prednisone

Prednisone is a synthetic glucocorticoid in the corticosteroid class used to treat a wide range of inflammatory and autoimmune conditions, as well as certain allergic reactions and some cancers. It is a prodrug that is rapidly converted in the liver to its active form, prednisolone. As a systemic steroid, it suppresses the immune system and reduces inflammation.

The drug works by binding to the glucocorticoid receptor, altering gene transcription and decreasing the production of inflammatory mediators. This leads to reduced leukocyte activity, suppressed immune responses, and diminished tissue inflammation. Clinical effects may begin within hours to days, depending on the condition and dose.

Prednisone is administered orally, in tablet or solution form, and is rapidly absorbed. The active metabolite prednisolone has a somewhat longer duration of action. Because the drug can suppress the hypothalamic-pituitary-adrenal axis, dosing is often given once daily in the morning to align with natural circadian rhythms and to minimize sleep disturbance. When used long term, gradual tapering is typically required to prevent withdrawal symptoms and adrenal insufficiency.

Common indications include inflammatory diseases such as rheumatoid arthritis, polymyalgia rheumatica, inflammatory bowel disease, asthma and COPD exacerbations, and certain dermatologic conditions; it is also used for autoimmune diseases like systemic lupus erythematosus, vasculitis, and for immunosuppression in some cancers or transplant settings.

Side effects increase with duration and dose and can include increased appetite and weight gain, mood changes, insomnia, fluid retention, high blood pressure, hyperglycemia, stomach ulcers, osteoporosis, muscle weakness, cataracts, and skin thinning. Short-term use carries fewer risks but still requires caution.

Interactions include increased risk of GI bleeding with NSAIDs, interference with live vaccines, and changes in prednisone levels with CYP3A4 inhibitors or inducers. Use during pregnancy and in children requires careful consideration and medical supervision.