How do prednisolone and prednisone differ

Cortisone therapy

Cortisone is a key drug in medicine today. The doctors say Glucocorticoidsbecause there is not just one, but many, cortisone supplements. Cortisone & Co. have the same effect as the body's own cortisone, the Cortisol and have a wide range of applications: from rheumatic diseases, allergies, chronic inflammatory bowel diseases, through autoimmune diseases to the suppression of rejection reactions in transplants - cortisone therapy has a regular place in today's medicine.

Glucocorticoids have vital functions in that they control metabolic processes: for example, body temperature, the expansion and constriction of blood vessels and keeping the pH value in the blood constant. They also play a key role in the body's adaptation to the day-night rhythm, temperature changes, noise and stress, which is why they are also counted among the stress hormones.

Effect. Cortisol and cortisone have the following effects - desirable and undesirable - in detail:

They influence inflammatory processes in a very extensive way - which is the main area of ​​application for cortisone therapy. Among other things, they dampen the formation of antibodies, which also increases the risk of long-term infections.

They support the formation of new sugar (glucose) in the liver and at the same time inhibit the absorption of glucose into the cells. This leads to a rise in blood sugar levels and symptoms similar to diabetes (steroid diabetes).

They inhibit the absorption of calcium in the intestines and kidneys, which lowers the level of calcium in the blood. As a countermeasure, the parathyroid gland secretes more parathyroid hormone, which now releases calcium from the bones: there is a risk of osteoporosis.

They intervene in the metabolism of sex hormones and inhibit sexual interest.

They mobilize fats from the adipose tissue and wash them into the blood (hyperlipidemia). The increased fat levels can be measured in the blood and are visible as trunk obesity.

Along with this, they increase appetite and cause insomnia.

They intensify gastric juice secretion: This increases the risk of developing stomach ulcers. If cortisone has to be taken for a long time, preventive treatment with a gastric acid-reducing drug, a so-called proton pump inhibitor such as pantoprazole or omeprazole, is necessary. Otherwise there is a risk of a stomach ulcer.

Principles of Cortisone Therapy

The various cortisones differ mainly in terms of their strength and duration of action, but Not in the nature of their effect. They are administered orally (tablets and capsules), locally (ointment, metered dose aerosol, intestinal enema and syringes in the joint space) and as an injection into a vein.

Dose. Normal cortisol production follows a clear diurnal rhythm with the highest level in the morning at 7 a.m. and a low point at midnight. In order not to disturb this circadian rhythm completely, cortisone tablets are therefore used basically early in the morning taken. Only with high doses are 2/3 of the daily dose taken in the morning and 1/3 at noon.

Determination of the target dose. The target dose is based on sufficient symptom improvement without suppressing the adrenal function.

In order to adjust the patient to the target dose that applies to him, the doctor initially uses the limit values ​​of the cortisone dose, which do not yet lead to Cushing's syndrome. These limit values, also called equivalent doses or Cushing threshold doses, are only guidelines based on experience. Since every person has their own Cushing threshold dose and this varies greatly from person to person, there is unfortunately no other option than to find out individually by trial and error. Thus, finding the right target dose is the main problem for the right cortisone therapy.

Overview of common (gluco) corticosteroid preparations:

  • Cortisol (hydrocortisone): strength 1; Equivalent dose 30 mg per day
  • Cortisone: strength 0.8; Equivalent dose 40 mg per day
  • Prednisone: strength 4; Equivalent dose 7.5 mg per day
  • Prednisolone: ​​strength 4; Equivalent dose 7.5 mg per day
  • Methylprednisolone: ​​strength 5; Equivalent dose 6 mg per day
  • Triamcinolone: ​​strength 5; Equivalent dose 6 mg per day
  • Dexamethasone: strength 25; Equivalent dose 1 mg per day

The circadian therapy (single administration daily) is differentiated from the alternating therapy (twice the dose of the usual daily amount every 2nd day). For long-term therapy, alternating therapy is preferred, as it stimulates the adrenal gland at least every other day.

Side effects

When used briefly and as shock therapy for acute illnesses, cortisone is practically free from side effects. If cortisone is used for a long time and not only in a localized manner, all symptoms of Cushing's syndrome occur. Fortunately, most complaints such as edema, full moon face, flushing of the cheeks and trunk obesity as well as the diabetes symptoms regress completely.

However, osteoporosis (thinning of the bones) caused by long-term therapy cannot be reversed. Patients who take cortisone for longer than 3 weeks are therefore given 2 x 500 mg calcium and 2 x 500 units of vitamin D3 daily as a "bone vitamin" as a precaution against irreversible bone damage.

Authors

Kristine Raether-Buscham, Dr. med. Arne Schäffler | last changed on at 09:34