API: Prednisone

What Is Prednisone and How Does It Work?

Prednisone is a synthetic glucocorticoid hormone. Glucocorticoids are produced by the adrenal gland and belong to the corticosteroid class of hormones. Glucocorticoids work by binding to glucocorticoid receptor proteins, which are expressed on the surface of almost every cell in the body. The activation of glucocorticoid receptors has immunosuppressive and anti-inflammatory effects, so the drug can be used to treat a wide range of conditions. However, administering synthetic hormones causes the adrenal glands to stop producing glucocorticoids naturally, so administration of prednisone, especially for periods longer than seven days, must be carefully monitored.

Approved Indications

Because of the drug’s broad systemic effects, prednisone has been approved to treat many different diseases and conditions,1 including:

  • Endocrine Disorders: Prednisone has been approved to treat endocrine disorders, including primary or secondary adrenocortical insufficiency (sometimes in conjunction with mineralocorticoids), congenital adrenal hyperplasia, nonsuppurative thyroiditis, and hypercalcemia associated with cancer.
  • Rheumatic Disorders: Prednisone effectively treats rheumatic disorders such as psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, acute and subacute bursitis, acute nonspecific tenosynovitis, acute gouty arthritis, post-traumatic osteoarthritis, synovitis of osteoarthritis, and epicondylitis.
  • Collagen Diseases: Prednisone can be used to treat systemic collagen diseases, such as lupus erythematosus and dermatomyositis, as well as acute rheumatic carditis.
  • Dermatologic Diseases: Prednisone can treat dermatologic diseases, including pemphigus, exfoliative dermatitis, mycosis fungoides, and bullous dermatitis herpetiformis, as well as severe forms of psoriasis, eczema, and erythema multiforme (Stevens-Johnson syndrome).
  • Allergic Conditions: A range of allergic conditions can be treated with prednisone, including seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity, severe hives, and reactions to Poison Oak.
  • Ophthalmic Diseases: Prednisone can be used to treat inflammatory conditions of the eye and the adnexa, including allergic corneal marginal ulcers, herpes zoster ophthalmicus, anterior segment inflammation, diffuse posterior uveitis and choroiditis, sympathetic ophthalmia, allergic conjunctivitis, keratitis, chorioretinitis, optic neuritis, iritis and iridocyclitis.
  • Respiratory Diseases: Prednisone provides effective treatment for laryngitis, sarcoidosis, Loeffler’s syndrome, berylliosis, aspiration pneumonitis, pulmonary tuberculosis, and severe asthma.
  • Hematologic Disorders: Several different blood disorders can be managed with prednisone, including idiopathic thrombocytopenic purpura, thrombocytopenia, acquired hemolytic anemia, erythroblastopenia, and congenital hypoplastic anemia.
  • Oral Disorders: When oral disorders such as desquamative gingivitis and recurrent aphthous stomatitis are unresponsive to topical therapy, prednisone can be used as an alternative treatment.
  • Neoplastic Diseases (Cancer): Prednisone is used in conjunction with other treatments to combat several different forms of cancer, especially acute lymphoblastic leukemia, multiple myeloma, and Hodgkin’s and non-Hodgkin’s lymphomas. It may also be used to manage breast cancer when a patient is unresponsive to other treatments.
  • Gastrointestinal Diseases: Prednisone can aid in the treatment of ulcerative colitis, regional enteritis, Crohn’s disease, and celiac disease.
  • Other Conditions: Prednisone has also been used to treat tuberculous meningitis, trichinosis, Meniere’s disease, liver disease, and relapses of multiple sclerosis. The drug can also delay the onset of symptoms of uveitis and Duchenne muscular dystrophy.

Side Effects and Drug Interactions

Because glucocorticoids work on a systemic level, they can have a wide range of side effects.

The most common side effects include:2

  • Confusion
  • Difficulty controlling emotion
  • Restlessness
  • Headache
  • Nausea
  • Vomiting
  • Thinning skin
  • Insomnia
  • Weight gain, with fat deposits in the abdomen, face, and neck
  • Fluid retention, with swelling in the lower legs
  • High blood pressure
  • Glaucoma

Extended use of glucocorticoids may also have long-term side effects, which include:3

  • Hirsutism / virilism
  • Impotence
  • Menstrual irregularities
  • Peptic ulcer disease
  • Cataracts
  • Myopathy
  • Osteoporosis
  • Type II Diabetes mellitus
  • Depression

Patients who experience serious side effects should contact a physician immediately. These side effects include:4

  • Severe allergic reactions. Signs include skin rash, hives, and swelling of the lips, face and tongue.
  • Changes in mood, or symptoms of severe depression
  • Changes in vision, which may be accompanied by eye pain
  • Infection. Signs include fever, cough, sore throat, and difficulty urinating.
  • High blood sugar. Signs include increased thirst, frequent urination, and confusion.
  • Severe swelling of the feet and ankles

Patients should also avoid abrupt discontinuation of prednisone treatment that has lasted longer than seven days. This can lead to an Addison (adrenal) crisis.

Using prednisone concurrently with other drugs can alter its efficacy. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin, and rifampin can increase the rate of clearance of prednisone, thereby decreasing its effectiveness. In contrast, troleandomycin and ketoconazole decrease the metabolism of corticosteroids, so prednisone will remain active in the system for longer than usual when used in conjunction with these medications. Prednisone may alter the effects of aspirin and anticoagulant drugs.5

Other medications that may interact with prednisone include:6

  • NSAID pain medications
  • Blood thinners, such as warfarin
  • Diuretics
  • Diabetes medicine
  • Macrolide antibiotics, such as azithromycin, clarithromycin, and erythromycin
  • Estrogen
  • Vaccines, including the flu shot

Latest News and Research

Prednisone was first isolated by American microbiologist Arthur Nobile in 1950 and became commercially available in 1955. Doctors began to prescribe prednisone more frequently in the 1980’s, as the medical community became increasingly aware that inflammation was the underlying cause of a broad range of diseases.7   

Prednisone can be used to treat many different diseases and disorders, so hundreds of new articles are about the drug are published each year. Recently, concerns have been raised about the severe side effects of prednisone, especially the long-term consequences of frequent use, so many researchers are examining the safety and effectiveness of different dosage schemes in the context of a wide variety of diseases. Scientists are also constantly exploring the ability of prednisone to treat more conditions, especially those that are unresponsive to other medications.

Buying Guide

Many compound pharmacists prefer Dexamethasone Sodium Phosphate, another glucocorticoid that treats many of the same conditions as prednisone and may have less severe side effects in some patients. Please find more information about our Bulk APIs here.

Show 7 footnotes

  1. “Indications,” April 20, 2007, http://www.rxlist.com/deltasone-drug/indications-dosage.htm
  2. “Prednisone and Other Corticosteroids,” November 26, 2015, http://www.mayoclinic.org/steroids/art-20045692?pg=2
  3. “Prednisone Side Effects,” May 2, 2016, http://www.drugs.com/sfx/prednisone-side-effects.html#refs
  4. “Prednisone, Oral Tablet,” April 20, 2015, http://www.healthline.com/drugs/prednisone/oral-tablet#Cost5
  5. “Drug Interactions,” April 20, 2007, http://www.rxlist.com/deltasone-drug/side-effects-interactions.htm
  6. “Prednisone (By mouth),” March 1, 2016, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011828/?report=details#how_to_use
  7. “Prednisone works well for range of conditions, but can have many side effects,” March 4, 2013, http://www.cleveland.com/healthfit/index.ssf/2013/03/prednisone_works_well_for_rang.html