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oral corticosteroid
Reduces inflammation and modulates immunity. This molecule appears in 68 of the medicines we have indexed.
We do not make a formula for this treatment. Talk to your doctor or pharmacist about these active ingredients.
See the detailsBy the Layer Nutrition editorial teamHow the atlas classifies the 664 molecules
This molecule belongs to the “oral corticosteroid (anti-inflammatory)” category. Corticosteroids reduce inflammation and moderate immune reactions.
In practice: Reduces inflammation and modulates immunity. How to use it is decided case by case with the professional who prescribes it.
These names come from the public registers of 32 countries: the ANSM for France, the AEMPS for Spain, the AIFA for Italy, the HPRA for Ireland, Swissmedic for Switzerland, and the European Medicines Agency for the others.
Most widespread
No name matches.
The atlas gives each molecule one of these three answers. Most call for nothing.
On prednisone, bone becomes fragile, more potassium is lost in the urine, and calcium is only well absorbed with vitamin D. Food supplies these three elements day after day, and it is the simplest lever to keep up.
Calcium is found in dairy products (milk, yoghurt, cheese), green vegetables such as broccoli and kale, canned salmon and sardines with their bones, almonds and sunflower seeds. For the body to truly use it, it needs vitamin D, present in oily fish such as salmon and mackerel, egg yolks, cheese and certain mushrooms.
Potassium is replenished with beans and lentils, tomatoes, potatoes and sweet potatoes, bananas, dried apricots, citrus fruits, milk and yoghurt, and fish such as salmon and sardines. Many of these foods tick several boxes at once, salmon and sardines chief among them, which simplifies meals alongside your treatment.
Prednisone is a prodrug: it is not active as swallowed. The liver converts it into prednisolone, its active metabolite, through the enzyme 11-beta-hydroxysteroid dehydrogenase. This active form enters cells and binds to the nuclear glucocorticoid receptor. The complex moves to the nucleus and alters the expression of many genes, which is known as the genomic effect.
Its anti-inflammatory action works largely through the inhibition of phospholipase A2, the enzyme that releases arachidonic acid from cell membranes. By cutting off this source, prednisone dries up the production of the inflammatory mediators derived from it. Its elimination half-life is short: 3 to 4 hours in adults, 1 to 2 hours in children. Its biological effects last well beyond that, because they rest on lasting changes in gene expression.
Prednisone is used across a very wide range of situations where inflammation must be calmed or the immune system modulated. Its approved indications cover endocrine, rheumatological, allergic, dermatological, ophthalmological and respiratory disorders. It also plays a role in blood diseases, certain cancers and gastrointestinal conditions. This versatility explains why it appears in very different prescriptions, at varying doses and for varying durations.
The dose and duration depend on the disease being treated and its severity. An acute flare is sometimes treated over a few days, while a chronic disease may call for prolonged treatment at a low dose. The balance between the expected benefit and the adverse effects is weighed case by case, and the doctor adjusts the prescription according to the response.
Prednisone is taken by mouth, with food or milk, to reduce digestive discomfort. Depending on the prescription, the rhythm ranges from one to four doses a day, or one dose every other day. Taken in the morning, before 9 a.m., it better respects the body’s natural rhythm and limits the shutdown of the hypothalamic-pituitary-adrenal axis, the circuit that governs the natural production of cortisol.
Regularity matters as much as the timing of the dose. Prolonged treatment is never stopped overnight on one’s own initiative: the adrenal glands, put to rest, need time to resume their work, and stopping is done through a gradual reduction decided with the doctor. Any change of dose belongs to the prescription, never to a decision made alone.
Adverse effects become common when treatment is prolonged: they affect up to 90% of patients who take it for more than sixty days. Bone is particularly exposed. Doses as low as 5 mg per day can lead to bone loss, with a notable drop in bone mineral density within the first 3 to 6 months. Rarer but serious, osteonecrosis, the death of an area of bone, is seen in 9 to 40% of patients on prolonged corticosteroid therapy.
Other effects stem from the corticosteroid’s metabolic action. It raises blood sugar in a dose-dependent way, within a few hours, and is the most frequent cause of drug-induced diabetes. On muscle, it slows protein synthesis and speeds up its breakdown, which leads to weakness and wasting of the proximal muscles over weeks to months. Finally, its mineralocorticoid activity retains water and sodium while causing potassium to be lost in the urine.
Bone loss on prednisone brings calcium and vitamin D to the fore. Calcium is the mineral of the bone framework, and the body needs vitamin D to absorb and use it. The doctor may indeed recommend a calcium-rich diet and prescribe supplements accordingly. Rebuilding these intakes supports bone while the treatment does its work.
Potassium deserves the same attention, because the corticosteroid’s mineralocorticoid effect increases its urinary losses. A diet low in salt and rich in potassium is often part of the advice, precisely to counterbalance sodium retention and potassium loss. Food remains the simplest way to rebuild these reserves, with supplements when they are prescribed.
Several medicines change prednisone’s effect by acting on the CYP3A4 enzyme that metabolises it. Inducers such as phenytoin and rifampicin reduce its efficacy, while inhibitors such as ketoconazole raise its levels. Grapefruit and its juice should be discussed with the doctor for the same reason. Combining it with a non-steroidal anti-inflammatory drug increases the risk of ulcer and digestive bleeding, and the effect of anticoagulants such as warfarin may be strengthened, which calls for close monitoring.
Other combinations call for caution: amphotericin B and medicines that lower potassium can cause hypokalaemia, and a live vaccine given under a high immunosuppressive dose (40 mg of prednisolone per day or more, for more than seven days) can increase the risk of infection. Monitoring accompanies treatment: blood sugar, blood pressure, electrolytes, weight and bone mineral density, with an annual eye examination.
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Calcium is the most abundant mineral in the body, involved in bone health. Calcium citrate is well absorbed, including away from meals, whereas carbonate requires an acidic environment for its absorption.
Preferred formcalcium citrate (does not depend on gastric acidity)
To be confirmed with your doctor or pharmacist.
Vitamin D is a fat-soluble vitamin. The D3 form (cholecalciferol) is the one adopted by most guidelines. It is better absorbed when taken during a meal that contains fats.
Preferred formD3 (cholecalciferol), during a fatty meal
To be confirmed with your doctor or pharmacist.
Type the name written on the box. The atlas gives you its answer.
For example Panadol, Doliprane or paracetamol.
Prednisone is an oral corticosteroid, used for its anti-inflammatory and immunosuppressive action in many situations. The specific indications and the framework for its use are set out in the patient leaflet, and your doctor or pharmacist remains the person to consult about your situation.
The patient leaflet notably mentions water retention, weight gain, sleep disturbances, a rise in blood pressure or blood sugar, and, with prolonged use, an effect on the bones. The full list and its frequency are detailed in the patient leaflet, to be read with your doctor or pharmacist.
The patient leaflet generally recommends taking it in the morning, to stay closer to the natural rhythm of cortisol secretion and to limit sleep disturbances. Follow the timing and method of use indicated on your prescription, and ask your pharmacist if in doubt.
A prolonged course of treatment should not be stopped abruptly: it is discontinued through a gradual reduction decided by the doctor, as a sudden stop can cause adverse effects. Never change your treatment on your own and refer to your doctor or pharmacist.
The patient leaflet lists several precautions and interactions, and what to do regarding alcohol or other medicines depends on your situation. Report all your treatments to your doctor or pharmacist and refer to the patient leaflet.
Studies link prolonged oral corticosteroid therapy to a decrease in bone density, and health authorities recommend monitoring calcium and vitamin D status during it. The active ingredient to consider is calcium, in the form of citrate or carbonate, and vitamin D in the form of cholecalciferol (D3). Monitoring through a blood test and the choice of supplementation are the responsibility of your doctor.
These answers draw on the patient leaflet and on the published literature. For any question about your medicine, the patient leaflet and your doctor or pharmacist are the reference.
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