Prednisone vs. Dexamethasone: Which Is Right for You?
Key takeaways:
Prednisone and dexamethasone are corticosteroid medications that treat many inflammatory, autoimmune, and allergic health conditions.
The main differences between dexamethasone and prednisone are how they’re given and what they’re used to treat. Prednisone and dexamethasone are both available as oral medications, but dexamethasone also comes as an injection and eye drop.
Talk to your pharmacist or healthcare provider if you’re experiencing any side effects from prednisone or dexamethasone. They both have common and potentially serious side effects to be aware of.
Table of contents
Corticosteroid medications can help treat a variety of health conditions. Whether it’s for COVID-19, flare-ups in your asthma symptoms, or you’ve developed a poison ivy rash after tending to your garden — your healthcare provider might prescribe corticosteroid medications to help.
Corticosteroids — often called glucocorticoids — are the most common steroid medications. They’re meant to mimic a hormone called cortisol in your body, and by doing so, they can help treat many inflammatory and autoimmune-related health conditions. They’re also very different from anabolic steroids, the type of steroids that have been highlighted in news stories about professional athletes and bodybuilders.
Here, we’ll compare two of the more common corticosteroids — prednisone versus dexamethasone — and how they differ.
What is prednisone?
Prednisone is an oral steroid medication. It controls swelling, redness, and inflammation in your body. Your healthcare provider could give you prednisone to treat various autoimmune, allergy, and inflammatory health conditions.
Prednisone is available as a tablet or liquid that’s taken by mouth. Prednisone’s dosing varies from person to person, but for the most part, it’s taken once per day at a fixed dose between 5 mg and 60 mg daily.
What is prednisone used to treat?
Autoimmune and inflammatory conditions are often a result of an overactive immune system. They can lead to symptoms that affect various parts of your body. Because of this, steroids like prednisone are FDA-approved to treat a wide range of health conditions.
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Below are some of the most common conditions it’s approved to treat:
Skin rashes
Rheumatoid arthritis (RA)
Psoriatic arthritis (PsA)
Multiple sclerosis (MS)
Prevention of organ transplant rejection
Adrenal insufficiency, which is when your body doesn’t make enough cortisol naturally
In addition to the conditions that prednisone is approved to treat, it’s often used off-label for other health conditions, too. This includes chronic obstructive pulmonary disease (COPD) exacerbations, hepatitis, heart inflammation, and more.
What is dexamethasone?
Dexamethasone is another steroid medication that treats many inflammatory and autoimmune disorders. Like prednisone, it’s also often taken as an oral tablet or liquid.
But it’s also given in a few other ways. For certain conditions, it can also be injected into a vein (intravenously) or administered as an eye drop. When swallowed or injected into a vein, the typical dose of dexamethasone ranges from 0.75 mg to 9 mg per day for adults.
What is dexamethasone used to treat?
Dexamethasone is approved to treat many of the same health conditions as prednisone. But it still has a number of unique uses, such as:
Certain types of cancer, like multiple myeloma
Eye inflammation
Cerebral edema (brain swelling)
Nausea before chemotherapy or after surgery
Lung development in unborn babies
Migraine prevention
How do corticosteroids work for inflammatory health conditions?
Normally, when your body thinks it has encountered a threat, like a virus or bacteria, it creates defense-oriented immune cells to fight it. But if your body makes too many of these immune cells, it’s possible to develop an overactive immune response. When this happens, you may feel symptoms of pain, irritation, or inflammation.
Steroids like prednisone and dexamethasone work by lowering and controlling your body’s immune response. They calm your immune system down. This can be helpful for many health conditions or after an injury has occurred.
Is dexamethasone more effective than prednisone?
One isn’t known to be more effective than the other. Small studies have found that they’re similar to each other in specific situations. For instance, in asthma studies in kids, they were found to be similarly beneficial. However, they haven’t been compared to each other in large clinical trials. A clinical trial would give us a better idea of how they stack up.
Still, dexamethasone is more potent (stronger) than prednisone. If you’re in a situation where you need a more potent steroid, dexamethasone will likely be the preferred option between the two. It also works longer in your body than prednisone does.
Are prednisone and dexamethasone used in different situations?
Oftentimes, yes. Even though they’re similar medications that can treat many of the same health conditions, they tend to be chosen by healthcare providers in different scenarios.
For example, one reason you might be given dexamethasone over prednisone is the intended route of administration. If you have eye inflammation and need an eye drop, you’d likely be prescribed a dexamethasone eye drop over an oral steroid like prednisone. Or, if you need an intravenous steroid, you’d likely be given dexamethasone. You might also be given dexamethasone if you need a more potent steroid.
What are the known side effects of prednisone and dexamethasone?
Like with all medications, prednisone and dexamethasone have a number of possible side effects. The most common ones include:
Elevated blood sugar levels
Insomnia or difficulty sleeping
Larger appetite than normal
Mood swings
Nausea
What are the serious side effects of prednisone and dexamethasone?
In addition to what’s mentioned above, prednisone and dexamethasone can cause more serious side effects. It’s important to note that these side effects occur more often in people taking steroids long-term (rather than those taking them for a couple of days).
Kidney injury
Higher risk of infection
Bone disease
If you’re experiencing — or think you’re experiencing — any of these side effects, reach out to your healthcare provider. Depending on your situation, they can step in and help you find a solution to the issue or recommend emergency treatment options as needed.
What drug interactions do prednisone and dexamethasone have?
Most medications will have some medications that they interact with — prednisone and dexamethasone are no exception. Some of the prednisone and dexamethasone’s more common drug interactions include:
Certain blood thinners, like warfarin (Coumadin, Jantoven)
Certain anti-seizure medications, like phenytoin (Dilantin)
Medications containing ritonavir
Cholestyramine (Prevalite)
Desmopressin (DDAVP)
Estrogen-containing medications
Blood sugar lowering medications
Live vaccines, like the rotavirus vaccine
These are not all the medications that steroids like these can interact with. For instance, you should also avoid taking dexamethasone with medications like rilpivirine. Make sure to talk to your pharmacist and healthcare provider to make sure your steroid prescription doesn’t interact with any medications or supplements that you take.
Can you take prednisone and dexamethasone together?
No. Prednisone and dexamethasone shouldn’t be taken together.
However, there’s an exception with dexamethasone eye drops. It may be reasonable for your healthcare provider to prescribe prednisone as a pill and dexamethasone as an eye drop, for example, to treat two different conditions. This is because dexamethasone eye drops affect only your eye — they don’t affect other parts of your body.
How much do prednisone and dexamethasone cost?
Prednisone and dexamethasone are relatively affordable. They’re both available as generic medications, which helps lower their price.
For instance, you can find 20 tablets of generic prednisone 20 mg for as low as $5 at certain pharmacies with a free GoodRx coupon. A comparable dose of 10 tablets of dexamethasone 6 mg can be as low as $9 with a free GoodRx coupon.
The bottom line
Dexamethasone and prednisone are used to treat similar inflammatory, autoimmune, and allergic health conditions. The main differences are how strong they are, how each one can be taken, and what they’re most often used to treat. Your healthcare provider can tell you if one may be a better fit for you than the other.
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References
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