prednisoneprednisolone

Prednisone and prednisolone are systemic glucocorticoids used to treat a wide range of inflammatory and autoimmune conditions. Prednisone is an inactive prodrug that is converted in the liver to prednisolone, the active form. In clinical practice, the two are often used interchangeably, with choice influenced by liver function and local practice.

Mechanism of action: They bind the glucocorticoid receptor, regulate gene transcription, and suppress multiple inflammatory pathways. The overall effect is reduced leukocyte activity, decreased production of inflammatory cytokines, and dampened immune responses. This yields anti-inflammatory and immunosuppressive actions, along with metabolic and catabolic effects.

Medical uses: They are prescribed for autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus, inflammatory bowel disease, dermatologic conditions, and acute asthma or COPD exacerbations. They are also used in allergic reactions, certain hematologic cancers, and as part of organ transplantation regimens. In adrenal insufficiency they may serve as replacement therapy when needed.

Dosing and administration: Regimens vary widely by condition and severity. Short courses minimize adverse effects; long-term therapy requires gradual tapering to avoid withdrawal. They can be given orally or intravenously, with dosing and duration tailored to the disorder and patient response. Regular reassessment is recommended.

Side effects and safety: Long-term use carries risks including hypothalamic-pituitary-adrenal axis suppression, hyperglycemia, weight gain, edema, osteoporosis, hypertension, cataracts, glaucoma, mood changes, insomnia, increased infection risk, and skin thinning. Growth suppression can occur in children. Use the lowest effective dose for the shortest duration, monitor for complications, and avoid abrupt discontinuation. Live vaccines are generally avoided during systemic corticosteroid therapy.

Pharmacokinetics and considerations: Prednisone depends on hepatic activation to prednisolone; liver disease can impair conversion and response. Caution is advised in pregnancy, lactation, and with drug interactions that affect corticosteroid metabolism.