Prednisone
oral corticosteroid · anti-inflammatory
Third-party optionBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Prednisone belongs to the « oral corticosteroid (anti-inflammatory) » category. Corticosteroids reduce inflammation and moderate immune reactions.
In practical terms, for Prednisone: Reduces inflammation and modulates immunity. The way it is used is decided on a case-by-case basis with the professional who prescribes it.
Under which brands it is found
In France, about 7 reimbursable presentations containing Prednisone are recorded. It comes under various trade names and in generic form.
- Cortancyl
- Prednisone Arrow
- Prednisone Biogaran
- Prednisone Eg
- Prednisone Sandoz
- Prednisone Viatris
- Prednisone Zentiva
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On your plate: calcium, potassium and vitamin D
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.
How prednisone works
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.
Why prednisone is prescribed
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.
How to take it day to day
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.
The effects to know about
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.
Why calcium, vitamin D and potassium matter
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.
Interactions and monitoring
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.
Sources
Related molecules
To explore in the « Pain and inflammation » family and its neighbours.
See the whole « Pain and inflammation » family · Back to the atlas
Supplements to consider
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
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 form calcium citrate (does not depend on gastric acidity)
Vitamin D3 (cholecalciferol)
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 form D3 (cholecalciferol), during a fatty meal
Frequently asked questions
What is prednisone used for?
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.
What are the side effects of prednisone?
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.
Should you take prednisone in the morning?
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.
Can you stop taking prednisone abruptly?
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.
Prednisone and alcohol: what does the patient leaflet say?
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.
Long-term corticosteroid therapy: why monitor calcium and vitamin D?
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.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.