II. Indications
- Acute Asthma Exacerbation
- Anti-inflammatory and Immunosuppresive Agent
- Multiple Sclerosis
- Bell's Palsy
III. Contraindications
- Severe liver disease
- Use Prednisolone instead (does not require first-pass metabolism for activation)
IV. Mechanism
- See Systemic Corticosteroid
- Prednisone is a prodrug, activated by first pass metabolism in the liver to Prednisolone
- Prednisone and Prednisolone have identical dosing and activity
- Intermediate activity duration (longer than Hydrocortisone, shorter than Dexamethasone)
- Intermediate Glucocorticoid (5 fold more than Hydrocortisone) activity
- Low mineralcorticoid activity (half that of Hydrocortisone)
V. Adverse Effects
VI. Safety
- See Systemic Corticosteroid
- Pregnancy Category C
- Considered safe in Lactation
VII. Medications
- Prednisone (Deltasone) Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg
- Prednisone Solution: 5 mg/5 ml
- Prednisone Concentrated Solution (Intensol): 5 mg/ml
- Prednisone Delayed Release Tablets (Rayos): 1 mg, 2 mg, 5 mg
VIII. Dosing: Adults
- See specific conditions for dosing protocols
- Prednisone dosing is equivalent to Prednisolone dosing
- Dosing: 5 to 60 mg orally daily (dosing and course depending on indication)
IX. Pharmacokinetics
- Requires first pass metabolism through the liver, but has 1:1 bioavailablity in most cases
- Consider Prednisolone instead in severe liver disease
- Medium potency
- Medium anti-inflammatory potency
- Has Mineralocorticoid Activity
- Medium Half-Life (~36 hours)
X. Resources
XI. References
- Swadron and Hope in Herbert (2018) EM:Rap 18(9):16-8
- Dvorin (2020) Am Fam Physician 101(2): 89-94 [PubMed]
- Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]