What’s the Difference Between Prednisolone and Prednisone?
Key takeaways:
Prednisolone and prednisone are corticosteroid medications. They can treat health conditions involving an overactive immune system, allergies, and more.
Prednisone is a prodrug, meaning it chemically changes in your body after you swallow it. It then turns into its active form, prednisolone.
Corticosteroids have many possible side effects, especially with higher doses and/or if they’re used for a long time. This includes high blood pressure, blood sugar changes, and weight gain.
Corticosteroids ("steroids") are useful medications for many health conditions, like rheumatoid arthritis, asthma, allergies, and more. Many corticosteroids are available, and they’re each unique. They come in a variety of strengths and preparations, and some are more useful in certain situations than others.
Among them, you might have heard of prednisolone and prednisone. At first glance, these two steroids have a lot in common. They’re both pretty popular, they have similar names, and they’re both used for many of the same health conditions. However, they have some key differences to know about.
Here, we'll compare prednisolone versus prednisone and explain how they differ.
Are prednisolone and prednisone the same medication?
No, but they're similar.
Prednisolone and prednisone are both corticosteroid medications. They’re both used in many short-term situations, like treating nausea or an asthma or COPD flare-up. But they’re also used for more long-term situations, including treating chronic health conditions related to an overactive immune system.
However, chemically, they have some differences. Prednisone is a prodrug that's activated in your liver. A prodrug is a chemical that changes into its active form after you take it. When prednisone enters your body, natural proteins and chemicals trigger prednisone to turn into its active form, prednisolone, so it can start to work.
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In comparison, prednisolone is already active and ready-to-go when you take it. Prednisolone doesn't need to change into a different chemical before being able to work.
Is prednisolone the same as methylprednisolone?
Not exactly. Prednisolone is different from methylprednisolone (Medrol) — another corticosteroid. They’re each available as oral tablets, but the clearest difference is that methylprednisolone is also available as an injection.
When injected into a joint, methylprednisolone lowers inflammation in the nearby area. This is helpful if your inflammation or pain is severe and you need quick relief from swelling or pain. When it’s injected into a vein, methylprednisolone helps reduce inflammation throughout the body. This is helpful for people with certain autoimmune disorders, such as lupus.
Methylprednisolone is stronger per milligram than prednisolone, so it may be a better option in certain situations.
How do corticosteroids work for inflammatory health conditions?
Corticosteroids act like cortisol. Cortisol is a hormone that’s naturally present in our bodies. Among other jobs, cortisol helps control inflammation. By acting like cortisol, corticosteroid medications can help control swelling or inflammation in your body.
How are prednisolone and prednisone dosed and given?
The biggest difference between prednisolone and prednisone is how they're given.
Both prednisone and prednisolone are available as oral tablets and an oral liquid. The tablets are swallowed whole and stored at room temperature. How you store the liquid depends on the specific product. Some must be refrigerated and others can be stored at room temperature.
But prednisone tablets actually come in two forms. One is the more common option — a "regular" immediate-release (IR) version. But a delayed-release (DR) formulation, called Rayos, is also available. Prednisone and Rayos are the same medication, but Rayos is designed to start working 4 hours after you take it.
By comparison, prednisolone is also available as an orally disintegrating tablet (ODT). ODTs are dissolved on your tongue and can be swallowed with or without water. They shouldn't be chewed or broken. Prednisolone is also available as an eye drop (Pred Forte).
Regardless of the formulation, doses vary widely. Typical doses for prednisolone and prednisone can range from 5 to 60 mg by mouth per day. The dose depends on what you’re treating and how serious it is. Your healthcare provider can raise or lower your dose based on how you respond to it and if you have any side effects.
In general, corticosteroids can upset your stomach. They can also make it hard to fall asleep. When possible, it's best to take both medications with food and in the morning. However, your healthcare provider may have you take Rayos at night.
Is prednisone more effective than prednisolone?
No. One isn’t necessarily better than the other. They’re also comparable on a mg-to-mg (strength) basis. But they haven’t been directly compared in many head-to-head studies.
Still, one important consideration is your liver health. When thinking about how well each medication works, it’s important to consider your liver’s ability to convert prednisone to its active form. If you have liver problems, prednisolone might be the better choice between the two.
What are the known side effects of prednisolone and prednisone?
Prednisolone and prednisone can cause similar side effects.
You're more likely to experience side effects if you're taking high doses, or if you're taking either of these medications for a long period of time. Because of this, your healthcare provider will try to make sure that you're taking the lowest dose for the shortest possible time.
Common side effects may include:
Swelling caused by fluid buildup
High blood sugar
Muscle weakness
Stomach pain
Changes in your mood
Headache
Weight gain
What are the serious side effects of prednisolone and prednisone?
In some cases, prednisolone and prednisone may cause more serious side effects. This is especially true if they’re taken for a long time. If you’re experiencing any of the following side effects, seek medical attention right away:
Eye problems (like glaucoma or cataracts)
Weaker bones
Infection
Behavior changes
Severe stomach problems, including stomach ulcers or gastritis
Adrenal gland problems, such as excessive tiredness or muscle weakness
Heart problems, such as heart failure or heart rate problems
What interactions do prednisolone and prednisone have?
Both prednisolone and prednisone can have problematic drug interactions. For example, if they’re taken with warfarin (Coumadin, Jantoven) — a type of blood thinner — they may cause your blood to become too thin.
Examples of other products that can interact with both include:
Medications containing ritonavir (Norvir), like Paxlovid or certain HIV medications
Non-steroidal anti-inflammatory drugs (NSAIDs), like meloxicam (Mobic)
Live vaccines, like the measles, mumps, and rubella (MMR) vaccine
Certain medications used to control Type 2 diabetes, like metformin
If you’ve been prescribed prednisolone or prednisone, make sure your healthcare provider and pharmacist know about all the medications and supplements you take. They can check to see if there are any potential drug interactions between your current medication regimen and your new prescription.
How much do prednisolone and prednisone cost?
Prednisolone and prednisone medications are pretty affordable, and they’re both available as generic medications. And if you have prescription insurance, there’s a good chance they’ll be covered. But be sure to check your plan for specific details.
Additional cost information is provided in the table below.
| Medication | Average Retail Price | GoodRx Price |
|---|---|---|
| Prednisone, (20 mg, 10 tablets) |
$9 | As low as $3 |
| Prednisolone oral liquid (15 mg/mL, 50 mL) |
$23 | As low as $6 |
| Prednisolone ODT (15 mg, 9 tablets) |
$225 | As low as $52 |
Can you take prednisolone and prednisone together?
No, prednisolone and prednisone are in the same class of medications. They shouldn't be used together. Using them at the same time can worsen the side effects of both medications without providing additional benefit.
The bottom line
Prednisolone and prednisone work similarly to treat a variety of short-term and long-term health conditions. The biggest difference between prednisolone and prednisone is how they're taken. A discussion with your healthcare provider about cost and personal preferences can help you make a decision between the two medications. Make sure to talk to your healthcare provider about any questions or concerns you may have.
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References
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Hodgens, A., et al. (2021). Corticosteroids. StatPearls.
Horizon Therapeutics USA, Inc. (2021). Rayos [package insert].
Madsbad, S., et al. (1980). Impaired conversion of prednisone to prednisolone in patients with liver cirrhosis. Gut.
National Adrenal Diseases Foundation. (n.d.). Corticosteroid comparison chart.
Pacific Pharma, Inc. (2020). Prednisolone [package insert].
Puckett, Y., et al. (2022). Prednisone. StatPearls.
Thau, L., et al. (2021). Physiology, cortisol. StatPearls.
Yasir, M., et al. (2021). Corticosteroid adverse effects. StatPearls.
