in 1955 and methylprednisolone in 1957
• Oral prednisone appears to be the favored corticosteroid in the U.S whereas Europe tends to favor oral methylprednisolone.

Because they are both corticosteroids, there are several similarities between them, for example:

• They both reduce inflammation and suppress the immune system by modifying glucocorticoids receptors and suppressing mediators of inflammation and are used to treat various allergic, respiratory, and autoimmune conditions
• Generics are available for both and costs are similar
• Both are recommended for short-term use only
• Both need to be tapered off slowly when they have been used for longer than a few weeks, to avoid withdrawal symptoms such anxiety, sweating, nausea, and insomnia
• Side effects are similar and include indigestion, agitation or irritability, fluid retention, mood changes, facial hair growth (especially in women), high blood pressure, an increased appetite, skin thinning, bone loss, and increased susceptibility to infection
• Long-term use of both methylprednisolone and prednisone has been associated with the suppression of the hypothalamic-pituitary-adrenal (HPA) axis (a complex interactive signaling and feedback system involving the hypothalamus, the pituitary gland, and the adrenal glands which control the body’s natural production of steroids). Therefore, slow withdrawal is necessary
• Methylprednisolone and prednisone interact with similar drugs, for example, aspirin, NSAIDs (such as diclofenac, ibuprofen, and naproxen), ketoconazole, phenobarbital, phenytoin, and warfarin.