Asthma exacerbation
First line
First-line systemic glucocorticoid for asthma exacerbation. GEMA 5.4 recommends oral prednisone 40–50 mg/day for 5–7 days without tapering when the course is under 14 days.
Sources
Short-to-medium acting systemic glucocorticoid
ATC code: H02AB07 (Prednisone)
Brand names
Deltasone, Rayos
Prodrug: liver-converted to active prednisolone via 11β-hydroxysteroid dehydrogenase type 1. Binds cytoplasmic glucocorticoid receptor, induces transcription of anti-inflammatory genes and suppresses NF-κB. Activity: 4× glucocorticoid, 0.8× mineralocorticoid vs cortisol. Half-life 2–4 hours, biological action 12–36 hours.
First line
First-line systemic glucocorticoid for asthma exacerbation. GEMA 5.4 recommends oral prednisone 40–50 mg/day for 5–7 days without tapering when the course is under 14 days.
Sources
First line
Cornerstone therapy in autoimmune disease (systemic vasculitis, SLE, dermatomyositis, autoimmune hepatitis) to suppress acute inflammation. Long-term use requires osteoporosis prophylaxis (calcium+vitD, bisphosphonate in patients >40 on >7.5 mg/day).
Second line
Glucocorticoid as bridge therapy at rheumatoid arthritis treatment start, while DMARDs (methotrexate, leflunomide) reach full effect. SER recommends short low-dose courses (prednisone ≤7.5 mg/day) tapered down over 3–6 months because of osteoporosis and metabolic complications.
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FDA Category C. Used in pregnancy for severe asthma exacerbations, SLE, autoimmune hepatitis and threatened preterm labour. Older data linked first-trimester exposure to cleft palate (small absolute risk). Prolonged therapy can cause neonatal adrenal insufficiency.
Compatible. Hale L2. Transfers into milk in small amounts. Single pulse doses and short courses do not produce clinically meaningful infant exposure. With prolonged high-dose therapy, monitor infant growth and adrenal function.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Prednisone is evaluated for the following indications with varying evidence strength: Rheumatoid arthritis (evidence tier A), Asthma exacerbation (evidence tier A), Autoimmune conditions (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Prednisone (≥ 1 in 100): Weight gain and Cushingoid features, Insomnia and mood changes, Hypertension and sodium retention, Hyperglycaemia, Gastritis and peptic ulcers, Osteoporosis with prolonged therapy. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. Used in pregnancy for severe asthma exacerbations, SLE, autoimmune hepatitis and threatened preterm labour. Older data linked first-trimester exposure to cleft palate (small absolute risk). Prolonged therapy can cause neonatal adrenal insufficiency.
Compatible. Hale L2. Transfers into milk in small amounts. Single pulse doses and short courses do not produce clinically meaningful infant exposure. With prolonged high-dose therapy, monitor infant growth and adrenal function.
Prednisone is contraindicated in: Hypersensitivity to prednisone; Systemic fungal infections; Active viral infection (varicella, measles, herpes zoster) in non-immunised patient; Live vaccines at immunosuppressive doses. Full list in the Safety section.