Prednisolone vs. Prednisone: What's the Difference?

If you or a loved one have been diagnosed with an inflammatory condition or an autoimmune disorder, your doctor may prescribe a corticosteroid medication for treatment. 

Among the most commonly prescribed corticosteroids are Prednisolone and Prednisone. Although they have many similarities, they aren't the same medications. 

In this blog post, we will explain the differences between these two popular medications, their side effects, drug interactions, and other important information you need to know so you can have a better understanding about each of them.

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What are corticosteroids?

Corticosteroids, or steroids, are synthetic versions of the cortisol hormone, which is usually produced by the adrenal glands in the body. 

Typically prescribed to reduce inflammation and suppress the immune system, Corticosteroids are used to treat both short-term and chronic conditions such as:

• Allergies (hay fever)

• Asthma

• Hives 

• Lupus

• Eczema

• Gout

• Inflammatory bowel diseases (IBD), like Crohn's disease and ulcerative colitis

• Chronic obstructive pulmonary disease (COPD)

• Autoimmune diseases, like Addison's disease or hypothyroidism

• Multiple sclerosis (MS)

• Polymyalgia rheumatica (PMR) 

What are the main differences between Prednisolone and Prednisone?

While Prednisolone(Millipred) and Prednisone are both used to treat inflammatory and autoimmune conditions, chemically, they are different. 

Prednisone is a prodrug, an inactive medication that activates after the drug enters the body. Once the liver metabolizes Prednisone, it's turned into its active form, Prednisolone, to cross the cell membrane. 

On the other hand, Prednisolone is the active form of the drug and can immediately infiltrate the cell membrane to suppress inflammatory and immune response markers. 

In addition, both corticosteroids are available in different dosages and administration types. 

• Prednisolone- Available in ophthalmic drops, injectable solutions, and oral formulations. Solutions come in 5 mg/ml, 10 mg/ml, and 15 mg/ml concentrations, whereas oral formulations are available in 5 mg tablets and 10 mg, 15 mg, and 30 mg disintegrating tablets.  

• Prednisone- Available in oral (2.5 mg, 5 mg, 10 mg, 20 mg, and 50 mg tablets) and oral solutions. 

What are the side effects of Prednisolone and Prednisone?

Prednisolone and Prednisone have very similar side effects, including:

• Acne

• Insomnia

• Weight gain

• Fluid retention and swelling

• High blood pressure

• High blood sugar

• Mood changes 

• Muscle weakness

• Stomach pain

When taken for an extended period or at a higher dose, more severe side effects may occur, such as:

• Eye problems (like glaucoma or cataracts)

• Bone loss 

• Osteoporosis

• Muscle weakness

• Thinning of the skin 

• Impaired wound healing

• Pancreatitis

• Behavior changes

• Stomach ulcers

• Heart issues, such as congestive heart failure (CHF) 

• Growth suppression in children 

If you experience any of these, you should immediately seek medical attention. 

Do either Prednisolone or Prednisone have adverse drug interactions?

Both drugs have adverse drug interactions, so always discuss your medical history and current medication list with your healthcare provider before starting either.

Prednisolone and Prednisone can cause drug interactions when they are taken in combination with::

• NSAIDs, such as Advil, Ibuprofen, and Meloxicam

• Medications containing ritonavir, such as  Paxlovid and some HIV medications 

• Immune suppressants, such as Prolia 

• Diuretics (water pills), such as Torsemide

• Azole antifungals, such as Ketoconzale

• Certain diabetic (Type 2) medications, such as Metformin

• Blood thinners (anticoagulants), such as Warfarin 

• Live vaccines, such as the MMR (measles, mumps, and rubella) and rotavirus vaccines

Please note: this is not an inclusive list. Some supplements, vitamins, food, and beverages are known to have negative reactions when taken with Prednisolone and Prednisone. 

Can Prednisolone and Prednisone be taken together?

Since Prednisolone and Prednisone are in the same class of medications, they shouldn't be taken together. By taking them simultaneously, you will increase the risk of severe side effects without providing additional benefits. 

How much do Prednisolone and Prednisone cost?

Prednisolone and Prednisone have generic options, meaning most health insurance plans usually cover them. It's always best to compare your insurance plan's out-of-pocket prescription costs with a pharmacy savings card like CareCard. 

Which drug is more effective: Prednisolone or Prednisone?

These two drugs share similarities and effectiveness in treating various short-term and long-term health conditions. The most significant difference between Prednisolone and Prednisone is how they're taken. Reviewing options and costs with your physician can help you decide which is right. 

Since Prednisolone is the active form of the drug, it might be the preferred choice if you have impaired liver function. 

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