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What is the difference between prednisone and prednisolone?

Medically reviewed by C. Fookes, BPharm Last updated on Aug 26, 2019.

Official Answer

by Drugs.com

The main difference between prednisone and prednisolone is that prednisone must be converted by liver enzymes to prednisolone before it can work. 

  • In people with severe liver disease, prednisolone is usually preferred. 
  • Prednisone is known as a prodrug which is defined as a biologically inactive compound that is metabolized in the body to produce a drug. In this case, prednisone is metabolized by 11-β-HSD liver enzymes to prednisolone.
  • Price-wise, prednisone is usually cheaper than prednisolone. 
  • Brand names for prednisone include Rayos, and for prednisolone, Millipred.

Both prednisone and prednisolone are man-made glucocorticoids. They are used to treat similar conditions and are generally considered equally effective. Other similarities include: 

  • Similar indications. For example, both prednisone and prednisolone may be used to treat allergies, arthritis, inflammatory bowel disease, lung conditions, or skin problems 
  • The same side effects, including acne, stomach irritation, weight gain, insomnia, fluid retention, facial hair growth, mood changes, high blood pressure, and, if taken for long periods of time, bone loss, osteoporosis, skin thinning, and a withdrawal syndrome on discontinuation if not tapered slowly enough. Both prednisone and prednisolone may suppress growth and development in children
  • Dosing schedules for prednisone and prednisolone are usually similar and range from 5mg to 60mg per day
  • The same interactions. Common interactions include NSAIDs, anti-infectives (such as ciprofloxacin, some HIV medicines), immune suppressants, diuretics ("water” pills), and anticoagulants (blood thinners), and others 
  • If you are taking either prednisone or prednisolone long-term it is a good idea to wear a medical alert tag or carry a Steroid Card.

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