Bedside Snapshot
  • What it is: Oral glucocorticoid used for steroid‑responsive inflammatory conditions.
  • Primary ED/EMS jobs: Discharge steroid for asthma/COPD exacerbations; adjunct for allergic reactions; selected inflammatory conditions.
  • Onset: Hours for genomic effects; not a rescue bronchodilator.
  • Typical courses: Short bursts (e.g., 40–60 mg PO daily for 3–5 days) without taper for many acute uses.
Note: Prednisone is oral; use IV agents (e.g., methylprednisolone or hydrocortisone) when rapid parenteral therapy is needed.
Brand & Generic Names
  • Generic Name: Prednisone
  • Brand Names: Deltasone (U.S.), others (various manufacturers)
Medication Class

Oral systemic corticosteroid (glucocorticoid) with anti‑inflammatory and immunosuppressive properties; prodrug converted to prednisolone in the liver.

Pharmacology

Mechanism of Action:

  • Glucocorticoid receptor agonist → alters gene transcription and suppresses pro‑inflammatory cytokines, reduces capillary permeability and edema.
  • Decreases airway mucosal inflammation and late‑phase allergic responses in asthma/COPD.

Pharmacokinetics:

  • Route: Oral; converted to active prednisolone (hepatic).
  • Onset: Clinical benefit over hours; peak systemic in 1–2 h.
  • Half‑life: Prednisone ~3–4 h (biologic effects longer); prednisolone ~2–4 h.
  • Elimination: Hepatic metabolism; renal excretion of metabolites.
Indications
  • Asthma or COPD exacerbations (short steroid burst as outpatient/ED discharge).
  • Allergic reactions/urticaria and angioedema adjunct (not a rescue for anaphylaxis).
  • Croup alternative where dexamethasone unavailable (local protocols vary).
  • Other steroid‑responsive inflammatory conditions per clinician discretion.
Dosing & Administration

Available Forms:

  • Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg; Oral solution often available as prednisolone for pediatrics.

Common Adult Dosing:

Indication Typical Dose Course Notes
Asthma/COPD exacerbation 40–60 mg PO daily 3–5 days Short burst usually without taper for brief courses.
Allergic reaction (adjunct) 40–60 mg PO daily 3–5 days Does not replace epinephrine for anaphylaxis.

Pediatric (examples, per local protocol):

  • Asthma: 1–2 mg/kg/day PO (max ~60 mg) for 3–5 days; prednisolone often preferred for palatability.
Contraindications

Contraindications:

  • Serious systemic fungal infections.
  • Known hypersensitivity to prednisone or formulation components.

Precautions:

  • Hyperglycemia, fluid retention/edema, mood changes/insomnia, GI upset; consider GI protection with risk factors.
  • Immunosuppression and masking infection; use shortest effective course.
  • Prolonged or repeated courses may require tapering to avoid adrenal suppression.
  • Use caution in uncontrolled hypertension, diabetes, peptic ulcer disease, psychosis.
Adverse Effects

Common:

  • Hyperglycemia, mood changes, insomnia, dyspepsia, fluid retention, increased appetite.

Serious:

  • GI bleeding/ulcer (with NSAIDs), psychosis, severe infection, adrenal suppression (with prolonged/repeated courses).
Special Populations
  • Renal impairment: No routine adjustment.
  • Hepatic impairment: Conversion to prednisolone may be altered; consider prednisolone directly in significant liver disease.
  • Pregnancy/lactation: Short courses generally acceptable when benefits outweigh risks; monitor neonate if prolonged maternal use.
  • Older adults: Higher risk of delirium, hyperglycemia, infection — use lowest effective dose.
Clinical Pearls
No taper usually needed: For short bursts ≤5 days in otherwise healthy adults.
Prednisone vs prednisolone: Use prednisolone in significant hepatic dysfunction or pediatrics (liquid).
Glycemic impact: Monitor glucose in diabetics; consider return precautions for infection and GI bleeding symptoms.
References
  • 1. StatPearls. (2024). Prednisone. https://www.ncbi.nlm.nih.gov/books/NBK534809/
  • 2. GINA. (2024). Global strategy for asthma management and prevention. https://ginasthma.org/
  • 3. GOLD. (2024). Global strategy for COPD diagnosis, management, and prevention. https://goldcopd.org/
  • 4. FDA. (2023). Prednisone labeling. https://www.accessdata.fda.gov/
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