Prednisone

Corticosteroid, Glucocorticoid (intermediate-acting), Immunosuppressant

Prednisone

Deltasone, Rayos (delayed-release); mostly prescribed generically

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Summary

Classes

Corticosteroid, Glucocorticoid (intermediate-acting), Immunosuppressant

Pharmacy

Starting dose

0.5-2 mg/kg/d divided or single morning dose for acute conditions; lowest effective dose for chronic conditions, with planned taper

Preparations

1, 2.5, 5, 10, 20, 50 mg tablets; 5 mg/5 mL syrup; 5 mg/mL concentrate

US FDA Max

No fixed maximum; cumulative-dose toxicity drives all chronic decisions

Pharmacology

Routes

Oral

Onset

Hours

Duration

Biologic half-life ~12-36 hours (intermediate-acting); plasma half-life shorter

Half-life

Plasma 3-4 hours; biologic ~12-36 hours

Bioavailability

70-80% (oral)

Pregnancy

Used when benefits outweigh risk; oral cleft signal in first-trimester exposure is debated and small in absolute terms.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Prednisone is an inactive prodrug converted by hepatic 11β-hydroxysteroid dehydrogenase to prednisolone, the active glucocorticoid receptor agonist; the activated receptor translocates to the nucleus and broadly remodels transcription of inflammatory, immune, and metabolic gene programs.▲0▼ Effects include suppression of phospholipase A2 (via lipocortin/annexin), NF-κB inhibition, lymphocyte and eosinophil depletion, monocyte/macrophage downregulation, and shifts in carbohydrate, lipid, and protein metabolism. Hepatic insufficiency reduces conversion, an argument for using prednisolone directly in severe liver disease.