Prednisone vs Prednisolone

[skipspmr]

I don't understand why prednisone is prescribed when prednisolone is available. Why do doctors in the U.S. prescribe prednisone when Medrol is available. If the liver has to convert the prednisone into prednisolone why not just take the prednisolone directly? I suspect that in the U.S. that prednisone has just evolved as the standard and now doctors prescribe it over prednisolone (Medrol) because it is safer for the doctor. Can anyone shed any light on this subject?

[PMRpro Ambassador]

I've already written about this in response to another post somewhere - might be another forum though I suppose.

There are several different medium acting corticosteroids, all do much the same things but some work for a particular patient better than another. Methylprednisolone (which is what Medrol is, not prednisolone) does nothing for me except cause nasty side effects, none of which occur with prednisolone or prednisone.

Most of the background as to which is used is tradition in a particular area - obviously between countries but sometimes even in the same country. Here where I live in Italy they use an anticoagulant called Sintrom, just 70km away in another hospital they use Coumadin/warfarin. It was probably a doctor's preference at one time. Then it is also a case of what is approved by the FDA at a given time.

The primary reason though is almost certainly the supply contracts drawn up between insurers and drug manufacturers and the lowest tenders submitted! They are made from slightly different processes:

"The first isolation and structure identifications of prednisone and prednisolone were done in 1950 by Arthur Nobile.[22][23][24] The first commercially feasible synthesis of prednisone was carried out in 1955 in the laboratories of Schering Corporation, which later became Schering-Plough Corporation, by Arthur Nobile and coworkers.[25] They discovered that cortisone could be microbiologically oxidized to prednisone by the bacterium Corynebacterium simplex. The same process was used to prepare prednisolone from hydrocortisone.[26]

The enhanced adrenocorticoid activity of these compounds over cortisone and hydrocortisone was demonstrated in mice.[27]

Prednisone and prednisolone were introduced in 1955 by Schering and Upjohn, under the brand names Meticorten and Delta-Cortef, respectively.[28] These prescription medicines are now available from a number of manufacturers as generic drugs."

You are in the USA I assume - why not ask your local pharmacist when he isn't busy? They may know.

[skipspmr in reply to PMRpro]

Thank you for all that information. I appreciate it.