Prednisone
Prednisone
Brand names:Deltasone, Rayos, Sterapred
An oral synthetic glucocorticoid used for short-course treatment of asthma and COPD exacerbations, severe allergic reactions, contact dermatitis (including significant poison ivy involvement), and inflammatory conditions. Prednisone is the oral follow-on after acute treatment with injectable steroids and the oral primary agent for sustained outpatient management.
Pharmacology and Actions
Prednisone is a synthetic glucocorticoid prodrug, converted to prednisolone (active form) in the liver. The active metabolite activates intracellular glucocorticoid receptors which translocate to the nucleus and modulate transcription of inflammatory mediators. Suppresses cytokine production (IL-1, IL-2, IL-6, TNF), reduces neutrophil and lymphocyte trafficking, decreases capillary permeability, and stabilizes membranes. Onset of clinical effect is 1 to 2 hours; full anti-inflammatory effect takes days.
Indications
- Asthma and COPD exacerbations (short course)
- Allergic reactions and contact dermatitis
- Poison ivy and severe allergic contact dermatitis
- Inflammatory conditions (autoimmune, vasculitis, rheumatologic)
- High altitude pulmonary edema (HAPE) treatment as adjunct
- Croup (dexamethasone preferred)
- Tactical operational use for severe allergic reaction or exacerbation when injectable steroids unavailable
Absolute Contraindications
- Known hypersensitivity to prednisone
- Untreated systemic fungal infection
- Live virus vaccination during therapy
Precautions and Side Effects
Short course (under 14 days): insomnia, mood changes, increased appetite, fluid retention, mild hyperglycemia, GI irritation. Long-term: Cushingoid features, osteoporosis, glucose intolerance, hypertension, immunosuppression, adrenal suppression, cataracts, glaucoma, skin thinning, increased infection risk. Drug interactions: reduces vaccine efficacy (live vaccines contraindicated); increased bleeding risk with NSAIDs; reduced effect of antidiabetic agents (hyperglycemia); CYP3A4 inducers (rifampin, phenytoin) reduce prednisone levels; CYP3A4 inhibitors (ketoconazole, ritonavir) increase levels; increased K+ loss with loop diuretics. Plasma half-life 2 to 3 hours; biological half-life 18 to 36 hours. Pregnancy Category C/D (avoid first trimester if possible due to small cleft palate risk; benefits often outweigh risks for severe maternal disease). Low transfer to breast milk; generally compatible with lactation. Elderly: increased risk of hyperglycemia, osteoporosis, infection. Pediatrics: growth suppression with chronic use. Cautious use in peptic ulcer disease, diabetes, hypertension, heart failure, osteoporosis, and psychiatric disease. Monitor blood pressure, glucose, infection signs, and mood. Counsel operators on expected sleep and mood effects.
Adult Dosing
Pediatric Dosing
1 to 2 mg/kg/day PO, max 60 mg/day. Croup: 1 mg/kg single dose (dexamethasone preferred). Asthma: 1 to 2 mg/kg/day for 5 days, max 60 mg/day.
Pharmacokinetics
Peak Effect: 1 to 2 hours plasma; days for full anti-inflammatory effect.
Duration: 12 to 36 hours (biological half-life longer than plasma half-life due to genomic effects).
Storage and Handling
Tablets: store at room temperature, protect from light and moisture. Stable in standard aid bag and IFAK conditions. Solutions and oral suspensions have shorter shelf life and require refrigeration in some cases.
Reconstitution:
Oral formulation only. Tablets available in 1, 2.5, 5, 10, 20, and 50 mg strengths.
TCCC and TECC Role
Prednisone is not in the TCCC core formulary - dexamethasone and methylprednisolone are the TCCC and standard EMS injectable steroids. Prednisone's tactical role is the oral followup course after acute treatment with injectable steroids, or for sustained outpatient management of asthma/COPD exacerbation, severe contact dermatitis, or inflammatory conditions in deployment medicine. Mission impact at typical short-course doses is minor; insomnia and mood changes are real and can affect performance.
Prednisone is the oral steroid most operators will encounter for short-course indications. The standard 40 to 60 mg per day for 5 to 7 days is well tolerated by most healthy operators, though sleep disruption and irritability are common and predictable. Counsel operators starting prednisone on the expected mood and sleep effects and on the importance of not stopping abruptly if the course extends beyond 2 weeks. For severe poison ivy or contact dermatitis from operational environments (poison oak, sumac, wild parsnip), a 7-day course at 60 mg with 2-week taper is more effective than 5-day burst regimens.
Stopping prednisone abruptly after a course longer than 14 days without taper. Adrenal suppression is real and abrupt discontinuation can precipitate adrenal crisis or symptom flare. The other mistake is using prednisone instead of injectable steroids for acute anaphylaxis - epinephrine is the life-saving treatment; oral steroids have onset measured in hours and have no role in acute anaphylaxis management beyond preventing biphasic reaction after definitive epinephrine and airway management.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Prednisone
| IV/IO | None (methylprednisolone is the IV analog; 4 mg methylprednisolone equivalent to 5 mg prednisone). (None) |
| IM | None (methylprednisolone or dexamethasone are the parenteral options). (None) |
| IN | None (None) |
| PO | Asthma/COPD exacerbation: 40 to 60 mg PO daily for 5 to 7 days (no taper needed for short course). Allergic reaction: 40 to 60 mg PO daily for 5 days. Severe allergic contact dermatitis (poison ivy with significant body involvement): 60 mg PO daily for 7 days, then taper over 2 weeks. Inflammatory conditions: variable dosing 5 to 60 mg daily. (1 to 2 hours (anti-inflammatory effect)) |