Prednisone is a corticosteroid used to reduce inflammation and calm an overactive immune response. In South Africa it is most often prescribed as a short course for asthma and chest flare-ups, severe allergic reactions, skin conditions and inflammatory joint problems. What it is prescribed for, and for how long, depends on your condition and is decided by your doctor.

What is Prednisone?

Prednisone is a synthetic corticosteroid — a medicine that mimics cortisol, a hormone your adrenal glands produce naturally. Cortisol has many jobs, and one of them is controlling inflammation. Prednisone supplies a much stronger version of that signal.

Your liver converts prednisone into prednisolone, which is the form that actually works in the body. That is why you may see both names used, and why some products are dispensed as prednisolone directly — particularly liquids for children and for people with liver problems.

In South Africa it is a Schedule 4 medicine, so it is prescription-only. It is dispensed under several brand names, including Trolic and Be-Tabs Prednisone, and as plain prednisone from various manufacturers. All contain the same active ingredient, most commonly in 5 mg tablets.

It is worth being clear about what corticosteroids are not. They are unrelated to the anabolic steroids associated with bodybuilding. Those are synthetic testosterone; prednisone acts on inflammation and immunity, and does not build muscle.

What is Prednisone commonly used for?

Prednisone is prescribed across an unusually wide range of conditions, because inflammation is a feature of so many of them. The most common reasons in South African practice include:

Asthma and COPD flare-ups, where a short course reduces airway swelling that inhalers alone are not controlling.
Severe allergic reactions, including reactions to medicines, insect stings and foods, usually alongside other treatment.
Skin conditions such as severe eczema, dermatitis and some drug rashes.
Inflammatory arthritis, including rheumatoid arthritis and flares of gout, and other rheumatological conditions.
Inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis.
Autoimmune conditions, where the immune system is attacking the body’s own tissue.
Some blood disorders and cancer protocols, where it forms part of a treatment regimen.
After transplant surgery, to suppress rejection.

Being prescribed prednisone therefore tells you very little on its own about your diagnosis. The same tablet, at the same strength, is used for a chest infection flare and for an autoimmune condition. If you are not sure why it was prescribed for you, that is a reasonable question to ask your prescriber or the pharmacist who dispensed it.

How Prednisone fits into this medicine category

Within pain and inflammation medicines, prednisone belongs to the corticosteroid group, and it works differently from the medicines most people reach for first.

Simple painkillers such as paracetamol relieve pain without doing much about inflammation. Anti-inflammatories — the NSAIDs, such as ibuprofen and diclofenac — reduce inflammation as well, by blocking a specific set of chemical signals. Corticosteroids act much further upstream, damping the immune response that produces the inflammation in the first place.

That makes them considerably more powerful, and it is also why they are prescribed as defined courses rather than taken as needed. A course exists to bring something under control; it is not a medicine to keep in the cupboard for the next flare.

Combination painkillers such as Synaleve sit in a different group again, pairing analgesics with codeine. You can browse the whole group on the pain, inflammation and musculoskeletal medicines hub.

What to check before using Prednisone

Check the pack against the prescription. Prednisone and prednisolone are closely related but not identical, and strengths differ between products.

Tell your prescriber and pharmacist if any of the following apply, because they change how prednisone is used and monitored:

You have diabetes. Prednisone raises blood glucose, often noticeably, and readings may need closer attention during the course.
You have high blood pressure, heart failure or kidney disease. It can cause fluid retention.
You have a history of stomach ulcers, or you take an anti-inflammatory. The combination raises the risk of stomach bleeding.
You have glaucoma or cataracts, or a family history of them.
You have osteoporosis, or risk factors for it.
You have had tuberculosis, or have been in contact with it. Suppressing the immune system can reactivate dormant TB, which matters in South Africa in particular.
You have any active infection, or a suppressed immune system for any reason.
You have a mental health condition. Corticosteroids can affect mood and sleep.
You are pregnant, planning pregnancy or breastfeeding.
You take other medicines, including anything bought over the counter or herbal.

Most people take prednisone in the morning with food. Morning dosing follows the body’s own cortisol rhythm and tends to interfere less with sleep; food reduces stomach irritation. Follow the dispensing label — this page does not set doses, and the right dose and course length depend on your condition.

Possible cautions and when to ask a pharmacist or doctor

Do not stop a longer course abruptly. This is the single most important point on this page. Taken for more than a short period, prednisone suppresses your own cortisol production, and stopping suddenly can leave you without enough of either. That causes severe weakness, nausea, dizziness and, in serious cases, a medical emergency. Longer courses are tapered down deliberately. If you want to stop, speak to the prescriber first.

It can mask and worsen infection. Because it damps the immune response, prednisone can hide the usual signs of infection while making you more susceptible to one. Report fever, sore throat, a cough that worsens, or any infection that is not settling.

Chickenpox and measles need urgent advice if you are not immune and are exposed while taking it. Both can be far more serious in someone on corticosteroids.

Avoid live vaccines during treatment unless your doctor says otherwise.

Expect some short-term effects. Increased appetite, difficulty sleeping, restlessness, fluid retention and a raised mood are common on short courses and settle afterwards. Tell your doctor if mood changes are marked.

Longer use carries more. Bone thinning, cataracts, skin fragility, muscle weakness and raised blood sugar are associated with extended treatment, which is why prescribers keep courses as short as the condition allows and monitor longer ones.

Carry a steroid card if you take it long term, so anyone treating you in an emergency knows.

Seek medical attention promptly for severe abdominal pain, black or tarry stools, vomiting blood, breathlessness, marked swelling, visual changes, or symptoms of infection. Contact your prescriber rather than stopping on your own.

Related medicine guides

Frequently asked questions

Is prednisone a painkiller? Not directly. It reduces inflammation, and pain caused by inflammation usually improves as a result. It does not block pain the way paracetamol or an anti-inflammatory does.

Can I stop taking it once I feel better? Not without advice. Short courses are usually completed as prescribed, and longer ones must be tapered. Stopping abruptly after extended use can make you seriously unwell.

Is prednisone the same as prednisolone? They are closely related. Your liver converts prednisone into prednisolone, which is the active form. Prednisolone is sometimes prescribed directly, particularly for children and in liver disease.

Why does it make me hungry and unable to sleep? Both are common corticosteroid effects and usually settle once the course finishes. Taking the dose in the morning generally helps with sleep.

Is it the same as the steroids used in bodybuilding? No. Those are anabolic steroids, related to testosterone. Prednisone is a corticosteroid that acts on inflammation and immunity, and does not build muscle.

Can I drink alcohol while taking it? There is no absolute prohibition, but both irritate the stomach lining, so the combination raises that risk. Ask your pharmacist about your own situation.

What Is Prednisone Used For?