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Prednisolone or Prednisone?

Posted , 13 users are following.

GeordieJane
GeordieJane

I am probably going to be prescribed steroids this week after weeks of 'refusing' this as an option. The pain has won! I realise I have so much to learn and want to have as many facts as possible when I have the discussion with my GP, who has been remarkably supportive and a great listener. I have just rejjalised that two drugs seem to be mentioned as the common ones prescribed for PMR, Prednisolone and Prednisone. Reading this forum, I appreciate that the PMR journey is a personal one for every sufferer but can anyone shed light on the difference between these two drugs and offer any advice on preference? 

Jane

0 likes, 27 replies

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  • robby6859
    robby6859 GeordieJane

    Posted

    I think they are the same.  They just call them prednisone in the US and prednisolone in UK.  Not sure but I think that is it.
    • EileenH
      EileenH robby6859

      Posted

      No - different substances as I've explained below.

  • EileenH
    EileenH GeordieJane

    Posted

    Prednisolone is the active form of the drug, if you are on prednisone it has to be metabolised by the liver to form the active substance. 

    You don't normally get a "choice" - different countries have different favoured drugs and prednisolone tends to be the choice in the UK and prednisone in the USA. To save me writing it all again you might like to read this thread from some time ago:

    https://patient.info/forums/discuss/prednisone-or-prednisolone--400961

    You'll see there is another drug in the mix - methylprednisolone, prednisolone with an extra bit added on. It is the injectable form and is used in the oral form here in Italy and also in the USA. I think it is horrible!

    Are you really a Geordie? If so, are you in contact with the NE PMRGCAUK group which is based in Gateshead and with a branch in Middlesborough. Or have you migrated...

    • GeordieJane
      GeordieJane EileenH

      Posted

      Thanks you Eileen. I appreciate your response. I am on this very steep learning curve at the moment and have just discovered NE PMRGAUK! I am a true Geordie, born and bred with a few years overseas, I am now retired and back home. 

      Jane

    • EileenH
      EileenH GeordieJane

      Posted

      I think you'll like the people at PMRGCAUKNE - they are lovely. i used to live in Durham but didn't get in touch with them until I had moved here but visit every year. They are very helpful, if you need a good rheumy, ask them!

  • Anhaga
    Anhaga GeordieJane

    Posted

    There is a difference.  Prednisone is an inactive drug precursor which must be converted to prednisolone in the liver to become active.  I have no idea why one is the standard medication in North America and the other in Europe and the UK.  There is also methylprednisolone which works better for some people with fewer side effects, but not for others, as Eileen will tell you!  For all intents and purposes prednisone and prednisolone are interchangeable when it comes to dosage and potential side effects.  Methylprednisolone dosages are not exactly equivalent.
    • EileenH
      EileenH Anhaga

      Posted

      It's not even blanket "Europe" - here in Italy it is Medrol, Rayos/Lodotra is prednisone and used in Germany amongst other places. Not sure what France and Spain use offhand.

    • philoso4
      philoso4 EileenH

      Posted

      I am in the US. My medication is Medrol which is methylprednisolone. 4mg of Medrol gives the same steroid effect as 5mg prednisone or prednisolone. I have experienced no particularly bothersome effects of Medrol. I wish I had started with prednisone because it comes in as little as 1mg tablets which makes it much easier to decrease dosage slowly.
    • philoso4
      philoso4 Anhaga

      Posted

      Concerned about switching from a drug I'm OK with and familiar with to one that could give me a bad reaction. Don't think it would be worth the chance.

  • tpaggs
    tpaggs GeordieJane

    Posted

    Another steroid is Medrol; whic I take because I had a terrible reaction to prednisone.

     

    • EileenH
      EileenH tpaggs

      Posted

      And I had a terrible reaction to Medrol! At least that justifies me being on Lodotra/Rayos!
    • tpaggs
      tpaggs EileenH

      Posted

      Just a suggesstion, should GeordieJane have a problem with Prednisone.
    • EileenH
      EileenH tpaggs

      Posted

      I know what you are saying - but oral Medrol is rarely used in the UK. It is used as injections though.
    • EileenH
      EileenH tpaggs

      Posted

      As i said in the other thread - tradition I think. Plus the lobby from the drug companies and the deals done with the health insurers.

      Methylprednisolone is the soluble form so is used for shots. It also comes as a depot formilation, for slow release over time. Trouble is you can't change your mind and stop if horrible side effects appear. Prednisolone is quicker to act - doesn't have to be processed by the liver. It is also used when there are liver problems for the same reason.

    • kup47
      kup47 tpaggs

      Posted

      Could be the Dr (specialist) preference, meaning through their practice of treating they have had the best results. Hence the term, best practice of research, and availability.
    • EileenH
      EileenH kup47

      Posted

      It is almost entirely down to availability in most of the world. It isn't as easy to get different corticosteroids in other countries as it probably is in the USA and even within the USA not everything is covered by every insurance plan. With corticosteroids the cost is a minor point in the USA, probably less than a co-pay. In the countries with non-privatised healthcare only certain things will be available on prescription which limits what the doctors use as a result. It isn't even "just" prednisolone, prednisone and methyprednisolone. There are other corticosteroids which are used in other countries. 

      They are all basically the same - but like every drug, different versions are tolerated better by some people than others. In some countries you may have a choice - but here in Italy, for example, there is Medrol (methylpred) and the local pharmacies have no way of obtaining anything else. Even with a private prescription. I MIGHT be able to get something different in Austria, I don't know, I assume a private prescription from here would be honoured in Austria but it would mean travelling there.

      Whether something is available in a particular country will probably be something only a pharmacist knows - doctors aren't usually aware of the machinations of drug supply! And in the UK recently there have been problems for lupus patients who need a particular brand of one particular drug. They have been told that it isn't available - by Boots the Chemist. The problem is that Boots now only obtains medications from one supplier, the one that is owned by the same group, Alliance and they don't stock it (they say, though even that is becoming doubtful). If the patients go to an independent chemist, they can usually get it as they have a far wider choice of supplier.

      It isn't always as simple as what they have found to be best.

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