Pred? Which is it?

[Dawnint]

I am on Prednisolone, but others are on Prednison. Are they similar and which do people mean when they say Pred.

[DorsetLady PMRGCAuk volunteer]

Hi,

Official answer -

“Prednisone and Prednisolone are used in the same manner and equally as effective. Prednisone is activated by the liver into prednisolone.

It was once thought that Prednisolone may be preferred in patients with liver disease but recent studies suggest that this is probably not the case.

They have slightly different chemical structures.”

Prednisolone is normally prescribed in UK, whereas Prednisone is mainly prescribed in other countries.

Because we are not sure sometimes where everybody lives most of us say Pred - which covers both varieties.

[KellyInTexas in reply to DorsetLady]

Hello,

And how would a ,” methylated” formulated variety differ?

How would the body break absorb this differently?

I have a severe case of APS, ( Anti Phospholipid Syndrome- it’s the clotting component of Lupus )and I’m on quiet a lot of warfarin.

I was very recently put on prednisone. ( different ways- 120 mg solumedrol- IM now its 5 mg tablets for 30 days. It seems I now also have Vasculitis.

I also have a very high rheum factor.

I’m not exactly sure what’s going on and neither is my Rheumatoligist.

The steroids are interfere with the INR, of course. Each time it has lowered it. ( I form DVT’s very quickly.)

This is a brand new learning curve for me. I just started the 5 mg prednisone yesterday. I’ve only ever been on IV, IM or the methylated form.

I’ve been “ lurking here” for about a month trying to learn about Pred and its relationship with warfarin. ( as I see this PMR condition is linked to Vasculitis.) many patients with Vasculitis are on Rituximab- some patients on Rituximab have severe APS like me ... just trying to find any patients on Rituximab, with APS , or on warfarin prednisone. It is destabilizing my INR quite profoundly.

I can always inject heparin to get it back to level- catching it in time is tricky. I get blood draws about 3 or 4 times a week.

So thank you for helping- I know I’m not exactly in the right place here- but it’s very close.

Greetings to you all from Texas.

[PMRpro Ambassador in reply to KellyInTexas]

In the case of prednisolone and methyl prednisolone the methylation is claimed to increase the antiinflammatory effect. For me all it did was increase the adverse effects! I switched from a relatively ineffective 20mg of methyl pred that took several hours to achieve anything to 15mg prednisone that was like the original miracle with prednisolone had been.

The other corticosteroids have different halflives - and so their effect may last much longer. The preds and methyl pred are used for convenience - single daily dosing works for most people.

I was on a warfarin clone and had next to no problem with my INR for some years and then suddenly it started swinging all over the place so I was switched to a NOAC. But I don't have APS - not sure if any are approved for that.

You won't find anyone here on rituximab - although it is used for other forms of vasculitis it is very rarely used for PMR or even GCA though there is one paper in the medical literature where it was used for some reason.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Thanks for answering - I wouldn't have known!

[KellyInTexas in reply to PMRpro]

No none are ,”approved.” But I clotted through an INR of 4.8 so we trialed an unusual dosing and dosing regiment of Apixiban. But it did fail- we did it knowing it had failed the trials.

I am a patient in both London ( Lupus Centre and here in Texas .

Thank you so much for your time here, ladies. This is a very well forum, and I really appreciate it.

I’m an administrator on the Hughes/ sticky blood HU forum, and we do have a few lupus patients on steroids. But not for maintenance like this.) I may share a few tips here with permission.

[PMRpro Ambassador in reply to KellyInTexas]

Feel free!

[nickm001]

add Japan to list of countries that use Prednisolone