Glucocorticoid·Endocrinology - Systemic Corticosteroids

Prednisone

Acute asthma/COPD, rheumatoid arthritis, IBD flares, severe allergic reactions, immunosuppression

PBSSTEROIDPanafcort, Sone1 mg tabletS4+1

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At a glance

Max Dose

75 mg/day

Half-life

2-3 h

Caution: Prodrug

HEPATIC ACTIVATION

Caution: Hyperglycemia

HIGH RISK

Cautions

Avoid / Cautions

Systemic fungal infections, live vaccines (if on high doses). Severe hepatic failure. Pregnancy Category A, but chronic use risks fetal adrenal suppression.

Where it stands

Rapid Summary

Overview

Oral systemic glucocorticoid. Biologically inactive prodrug that must be converted by the liver into the active drug, Prednisolone. Identical clinical use to Prednisolone.

Clinical Focus

Completely useless in severe liver failure, as the liver cannot convert it to the active form. Use Prednisolone instead in cirrhotic patients.

Bottom Line

Prednisone is an oral corticosteroid prodrug (converted to prednisolone) for inflammatory and autoimmune conditions, but shares all the same long-term risks as prednisolone including adrenal suppression.

Formulation & Access

Brand Names

Panafcort, Sone

Oral Routes

Take with food

Tablets (1 mg, 5 mg, 25 mg). Take with food to prevent gastric ulceration.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Acute asthma/COPD, rheumatoid arthritis, IBD flares, severe allergic reactions, immunosuppression.

Clinical Place

Widely prescribed globally (particularly in the US), though Australia frequently defaults directly to Prednisolone to eliminate the metabolic variable.

Quick reference

Class & Role

Glucocorticoid — Oral systemic glucocorticoid.

Route / Formulation

Tablets (1 mg, 5 mg, 25 mg). Take with food to prevent gastric ulceration. (Panafcort, Sone)

Usual Dose & Max

PO 40-50 mg OD in the morning for 5 days. Max 75 mg/day.

Key Indication Doses

Asthma / COPD Flare: PO 40-50 mg OD in the morning for 5 days. Rheumatoid / Autoimmune Flare: PO 10-25 mg OD, tapering rapidly to lowest effective dose. Hepatic Impairment: Avoid. Must substitute with Prednisolone to bypass the broken hepatic conversion step.

Best Uses

Key Risks

Endocrine: HPA axis suppression if used > 2 weeks. HIGH — Severe hyperglycemia, Cushing's syndrome (moon face, central obesity). Neurological: Steroid psychosis, delirium, severe insomnia. Musculoskeletal: Osteoporosis (with chronic use), avascular necrosis of the femoral head, steroid myopathy. Immunological: Profound immunosuppression (risk of thrush, severe infections).

Key Interactions

NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI. Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture.

Monitoring

BSL checks. Even non-diabetic patients can hit sugars of 20+ on 50mg of prednisone. Take the full dose in the morning to prevent severe insomnia.

Clinical Pearl

Prednisone and Prednisolone are mg-for-mg equivalent. 25mg of Prednisone = 25mg of Prednisolone. You can safely swap them 1:1 on the ward if stock of one runs out (provided the patient has a functioning liver).

Access

Panafcort, Sone1 mg tablet

Brand: Panafcort, Sone
Formulation: Tablets (1 mg, 5 mg, 25 mg). Take with food to prevent gastric ulceration.

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