Dexamethasone vs. Prednisone: Similarities & Differences
Medically reviewed by Femi Aremu, PharmD
Dexamethasone and prednisone are corticosteroid medications commonly known as steroids. Healthcare providers prescribe steroids to treat various conditions involving inflammation in the body, such as arthritis (joint inflammation).
Dexamethasone and prednisone are generic drugs but are available in brand-name form. Hemady is a brand-name version of dexamethasone. Rayos is a prednisone brand. However, it is more commonly known as prednisone to the general public.
These medications are similar but have many differences. Notably, dexamethasone generally has longer-lasting effects than prednisone.
Their main difference, however, is that they are prescribed to treat different conditions, although there is some overlap.
Read on to learn about the similarities and differences between dexamethasone and prednisone, why they’re prescribed, their possible side effects, who should avoid them, and more.
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What Is Dexamethasone?
Dexamethasone, a corticosteroid, is available by prescription only in several different dosage forms, including an oral tablet, oral solution, and eye drops. This medication is available only by prescription.
An injectable form of dexamethasone is also available, which comes as dexamethasone sodium phosphate.
The Food and Drug Administration (FDA) has approved dexamethasone to treat various conditions in adults and children, including:
Rheumatic (joint-related) conditions in adults, including gout, ankylosing spondylitis (an inflammatory disease of the spine), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) or juvenile RA in children
Severe allergy-related conditions, such as asthma or atopic dermatitis (also known as eczema)
Rashes or other skin reactions, such as Stevens-Johnson syndrome (SJS), a severe disorder of the skin and mucous membranes
Flare-ups of ulcerative colitis (UC) a type of inflammatory bowel disease (IBD)
Certain blood disorders, such as idiopathic thrombocytopenic purpura
Blood cancers, such as leukemia
Dexamethasone is also FDA-approved for diagnostic testing to identify adrenal gland problems and to reduce inflammation in the brain, nerves, eyes, kidneys, or lungs due to various causes.
In addition, dexamethasone is commonly prescribed for many different off-label uses. Off-label prescribing is when a medicine is prescribed for a not specifically FDA-approved purpose.
Some notable examples include:
Iontophoresis for osteoarthritis of the knee or other joints
Treat altitude sickness
Management of COVID-19 in hospitalized people
How Does Dexamethasone Work?
Inflammation can result in different symptoms depending on where it occurs in the body. For instance, knee inflammation can cause pain, swelling, and difficulty walking.
Healthcare providers commonly prescribe corticosteroids to adults and children to treat inflammation due to various causes.
Dexamethasone belongs to a class of drugs called corticosteroids, commonly called steroids. It works by acting like a natural hormone in your body called cortisol.
Steroids block specific processes within the body’s immune system, preventing the release of certain compounds. Through this mechanism, steroids help to reduce inflammation.
What Is Prednisone?
Like dexamethasone, prednisone is a corticosteroid available by prescription only in different dosage forms.
The only brand-name version available is Rayos, a delayed-release oral tablet. Generic prednisone is much more commonly prescribed.
The FDA has approved prednisone to treat numerous conditions and symptoms in adults and children. While not an all-inclusive list, prednisone's common indications include:
Endocrine system disorders, such as primary or secondary adrenal insufficiency or other conditions causing low corticosteroid levels in the body
Rheumatic disorders, such as short-term treatment of flare-ups of PsA or RA
Rashes and skin conditions like psoriasis, eczema, and severe seborrheic dermatitis (a common skin condition that causes red patches with yellow scales and flaky skin)
Allergy-related conditions, including asthma, severe allergic rhinitis, and allergic reactions to medications
Ophthalmic (eye) diseases, such as allergic conjunctivitis or other causes of eye inflammation
Blood disorders, including certain types of anemia
Cancer of the blood, such as leukemia or lymphoma
Short-term treatment of symptoms of gastrointestinal (GI) diseases, such as UC
Nervous system disorders, such as acute exacerbations of multiple sclerosis (MS)
Severe forms of bacterial meningitis, such as tuberculous meningitis (TB)
Prednisone also has off-label uses, such as managing flare-ups of chronic obstructive pulmonary disease (COPD).
How Does Prednisone Work?
Like dexamethasone, prednisone works by blocking specific processes in the immune system. By lowering the immune system's activity, prednisone helps control inflammation and reduces symptoms caused by it.
Prednisone is available by prescription in three different dosage forms: an oral tablet, a liquid solution, and a delayed-release (DR) oral tablet.
Dosing Overview
In terms of oral dosages, dexamethasone is generally more potent than prednisone. This means it typically takes a lower dose of dexamethasone to produce the same therapeutic results as a relatively higher prednisone dose.
Also, dexamethasone produces longer-lasting effects in the body than prednisone. But this isn’t always desirable considering the reason the drug is being prescribed and the potential side effects.
The specific dosing for dexamethasone and prednisone depends on the condition being treated.
The table below compares the forms and strengths available for dexamethasone and prednisone:
| Dexamethasone: | Prednisone: |
Oral Tablet: | • 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg, 20 mg | • 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg |
Delayed-Release Oral Tablet: | • N/A | • 1 mg, 2 mg, 5 mg |
Oral Solution (Liquid): | • 0.5 mg per 5 milliliter (mL) and 1 mg/mL (intensol concentrate) | • 5 mg/5 mL and 5 mg/mL (intensol concentrate) |
Eye Drops: | • 0.1% | • N/A* |
Injection: | • 4 mg/mL, 10 mg/mL | • N/A* |
*Prednisone is not available as an eye drop or an injection. However, a similar prescription drug called prednisolone is available in these and other forms.
Healthcare providers typically prescribe dexamethasone or prednisone for short-term use. In many cases, your provider will prescribe a steroid taper.
This means you’ll start with a higher dosage and gradually decrease it over weeks or days before stopping it.
Comparing Efficacy
Since dexamethasone and prednisone can treat various medical conditions, it is difficult to determine which drug is generally more effective.
In clinical trials comparing the two drugs, researchers have mainly focused on evaluating the treatment of asthma flares in young people.
For example, in a 2021 study, adolescents (between 3 and 21 years old) who received dexamethasone upon hospital admission for acute asthma exacerbation recovered more quickly than those who received prednisone, based on the average length of their hospital stay.
In another study of children (between 1 and 14 years old) treated in the emergency room for acute asthma, two doses of dexamethasone were shown to be equally effective for symptom resolution as a five-day course of prednisone.
However, the choice between these drugs depends on your specific medical needs.
Your healthcare provider will decide which drug to prescribe based on your health history, medical conditions, and other medications you're taking.
Use in Treating Cancer-Related Symptoms
Dexamethasone and prednisone may be prescribed to manage specific symptoms due to cancer or to manage the side effects of cancer treatments.
Healthcare providers commonly prescribe dexamethasone to help prevent and treat nausea and vomiting in people undergoing chemotherapy or radiation treatments for cancer. It’s used as part of a regimen with other antiemetic drugs, such as Zofran (ondansetron).
Providers may prescribe prednisone for palliative treatment of leukemias and lymphomas. The drug is also used to manage hypercalcemia (high calcium levels) related to cancer.
Again, a healthcare provider will choose whether or not to prescribe one of these medications based on your condition and specific medical needs.
Alternative Treatment Options
With arthritis comes chronic pain and inflammation in one or more joints. Unfortunately, there isn’t a simple solution for the chronic pain and swelling of arthritis.
While steroids like prednisone can help short-term, your healthcare provider may recommend it as just one small part of a comprehensive plan to manage the symptoms.
This plan may include nondrug methods like heat therapy, exercise, massage, using supports like splits, psychological therapy to change thoughts and behaviors, and even mindfulness.
Healthcare providers may prescribe steroids like dexamethasone or prednisone to manage conditions involving low corticosteroid levels. A typical example is adrenal insufficiency, in which the adrenal glands produce little to no cortisol.
There are many different causes and types of adrenal insufficiency—including long-term use of steroids leading to impaired cortisol production. Adrenal crisis may occur if adrenal insufficiency occurs suddenly or abruptly worsens.
People with low cortisone levels are advised to minimize stress and other factors that may trigger an adrenal crisis.
Risk factors may include prolonged exercise, extreme stress, exposure to intense heat, infection, fever, trauma, surgery, and significant emotional distress.
Because many different factors can affect cortisol levels, no single set of lifestyle changes will work for everyone, though. Consult a healthcare professional for advice that applies to your situation.
Side Effects & Safety
Like all drugs, dexamethasone and prednisone carry the potential for adverse effects.
If you or a loved one begins treatment with dexamethasone or prednisone, be sure to monitor for the emergence of side effects closely.
Remember that steroids like prednisone and dexamethasone are usually weaned or tapered if taken for more than a few days. If you take steroids long-term, your healthcare provider will instruct you to taper much more gradually over several weeks or even months.
This is because these drugs affect the adrenal glands, so slowly stopping the medication allows the adrenal glands to return to their normal function.
Stopping a steroid too suddenly can cause withdrawal symptoms such as extreme tiredness, weakness, lightheadedness, body aches, joint pain, nausea, and appetite loss.
When taking a steroid such as dexamethasone or prednisone, your healthcare provider will provide instructions for gradually tapering the medication over time, depending on how long your treatment is, to help prevent withdrawal side effects.
Common Side Effects
Common side effects of dexamethasone and prednisone include:
Increased appetite
Acne
Weight gain
Other side effects are possible, some of which are serious and more likely to occur if you take either drug long-term or in high doses.
Severe Side Effects
Examples of potentially severe side effects of dexamethasone or prednisone are:
Increased risk of infection
Cardiovascular disease, such as heart failure and hypertension (high blood pressure)
New onset of diabetes or worsening control of existing diabetes
Electrolyte imbalances, such as low potassium
Slowed growth in children
Potential for Interaction
Dexamethasone and prednisone share many drug interaction risks.
While the list below is not all-inclusive, it highlights some examples of medications to avoid, if possible, during treatment with dexamethasone or prednisone:
Nonsteroidal anti-inflammatory drugs (NSAIDs), which are medications that may increase the risk of GI bleeding. Examples include Advil and Motrin (ibuprofen), Aleve (naproxen) and aspirin.
Cholesterol-lowering drugs, such as Prevalite (cholestyramine), which may lower the effectiveness of dexamethasone or prednisone if taken simultaneously.
Antidiuretic medications (drugs used to control blood pressure), such as Ddavp (desmopressin). Ddavp may increase the risk of hyponatremia (low sodium levels) if taken alongside dexamethasone or prednisone.
Antiarrhythmic medications (drugs used to treat an irregular heartbeat), such as Tikosyn (dofetilide). Tikosyn may increase blood pressure and fluid retention with dexamethasone or prednisone.
Hormonal contraceptives (birth control medications), such as Plan B (levonorgestrel). The simultaneous use of dexamethasone or prednisone with Plan B may lead to decreased effectiveness of birth control.
Thiazide diuretics (drugs that increase urine flow), such as Microzide (hydrochlorothiazide (HCTZ)). The simultaneous use of dexamethasone or prednisone with Microzide may lead to the risk of hypokalemia (low potassium levels).
Warning on Vaccine Use
Also, live vaccines, such as the measles-mumps-rubella (MMR) or intranasal (in-the-nose) flu vaccines should not be administered to people with suppressed immune systems.
Dexamethasone or prednisone can suppress the immune system if taken above a specific dosage. Please consult a healthcare professional before you receive any vaccines during steroid treatment.
In addition, avoid grapefruit and grapefruit juice while taking dexamethasone.
Consuming grapefruit products during dexamethasone treatment may increase the levels of dexamethasone in the body, raising the risk of side effects. Prednisone, conversely, is not known to interact with grapefruit.
Summary
Dexamethasone and prednisone are both generic steroid drugs prescribed for treating health conditions involving inflammation.
Both work by lowering the activity of the immune system. The main differences include the specific conditions they are commonly used for and how they are taken.
Your healthcare provider can determine which one might work better for your needs.
Frequently Asked Questions
How should dexamethasone and prednisone be stored?
Both dexamethasone and prednisone should be stored at room temperature (between 68 and 77 degrees F). Keep all medications out of the reach of children and pets.
Are there any dietary guidelines for using dexamethasone or prednisone?
Take prednisone or dexamethasone with food. While taking dexamethasone, avoid grapefruit and grapefruit juice, as grapefruit can raise dexamethasone levels and increase the risk of side effects.
Prednisone does not have known interactions with grapefruit.
How can I dispose of dexamethasone or prednisone, if needed?
Experts strongly discourage flushing medications down the toilet or tossing them in the trash. Instead, check if your pharmacy or healthcare provider’s office has a disposal kiosk where you may drop off unwanted medications.
Also, many areas now have local household hazardous waste drop-off facilities offering safe, environmentally friendly drug disposal.
Read the original article on Verywell Health.
