If you have been prescribed a steroid course in the US, it was probably prednisone. In the UK, India and much of the world, doctors usually prescribe prednisolone instead. The names differ by only two letters, and the medicines are closely related. In fact, one turns into the other inside your body. Here is what that means for dosing, when one is preferred over the other, and how to take a steroid course safely.
Prednisolone vs prednisone at a glance
| Prednisolone | Prednisone | |
|---|---|---|
| What it is | The active steroid | A prodrug the liver converts into prednisolone |
| Strength | 5 mg ≈ 5 mg prednisone | 5 mg ≈ 5 mg prednisolone |
| Common forms in the US | Liquids for children, eye drops, some tablets | Tablets (most common), liquid |
| Common forms elsewhere | Tablets, dispersible tablets, liquids | Less widely used |
| Severe liver disease | Often preferred (no conversion needed) | Conversion may be less reliable |
| Uses | Asthma and COPD flares, severe allergies, autoimmune and inflammatory conditions, some skin and blood disorders | |
One medicine, two forms
Prednisone has no steroid activity of its own. After you swallow it, enzymes in the liver convert it to prednisolone, which does the work. For people with healthy livers, this conversion is quick and efficient, so prednisone and prednisolone are considered equivalent milligram for milligram: 5 mg of one does the same job as 5 mg of the other. Indian brands such as Omnacortil and Wysolone are prednisolone tablets.
Prednisolone is often chosen when the liver may not convert prednisone reliably, as in severe liver disease, and as a liquid for children because it is available in better-tasting formulations.
Steroid dose equivalents
Doctors use equivalence tables when switching between corticosteroids. These approximate anti-inflammatory equivalents are widely used:
| Steroid | Equivalent dose |
|---|---|
| Prednisone | 5 mg |
| Prednisolone | 5 mg |
| Methylprednisolone (Medrol) | 4 mg |
| Hydrocortisone | 20 mg |
| Dexamethasone | 0.75 mg |
That is why Medrol 4 mg tablets come in that slightly odd strength. Equivalence covers anti-inflammatory effect only; the steroids differ in how long they last and how much salt and water they retain, so switching should always be done by a doctor.
What these steroids are used for
Oral steroids calm inflammation and an overactive immune system quickly. Common reasons for a course include:
- Asthma or COPD flare-ups that do not settle with inhalers
- Severe allergic reactions, hives or hay fever that has not responded to other treatment
- Autoimmune and inflammatory conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease and polymyalgia rheumatica
- Some skin conditions, kidney diseases and blood disorders
For an asthma flare in adults, a typical course is 40 to 50 mg once a day for 5 to 7 days. Children usually receive a dose based on their weight, for a shorter time. Other conditions use very different doses and durations, so always follow your own prescription.
How to take a steroid course
- Take it in the morning, with food. Morning dosing matches the body’s natural cortisol rhythm and causes less sleeplessness.
- Swallow tablets with breakfast to reduce indigestion. Some doctors add a stomach-protecting medicine for longer courses.
- Do not stop suddenly after long use. Courses of more than about three weeks, or frequent repeated courses, suppress the body’s own cortisol production. The dose must then be tapered down gradually. Short courses for a flare can usually be stopped at the end, but follow your doctor’s instructions.
- If you are on long-term steroids, carry a steroid card or wear a medical ID, because extra steroid may be needed during surgery, injury or serious illness.
Side effects
A short course is usually well tolerated. You may notice a bigger appetite, trouble sleeping, mood changes (from feeling energetic to irritable or low), indigestion and higher blood sugar, which matters if you have diabetes. These settle after the course ends.
Long-term use carries more serious risks, which is why doctors aim for the lowest dose for the shortest time: weight gain and a rounded face, thinning bones (osteoporosis), high blood pressure, diabetes, cataracts and glaucoma, thin skin and easy bruising, muscle weakness and a higher risk of infections. People on long-term treatment may need bone protection, eye checks and blood sugar monitoring.
Seek urgent help for black or bloody stools, severe stomach pain, signs of serious infection, sudden vision changes, or severe mood changes including thoughts of self-harm.
Precautions and interactions
- Infections: steroids weaken immune defenses. If you have not had chickenpox or measles, avoid people with these infections and see a doctor promptly after any exposure.
- Vaccines: live vaccines should be avoided during high-dose treatment.
- NSAIDs such as ibuprofen, naproxen and aspirin increase the risk of stomach ulcers and bleeding.
- Diabetes medicines may need adjusting, and warfarin needs closer INR checks.
- Tell your doctor about stomach ulcers, heart failure, high blood pressure, glaucoma, osteoporosis, mental health conditions, tuberculosis or pregnancy.
Frequently asked questions
Is prednisolone stronger than prednisone?
No. At the same milligram dose they have the same effect in most people, because prednisone becomes prednisolone in the liver.
Can I switch from prednisone to prednisolone?
Doctors commonly switch milligram for milligram, for example 20 mg prednisone to 20 mg prednisolone. Confirm with your prescriber, especially if you have liver disease or are tapering.
Is a steroid tablet the same as an anabolic steroid?
No. Prednisolone and prednisone are corticosteroids that reduce inflammation. They are unrelated to the anabolic steroids misused for muscle building.
Can I drink alcohol on a steroid course?
Moderate amounts are usually acceptable on a short course, but alcohol adds to the stomach irritation steroids can cause. Ask your doctor if you are on a long course.
For asthma, inhaled steroids reduce how often oral courses are needed; see our asthma inhaler guide and the allergy range.
This article gives general information and does not replace advice from your doctor. Do not stop a long-term steroid suddenly without medical advice.
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