[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/) › Prednisone

[Pharmacology](https://durgical.com/en/pharmacology/) · [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

# Prednisone

An oral corticosteroid prodrug: the liver turns it into prednisolone. Widely used for asthma, rheumatic and autoimmune diseases.

Updated 2026-11-01

- Class: [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)
- Receptor: Glucocorticoid receptor (GR), a nuclear receptor
- ATC code: H02AB07

◎**Glucocorticoid receptor (GR), a nuclear receptor**Prednisone

ⓘ The figure shows cortisol (hydrocortisone) in the ligand-binding pocket of the human glucocorticoid receptor; prednisolone, the active form of prednisone, binds the same pocket.

**Target in 3D:** Glucocorticoid receptor (GR), a nuclear receptor. PDB structure 4P6X (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4P6X) · Drag to rotate · pinch to zoom

## Mechanism of action

Prednisone itself is inactive. In the liver, 11β-hydroxysteroid dehydrogenase converts it to prednisolone, which binds the glucocorticoid receptor. The receptor complex enters the nucleus, switches on anti-inflammatory genes and represses NF-κB and AP-1, lowering cytokines and immune cell activity. It has intermediate duration and some salt-retaining effect.

- The liver converts prednisone into active prednisolone
- Prednisolone binds the glucocorticoid receptor and enters the nucleus
- Anti-inflammatory genes on; NF-κB and AP-1 repressed
- Less inflammation and immune activity

## Pharmacokinetics

**Absorption**
Given by mouth, usually with food

**Metabolism**
Prodrug: activated to prednisolone in the liver; severe liver disease can blunt activation

**Half-life**
Intermediate-acting glucocorticoid

## Indications

- Asthma and COPD exacerbations [Asthma →](https://durgical.com/en/conditions/asthma/)
- Rheumatoid arthritis and other rheumatic diseases [Rheumatoid arthritis →](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- Systemic lupus erythematosus [Systemic lupus erythematosus →](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- Inflammatory bowel disease flares [Crohn disease →](https://durgical.com/en/conditions/crohn-disease/)
- Multiple sclerosis exacerbations [Multiple sclerosis →](https://durgical.com/en/conditions/multiple-sclerosis/)
- Lymphomas and leukaemias, as part of combination regimens

## Adverse effects

### Common

- Insomnia and mood swings
- Increased appetite, weight gain and central fat
- Hyperglycaemia
- Thin skin, stretch marks and slow wound healing
- Muscle weakness

### Serious (rare, important)

- Infections, which the drug can also mask
- Adrenal suppression: adrenal insufficiency if stopped abruptly after prolonged use
- Osteoporosis and fractures with long use
- Peptic ulcer and gastrointestinal bleeding, especially with NSAIDs
- Posterior subcapsular cataract and glaucoma
- Psychiatric reactions (euphoria, depression, psychosis)
- Slowed growth in children

## Contraindications

- Systemic fungal infections
- Hypersensitivity to the product
- Live or live attenuated vaccines during immunosuppressive doses

## Key interactions

**CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, barbiturates)**
Faster clearance and a weaker corticosteroid effect

**Strong CYP3A4 inhibitors (ketoconazole)**
Higher corticosteroid levels and more side effects

**Aspirin and other NSAIDs**
Higher risk of gastrointestinal ulcer and bleeding

**Potassium-depleting drugs (loop or thiazide diuretics, amphotericin B)**
Hypokalaemia; with digoxin, more risk of arrhythmia

**Warfarin**
The anticoagulant response changes; INR is checked more often

## What is monitored

- Blood glucose
- Blood pressure and weight
- Potassium
- Signs of infection
- Eye pressure and bone density with long use

## Administration and safety

- Given by mouth with food; delayed-release forms are swallowed whole
- A single morning dose follows the natural cortisol rhythm and causes less insomnia
- Long courses are tapered, not stopped suddenly

## Nursing care

- Check glucose, especially in people with diabetes; corticosteroids raise it
- Watch for infection: fever and other signs may be blunted
- Watch mood and sleep; report agitation, depression or confusion
- Teach that a long course is not stopped suddenly; it is tapered under medical supervision
- Ask about black or tarry stools, a sign of digestive bleeding

## Pregnancy and breastfeeding

Used in pregnancy when the benefit justifies it; newborns of mothers on substantial doses are watched for adrenal insufficiency.

## Memory aid

PredniSONE needs the liver to become predniSOLONE: the ONE becomes the active OLONE.

## Test yourself

Think of the answer, then tap the question to see it.

## Prednisone is a prodrug. What is its active form and where is it made?

Prednisolone, made in the liver by 11β-hydroxysteroid dehydrogenase.

## Why is a once-daily prednisone dose usually given in the morning?

It matches the natural morning cortisol peak, causes less insomnia and suppresses the HPA axis less than evening doses.

## Which vaccines are avoided during immunosuppressive doses of prednisone?

Live or live attenuated vaccines, because the weakened immune system may let the vaccine organism replicate.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/prednisone/)

## Related drugs

- [Prednisolone](https://durgical.com/en/pharmacology/prednisolone/)
- [Methylprednisolone](https://durgical.com/en/pharmacology/methylprednisolone/)
- [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/)

## Related conditions

- [Asthma](https://durgical.com/en/conditions/asthma/)
- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Crohn disease](https://durgical.com/en/conditions/crohn-disease/)
- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)

[← Back to the class: Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Prednisone: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a601102.html) (MedlinePlus (U.S. National Library of Medicine), 2024); [DailyMed - PREDNISONE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2bb5bba8-60ae-4789-90eb-2d4a43e7a14b) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=H02AB07) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 39 (McGraw Hill, 2025).

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Representative model, for educational purposes only.

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