Prednisone vs Hydrocortisone

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For patients with conditions involving inflammation such as allergies, arthritis, asthma, or autoimmune diseases, certain medications that control the body's immune response can help manage symptoms and improve quality of life. Prednisone and Hydrocortisone are two such drugs often prescribed for these conditions. They are both corticosteroids, mimicking the action of cortisol to suppress inflammation in the body. Prednisone is a synthetic glucocorticoid used to treat various inflammatory disorders; it exhibits potent anti-inflammatory effects but can lead to more severe side effects due to its systemic nature if taken long-term. On the other hand, Hydrocortisone is a lower potency steroid commonly used topically for skin inflammations; it has less potential for serious side effects compared to prednisone but may not be as effective in controlling severe systemic inflammation.

What is Prednisone?

Prednisone (generic name for Deltasone among other brands) was a significant advancement in the class of corticosteroids, following the advent of Hydrocortisone. Prednisone is often prescribed to suppress immune system responses and reduce inflammation. It's typically used to treat autoimmune diseases, allergies, asthma, and arthritis. Prednisone was first approved by the FDA in 1955. By mimicking cortisol, a hormone naturally produced by adrenal glands, it helps regulate bodily functions like stress response and immune system activity — but at a higher potency than its predecessor Hydrocortisone. Although both drugs have similar effects on reducing inflammation and allergic reactions, Prednisone has more systemic effects making it beneficial for conditions that require stronger suppression of the immune system or reduction of inflammation throughout the body as compared to Hydrocortisone which is often preferred when localized treatment is sufficient.

What conditions is Prednisone approved to treat?

Prednisone and Hydrocortisone are prescribed for varying medical conditions:

  • Prednisone is often used in the management of inflammatory conditions, autoimmune disorders like lupus, severe allergies and asthma. It's also employed to suppress immune response in cases such as organ transplantation.

  • Hydrocortisone on the other hand, although it can be used systemically for similar indications as prednisone, is more commonly utilized topically for skin inflammation due to its lower potency. It could also be employed for adrenal insufficiency or Addison’s disease which involve a deficiency of natural corticosteroids produced by our body.

How does Prednisone help with these illnesses?

Prednisone helps to manage inflammation by mimicking the effects of hormones that are naturally produced by adrenal glands. It does this by suppressing the immune system and reducing the production of chemicals that cause inflammation in the body. These chemicals play a crucial role in our immune response, causing redness, heat, swelling and pain as part of their protective function against harmful stimuli like pathogens or damaged cells. However, excessive or prolonged activation can lead to tissue damage and various diseases such as asthma, rheumatoid arthritis among others. By counteracting these chemicals' effects, Prednisone can limit inflammatory responses in patients with certain autoimmune conditions and stabilize their symptoms.

On the other hand, Hydrocortisone also works similarly but it's less potent than Prednisone making it suitable for treating skin conditions like eczema where systemic steroids might have too strong side-effects.

What is Hydrocortisone?

Hydrocortisone, also known as Cortef or A-Hydrocort, is a corticosteroid that functions by reducing inflammation and modifying the body's immune response. It does this through its action on glucocorticoid receptors which leads to changes in gene transcription and protein synthesis. Hydrocortisone was first approved by the FDA in 1952. Unlike prednisone, hydrocortisone closely mimics cortisol - a hormone naturally produced by the adrenal glands in response to stress. This makes hydrocortisone preferable for patients with adrenal insufficiency or those undergoing physiological stress such as surgery or severe illness where cortisol levels typically rise. However, it has a shorter duration of action than prednisone requiring multiple doses throughout the day for effective treatment of conditions like rheumatoid arthritis or asthma. Its side effect profile can vary depending on dose but may include weight gain, mood changes, increased blood glucose levels and hypertension; these are similar to other corticosteroids including prednisone.

What conditions is Hydrocortisone approved to treat?

Hydrocortisone is an approved medication for the treatment of various conditions, including:

  • Adrenocortical insufficiency (a condition where your adrenal glands do not produce enough steroids)
  • High blood calcium levels resulting from cancer
  • Thyroid inflammation It's also commonly used to treat skin disorders such as eczema, dermatitis, allergies and rashes. Hydrocortisone mimics cortisol, a hormone naturally produced by the adrenal glands in response to stress.

How does Hydrocortisone help with these illnesses?

Hydrocortisone is a corticosteroid hormone that plays roles in many processes within the body, affecting immune response, inflammation reduction and metabolic functions. It's also heavily engaged in stress responses to prepare the body for action under taxing conditions. Low levels of corticosteroids have been implicated in autoimmune diseases and allergies. Hydrocortisone works by supplementing or replacing the steroids naturally produced by adrenal glands when these levels are too low, thereby alleviating symptoms of certain health issues such as arthritis, asthma, skin disorders among others. Its effect on glucose metabolism and immune system activity may play roles in its widespread application as an anti-inflammatory medication. Since it does not significantly affect serotonin or norepinephrine levels (like antidepressant medications do), it is sometimes prescribed when a patient shows excessive inflammatory response or has disorders related to insufficient cortisol production (such as Addison's disease). Comparatively speaking, prednisone - another type of corticosteroid - has more potent anti-inflammatory effects but may also be associated with more side-effects due to its broader systemic impact.

How effective are both Prednisone and Hydrocortisone?

Both prednisone and hydrocortisone are corticosteroids, which have been effective in treating many inflammatory and autoimmune conditions. They were initially approved by the FDA several years apart with hydrocortisone being the first to be approved. Since they act on different metabolic pathways, they may be prescribed under different circumstances. Their effectiveness in managing inflammation was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy as well as similar safety profiles. No significant difference in symptom management was observed between patients treated with either prednisone or hydrocortisone.

A 2008 review of meta-analysis reports on prednisone demonstrated that it is effective from the first week of treatment, that its side effect profile is generally favorable over other corticosteroids, and that it is well-tolerated even in elderly populations. This study reported that prednisone has become one of the most widely prescribed corticosteroid globally due to its broad range of therapeutic uses including for arthritis, allergies, and asthma among others.

Hydrocortisone seems to be more potent than placebo in reducing inflammation related symptoms according to a 2016 review and meta-analysis report but tends to work best when used topically for skin-related issues like rashes or eczema rather than systemic use due to its shorter half-life compared with other steroids such as prednisone. Significant research on hydrocortisones involves their co-prescription alongside other anti-inflammatory medications so data confirming its efficacy as standalone treatments may not be robust across all indications when compared with treatments like Prednisone. Nonetheless because Hydrocortisones are less likely cause serious adverse effects such as osteoporosis (bone thinning), diabetes mellitus type II (sugar diabetes) among others seen frequently with long-term systemic usage unlike Prednisones; it becomes an optimal choice for individuals who need topical application or short term oral administration while avoiding common side effects associated with long term steroid use.

abstract image of a researcher studying a bottle of drug.

At what dose is Prednisone typically prescribed?

Oral dosages of Prednisone range from 5-60 mg/day, but the amount can vary widely depending on the specific disease entity being treated. In situations of less severity or in maintenance therapy, lower doses are usually sufficient. Children and adolescents may have their dosage determined by their body weight at a rate of 0.14 to 2 mg/kg/day in three or four divided doses. The dosage can be altered after a few weeks based on response and tolerance. However, long-term high-dose usage should be avoided due to potential adverse effects.

In contrast, Hydrocortisone is typically administered at oral doses ranging from 20–240 mg/day for adults with acute conditions while children's dosing often starts around 8-12mg/m^2 /day given in three divided doses; these amounts also depend largely on the exact condition being targeted for treatment. As always, it is crucial to follow healthcare provider recommendations when adjusting any medication regimen.

At what dose is Hydrocortisone typically prescribed?

Hydrocortisone treatment typically begins at a dosage of 10-20 mg/day. The dose can then be increased to 30-40 mg/day, divided into one or two doses. These doses should ideally be taken in the morning and/or early afternoon, as this aligns with your body's natural cortisol production cycle. The maximum dose is dependent on individual patient needs and their response to treatment; however, it shouldn't exceed 240 mg/day which may be distributed in three to four doses throughout the day under severe conditions such as shock or surgery recovery. This higher dosing should only occur under direct medical supervision because long-term use at these levels can have significant side effects.

What are the most common side effects for Prednisone?

Common side effects of prednisone include:

  • Sleep problems (insomnia)
  • Mood changes
  • Increased appetite, gradual weight gain
  • Acne, increased sweating, dry skin, thinning skin
  • Slow wound healing
  • Changes in the shape or location of body fat (especially in your arms, legs, face, neck)
  • Nausea and stomach pain

Similarly for hydrocortisone:

  • Sleep problems (insomnia), mood changes
  • Acne or other skin reactions
  • Dryness and itching
    -Nausea or vomiting -Increased sweating

In both cases if you experience any severe symptoms such as vision problems or unusual weight gain seek immediate medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Prednisone?

While Prednisone and Hydrocortisone are both corticosteroids used to reduce inflammation, they can have different side effects. With Prednisone, it's important to watch for:

  • Mood changes or emotional instability
  • Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat
  • Vision problems including blurred vision or seeing halos around lights
  • Rapid weight gain due to fluid retention
  • Imbalanced electrolytes leading to symptoms like confusion, uneven heart rate, extreme thirst and muscle weakness
  • Severe nervous system reactions – rigid muscles, sweating excessively even without physical exertion

On the other hand with Hydrocortisone:

  • Overuse could lead to thinning skin or discoloration at the site of application.

If you experience any of these symptoms while taking either medication speak with your healthcare provider right away.

What are the most common side effects for Hydrocortisone?

While using Hydrocortisone, you may experience:

  • Indigestion or heartburn
  • Sleep problems (insomnia)
  • Increased sweating
  • Mood changes and feeling of anxiety or nervousness
  • Skin reactions such as a rash
  • Dizziness or spinning sensation
  • Muscle weakness or joint pain These side effects are generally less severe than those associated with Prednisone. It's important to note that this is not an exhaustive list and individual responses can vary. Always consult your health care provider for personalized advice.

Are there any potential serious side effects for Hydrocortisone?

While it is generally safe, Hydrocortisone can also cause severe side effects in some rare cases. Symptoms that may indicate serious adverse reactions include:

  • Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat
  • Mood changes or feeling very irritable
  • Changes in personality
  • A sensation of spinning
  • Muscle weakness or loss of muscle mass
  • Unusual weight gain particularly around the midsection and the upper back
  • New or unusual acne on the face
    If you notice any of these symptoms after taking hydrocortisone, get medical attention immediately.

Contraindications for Prednisone and Hydrocortisone?

Prednisone and Hydrocortisone, like all corticosteroids, can cause a variety of side effects in some people. If you notice any unusual physical or emotional changes such as increased thirst, mood swings or irregular heartbeat while taking these medications, please seek immediate medical attention.

Neither Prednisone nor Hydrocortisone should be taken if you are currently using other steroid medication unless directed by your physician. Unintentional mixing of steroids can lead to overuse and may result in severe health complications including immune suppression and adrenal insufficiency.

Before starting either Prednisone or Hydrocortisone treatment, always inform your healthcare provider about any other prescriptions, over-the-counter drugs or supplements that you are currently taking; certain combinations might require an adjustment period to prevent dangerous interactions with these corticosteroids.

How much do Prednisone and Hydrocortisone cost?

For the brand name versions of these drugs:

  • The price of 60 tablets of Prednisone (20 mg) averages around $30, which works out to about $0.50/day.
  • The price for a tube of Hydrocortisone cream (2.5%, 30g) is roughly $65, which can last for varying lengths depending on usage frequency.

Thus, brand-name Prednisone is less expensive than Hydrocortisone on a per-day treatment basis if you're using them regularly. However, cost should not be your primary consideration in determining which one is more suitable for your condition.

For the generic versions of Prednisone and Hydrocortisone, costs are significantly lower:

  • Generic Prednisone (20mg tablets) comes in packs ranging from 10 to hundreds or even thousands with approximate costs starting as low as $0.15/day and rarely exceeding $1/day.
  • Generic Hydrocortisone creams (2.5%) typically come in tubes that range from 15g to 60g with prices that start at around $12/tube ($0.80-$3 per day based on usage).

Popularity of Prednisone and Hydrocortisone

Prednisone, available as a generic drug or under brand names such as Deltasone, was estimated to have been prescribed to about 23.7 million people in the US in 2020. Prednisone accounted for just over 17% of corticosteroid prescriptions in the US. However, it appears to be one of the most-common systemic corticosteroids (not classified as a topical or inhalation corticosteroid). The use of prednisone has remained approximately steady over the last decade.

Hydrocortisone, including brand versions such as Cortef and Solu-Cortef, was prescribed to around 2 million people in America during 2020. In terms of overall corticosteroid prescriptions within the US, hydrocortisone accounts for under 3%. This medication is commonly used both systemically and topically for a variety of health conditions related to inflammation. The prevalence of hydrocortisone has remained fairly stable over the past ten years.


Both Prednisone and Hydrocortisone have long-standing records of usage in reducing inflammation and suppressing the immune system, applicable to a variety of medical conditions. They belong to a class of drugs known as corticosteroids, which mimic the effects of natural hormones produced by the adrenal glands. The decision between prednisone and hydrocortisone usually depends on the specific condition being treated.

Prednisone is often chosen for its potent anti-inflammatory effects, making it useful in managing autoimmune diseases or inflammatory conditions such as rheumatoid arthritis or asthma. On the other hand, hydrocortisone more closely mimics cortisol - our body's 'natural' steroid hormone – making it suitable for treating adrenocortical insufficiency where there is deficient production of steroids in the body.

Both medications are available generically, offering cost savings for patients who must pay out-of-pocket expenses. It’s worth noting that both prednisone and hydrocortisone may require an adjustment period upon starting treatment or altering dosage.

Side effect profiles are similar due to their shared mechanism; common side-effects include fluid retention, mood changes and upset stomach. Long-term use can lead to more serious problems like osteoporosis or diabetes so close monitoring is essential when taking these medications over extended periods. Patients should seek immediate medical attention if they experience severe symptoms such as rapid weight gain or vision problems.