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Learning Center/Pharmacology/Prednisone

Prednisone

Deltasone / Rayos

corticosteroid systemicoralOnset: 4–6 hoursDuration: 12–36 hours

Mechanism of Action

Oral glucocorticoid prodrug, converted to active prednisolone in liver. Same mechanism as methylprednisolone. Potency: 4× cortisol.

Dosing

Adult

Asthma/COPD exacerbation: 40–60 mg/day × 5–7 days (no taper needed for short course). Long-term maintenance: lowest effective dose; may require taper

Pediatric

1–2 mg/kg/day (max 60 mg) × 3–5 days for asthma exacerbation

Indications

Asthma exacerbation (outpatient — step-down from IV)
COPD exacerbation
Inflammatory and autoimmune conditions

Contraindications

Systemic fungal infections
Live vaccines
Severe hepatic impairment (conversion to prednisolone impaired)

Side Effects

Hyperglycemia
Fluid retention / edema
Hypertension
GI upset / peptic ulcer
Mood changes / insomnia
Osteoporosis (long-term)
Cushingoid appearance (long-term)
Adrenal insufficiency on abrupt discontinuation

Monitoring Parameters

Blood glucose
Blood pressure
Weight / fluid status
Bone density (long-term)

Drug Interactions

NSAIDs (GI ulceration)
Antidiabetics (counteraction)
Warfarin
CYP3A4 inhibitors/inducers

Clinical Pearls

Prodrug — requires hepatic conversion to prednisolone (may be impaired in severe liver disease)
Outpatient standard for asthma exacerbations after ED discharge
Short burst (5–7 days) for acute asthma: no taper required
Long-term use requires gradual taper to avoid adrenal insufficiency
Take with food to minimize GI upset

Mnemonic

💡 Prednisone = PRe-Drug → needs liver to activate (prodrug)

NBRC High-Yield

Oral systemic corticosteroid — standard for outpatient asthma exacerbation
Short course (5–7 days) does not require tapering
Prodrug converted to prednisolone in liver
Same side effect profile as methylprednisolone
40–60 mg/day for asthma exacerbation

Prednisone (Deltasone, Rayos) — Respiratory Pharmacology