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Prednisone is a synthetic glucocorticoid (steroid hormone) that metabolizes in the liver and turns into prednisolone. It has an anti-inflammatory and immunosuppressive effect. It is available under various brand names:

• Deltasone;
• Orasone;
• Liquid Pred;
• Rayos;
• Sterapred;
• PredniSONE, etc.

The mechanism of action

Prednisone inhibits inflammatory processes, such as:

• edema (swelling);
• fibrin deposition (fibrin is a protein that helps create a blood clot and mitigate tissue damage; a part of an acute inflammatory response);
• capillary dilatation (small blood vessels widen during the inflammatory process to let more nutrients and white blood cells into the damaged area);
• migration of leukocytes (white blood cells);
• phagocytosis (the process when the cell engulfs a large particle or another cell to contain it; part of the immune response);

It also alters how the immune system of the body reacts to various stimuli. This helps to alleviate health problems related to the body’s immune reactions, from allergies to acute leukemia.

Indications, off-label use

In the USA, prednisone was FDA-approved in 1955. It is indicated for the following health issues:

• allergic: atopic dermatitis, cases of hypersensitivities to drugs, allergic rhinitis, etc.;
• skin health issues: dermatitis, erythroderma, Stevens-Johnson syndrome, mycosis fungoides, etc.
• endocrine: nonsuppurative thyroiditis, adrenocortical insufficiency, hypercalcemia of malignancy, congenital adrenal hyperplasia;
• GI: Crohn’s Disease, ulcerative colitis;
• hematologic (related to blood) conditions: (autoimmune) hemolytic anemia, secondary thrombocytopenia in adults, pure red cell aplasia, etc.;
• neoplastic conditions (as a palliative drug): acute leukemia, aggressive lymphomas;
• nervous system: acute exacerbations of multiple sclerosis, cerebral edemas;
• ophthalmic (eye) pathologies: sympathetic ophthalmia, uveitis, and ocular inflammatory conditions unresponsive to topical steroids;
• organ rejection after transplantation;
• pulmonary diseases: asthma, pneumonia, COPD, etc.;
• rheumatologic conditions, such as arthritis, polymyalgia, vasculitis, etc.;
• certain infectious and renal diseases.

In other countries, the officially approved use of prednisone may vary. There is also so-called off-label use: when the drug is not officially indicated for a certain condition, but it is used because it helps the patient. For example, in the event of severe obstructive bronchitis, prednisone may be prescribed by the physician to lessen inflammation and aid breathing in the patient. There was even research on how prednisone may improve semen quality after the reversal of vasectomy.

Dosage and administration

Usually, prednisone is administered as an oral treatment (taken through your mouth in pills). This form is not less efficient than IV treatment, as stated in this trial overview. In some cases, such as difficulty swallowing, emergency treatment, or patient’s unconsciousness, administration through IV or IM injection is preferable.

There are also such forms as suppositories (vaginal and rectal), nasal sprays, liquids, solutions, suspensions, and syrups.

Oral forms of the drug (tablets, pills) come in doses from 1 mg to 50 mg. The starting dose may vary from 5 mg to 60 mg and be further adjusted according to the patient’s needs and response to therapy. The process is to be carefully monitored and controlled by a healthcare specialist; it is not advised to drop the treatment abruptly.

The medication should be taken with food and is available only with a doctor’s prescription.

Side effects and contraindications

An adverse reaction to corticosteroids may develop and manifest as:

• edema (retention of fluids);
• changes in tolerance to glucose;
• hypertension (blood pressure increases);
• changes in mood and behavior;
• increased appetite and body mass.

Prednisone medications are contraindicated if there is known hypersensitivity to the active component or any other constituent of the drug.

You can read more about warnings and precautions on the Rayos label at https://www.accessdata.fda.gov.

Summary

Prednisone is a synthetic corticosteroid used as an anti-inflammatory and immunosuppressive agent. The drug is indicated and used to treat many conditions, such as allergic reactions, dermatologic conditions, GI and pulmonary diseases, etc. The medicine is available only with a doctor’s prescription, and the treatment should be carefully monitored.