Many often wonder when to use prednisone versus prednisolone and why we may see one over the other prescribed in practice. They are not the same medication and have their differences, but they also share a lot of similarities. To make it simple it is often about what is the easiest dosage form for the patient to tolerate both in financial aspects and swallowing abilities.
What are Prednisone and Prednisolone and How Do They Work?
Prednisone and prednisolone are both steroids, specifically glucocorticoids, that work to reduce inflammation. Prednisone is a prodrug, which is an inactive drug that needs to be metabolized by the body into the active form. Prednisone is broken down by the liver into its active component of prednisolone. This is why the two agents are therapeutically very similar.
Comparison Chart of Prednisone Versus Prednisolone
| Dosage form | Prednisone | Prednisolone |
| Tablet | Strengths available: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg Cost: Inexpensive | Strengths available: 5 mg Cost: Expensive |
| Oral Solution | Strengths available: 5mg/5mL Cost: Cheap Prednisone intensol: 5mg/1mL Cost: Relatively Inexpensive | Strengths available: 5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL, 20 mg/5 mL, 25 mg/5 mL Cost: Ranges based on strength and generic availability but relatively inexpensive |
| Orally disintegrating | NA | Strengths available: 10mg, Cost: Relatively expensive |
| Delayed release tablet | Strengths available: 1mg, 2mg, 5mgCost: Expensive | NA |
| Eye drops | NA | Strengths available: 1% Cost: Relatively inexpensive |
*Cost may be variable based on location, brand names, and availability
Clinical Selection
Prednisone tablets may be prescribed to a patient with healthy liver function due to their cheap and easy administration. The multiple strengths available allow for higher doses to be achieved and fewer tablets needing to be administered. For example, if a patient needs a 40mg dose they could take 2 tablets of prednisone 20mg instead of 8 tablets of prednisolone 5mg tablets.
Prednisolone solution may be administered to children or adults without the capability of swallowing tablets. Prednisolone may be preferred in patients with hepatic dysfunction due to the potential risk of variability in concentrations that may occur in prednisone due to the extensive liver metabolism of prednisone into its active form. Based on dosage forms, the oral solution of prednisolone has a higher concentration available for a more cost-effective option compared to the prednisone solution. With a higher concentration of prednisolone solution available, a higher dose can be achieved with less solution.
Medications can be hard to administer in children and the least amount of solution they need to try and swallow, especially if they do not like the potentially unfavorable taste, the better. In addition to smaller quantities being administered, prednisolone tends to have a better taste than many other liquid corticosteroids. This is why you may frequently see prednisolone liquid used over prednisone in pediatric patients. Note that dexamethasone may have the largest amount of evidence supporting its use for an indication like croup.
To summarize, liver function, disease state, dose needed, swallowing ability, age, taste, insurance, and product availability/cost in the United States may be a deciding factor in choosing prednisone versus prednisolone.
This article was written by Leah Lowenberg, PharmD Candidate in collaboration with Eric Christianson, PharmD, BCPS, BCGP
For more on corticosteroids and prednisolone specifically, check out this podcast episode.
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- 18+ Page Drug Interaction PDF
- 10 Commandments of Polypharmacy Webinar based on my experiences in clinical practice
Citations:
Prednisolone. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed January 22, 2024. http://www.micromedexsolutions.com
Prednisone. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed January 22, 2024. http://www.micromedexsolutions.com
Prednisolone: Uses, side effects, dosage & reviews. GoodRx. (n.d.). https://www.goodrx.com/prednisolone/what-is#cost Prednisone: Uses, side effects, dosage & reviews. GoodRx. (n.d.). https://www.goodrx.com/prednisone/what-is#cost
In my clinical practice I tend to see Prednisolone given to pediatric patients and Prednisone given to adult patients, with Dexamethasone reserved for more severe indications. Your write up supports what I’ve seen. As for flavor, both Prednisone and Prednisolone are AWFUL. An old trick is to have the child take the Prednisolone with a heaping spoonful of Chocolate Syrup. Seems to work better than the established flavoring options most pharmacies stock.
As a minor note, the distinction is important in veterinary medicine. Canines can absorb and metabolize either form, but cats cannot really utilize prednisone well, so prednisolone is always written instead.
Cheers.