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Research · Medication

Oral corticosteroids

Short courses lowered relapse after asthma attacks and halved treatment failure in COPD flare-ups, and eased rheumatoid arthritis, gout flares and croup. In sciatica they improved function slightly. Harms rise with dose and duration: infections in 12.7% against 8.0% of controls, raised blood sugar, fractures and adrenal suppression.

Add to Bio HackChecked 2026-11-13
Status
Prescription drugs in the US. The prednisone label lists approved uses across endocrine, rheumatic, collagen, skin, allergic, eye, respiratory, blood, cancer, fluid-retention and gastrointestinal conditions. It carries no boxed warning.
Also called
prednisone, Deltasone, Rayos, prednisolone, Orapred, Prelone, Millipred, methylprednisolone, Medrol, Medrol Dosepak, dexamethasone, Decadron, glucocorticoids, steroids, steroid burst, steroid pack
Taken for
asthma attacks, COPD flare-ups, rheumatoid arthritis, gout flares, sciatica, back pain, sore throat, croup, severe COVID-19, migraine, inflammation, athletic performance

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help9

Reported risks14

What people take it for, and what was found

Shown to help9

Strong

Asthma attacks

Shown to lower hospital admission and relapse after an asthma attack, with about 8 to 10 people treated to prevent one.

The numbers and sources
Effect
Given within an hour of arriving at an emergency department, systemic corticosteroids lowered hospital admission (OR 0.40, 95% CI 0.21 to 0.78), a number needed to treat of 8. Oral corticosteroids in children showed a larger effect (OR 0.24, 95% CI 0.11 to 0.53), and no adult trial used the oral route [1]. After discharge, a short course lowered relapse needing more care in the first week (RR 0.38, 95% CI 0.2 to 0.74) and over 21 days (RR 0.47, 95% CI 0.25 to 0.89), and lowered later hospitalization (RR 0.35, 95% CI 0.13 to 0.95), with about 10 treated to prevent one relapse [2].
Population
863 people with acute asthma in 12 studies [1]; 374 people in 6 trials, 5 of them of oral corticosteroids [2].
Sources
[1], [2]
Caveats
The reviews date from 2001 and 2007 and cover small trials. Side effects were rarely reported and did not differ from placebo over 7 to 10 days [2].
Moderate

COPD flare-ups

Shown to cut treatment failure in COPD flare-ups by about half, with 9 treated to prevent one, and no change in deaths.

The numbers and sources
Effect
Systemic corticosteroids lowered treatment failure against placebo (OR 0.48, 95% CI 0.35 to 0.67), a number needed to treat of 9 (95% CI 7 to 14), and lowered relapse by 1 month (HR 0.78, 95% CI 0.63 to 0.97). Hospital stay was 1.22 days shorter. Deaths within 30 days did not differ (OR 1.00, 95% CI 0.60 to 1.66). Adverse events were more frequent (OR 2.33, 95% CI 1.59 to 3.43), one extra for every 6 treated, and high blood sugar was more frequent (OR 2.79, 95% CI 1.86 to 4.19). Oral and injected treatment did not differ in treatment failure, relapse or deaths [3].
Population
1,787 people in 16 studies, mean age 68, with a median treatment length of 14 days [3].
Sources
[3]
Caveats
Lung function was better at 72 hours and not at later time points [3].
Strong

Rheumatoid arthritis

Shown to ease joint tenderness and pain in rheumatoid arthritis more than placebo or NSAIDs, and to slow joint damage on X-ray over 1 to 2 years.

The numbers and sources
Effect
Low-dose prednisolone, at no more than 15 mg a day, improved joint tenderness against placebo by 12 tender joints (95% CI 6 to 18) and improved pain (SMD 1.75, 95% CI 0.87 to 2.64) and grip strength. Against NSAIDs it improved joint tenderness by 9 joints (95% CI 5 to 12) and pain (SMD 1.25, 95% CI 0.26 to 2.24) [4]. Across 15 studies, mostly in early disease and added to other disease-modifying drugs, glucocorticoids slowed X-ray progression (SMD 0.40, 95% CI 0.27 to 0.54), with a similar effect at 2 years (0.42, 95% CI 0.30 to 0.55) [5]. In a 2-year trial of prednisone 10 mg a day, clinical improvement over placebo was seen mainly in the first 6 months and X-ray progression was lower after month 6, with more osteoporotic fractures in the prednisone group [6].
Population
320 people with rheumatoid arthritis in 10 short-term studies [4]; 1,414 people in 15 studies [5]; people with early active rheumatoid arthritis not yet on disease-modifying drugs [6].
Sources
[4], [5], [6]
Caveats
The short-term review covers small trials [4]. The mean cumulative dose in the X-ray studies was 2,300 mg of prednisone equivalent in the first year [5].
Moderate

Sciatica and low back pain

Shown to improve function slightly in sciatica from a herniated disk, with pain about half a point of 10 lower and no change in surgery rates.

The numbers and sources
Effect
In adults with sciatica from a herniated disk, a 15-day prednisone course improved disability at 3 weeks by 6.4 points more than placebo on a 100-point scale (95% CI 1.9 to 10.9) and by 7.4 points at 52 weeks. Leg pain did not differ at 3 weeks (0.3 points of 10, 95% CI -0.4 to 1.0) or 52 weeks, and surgery rates did not differ [9]. A Cochrane review of 13 trials found systemic corticosteroids probably lower radicular pain slightly in the short term (0.56 points of 10, 95% CI 0.04 to 1.08) and raise the likelihood of improved function (RR 1.52, 95% CI 1.22 to 1.91), with no difference in surgery (RR 1.00, 95% CI 0.68 to 1.47). For low back pain without sciatica and for spinal stenosis, the limited evidence showed no clear benefit [10].
Population
269 adults with radicular pain for 3 months or less and a herniated disk on MRI, 181 on prednisone and 88 on placebo [9]; 1,047 participants in 13 trials [10].
Sources
[9], [10]
Caveats
The long-term function result rests on a single trial [10]. At least one adverse event was reported by 49.2% on prednisone and 23.9% on placebo at 3 weeks [9].
Moderate

Sore throat

Shown to raise the share with sore throat pain relieved at 24 hours by 12 percentage points after one low dose, mostly of dexamethasone.

The numbers and sources
Effect
After a single low dose, most often oral dexamethasone at up to 10 mg, people were about twice as likely to have pain relief at 24 hours (RR 2.2, 95% CI 1.2 to 4.3, risk difference 12.4%) and 1.5 times as likely to have no pain at 48 hours (RR 1.5, 95% CI 1.3 to 1.8, risk difference 18.3%). Pain relief began 4.8 hours earlier on average. Six of the 9 trials that looked for adverse events reported none [11].
Population
1,426 people with sore throat in 10 trials [11].
Sources
[11]
Caveats
The trials gave one dose and did not assess repeated courses [11].
ModerateStudied in children

Croup in children

Shown to lower croup symptom scores in children within 2 to 12 hours against placebo, with fewer return visits on dexamethasone than on prednisolone.

The numbers and sources
Effect
Against placebo, glucocorticoids lowered croup scores at 2 hours (SMD -0.65, 95% CI -1.13 to -0.18), 6 hours (SMD -0.76, 95% CI -1.12 to -0.40) and 12 hours (SMD -1.03, 95% CI -1.53 to -0.53). Prednisolone and dexamethasone did not differ in croup score at 2 hours. Return visits or admissions were about half as frequent on dexamethasone (RR 0.55, 95% CI 0.28 to 1.11), and fewer children on dexamethasone needed additional glucocorticoid (RR 0.72, 95% CI 0.53 to 0.97) [12].
Population
5,888 children with croup in 45 trials [12].
Sources
[12]
Caveats
The reviewers rated the evidence against placebo low certainty and judged 98% of studies at high or unclear risk of bias. The interval for return visits includes no difference [12].
Moderate

Severe COVID-19 and pneumonia in hospital

Shown to lower 28-day deaths in hospitalized COVID-19 patients, 22.9% against 25.7%, with the benefit limited to those on oxygen or a ventilator.

The numbers and sources
Effect
Dexamethasone 6 mg a day for up to 10 days, by mouth or vein, lowered 28-day deaths from 25.7% on usual care to 22.9% (rate ratio 0.83, 95% CI 0.75 to 0.93). Deaths were 29.3% against 41.4% in those on a ventilator and 23.3% against 26.2% in those on oxygen. In those on no respiratory support they were 17.8% against 14.0% (rate ratio 1.19, 95% CI 0.92 to 1.55) [13]. In severe community-acquired pneumonia, added corticosteroids lowered deaths (RR 0.47, 95% CI 0.3 to 0.74) and C-reactive protein on day 8 (SMD -0.8, 95% CI -1.11 to -0.5), with no difference in gastrointestinal bleeding or high blood sugar [14].
Population
6,425 people hospitalized with COVID-19, 2,104 on dexamethasone and 4,321 on usual care [13]; 665 people with severe community-acquired pneumonia in 10 trials [14].
Sources
[13], [14]
Caveats
The COVID-19 trial was open label [13]. The pneumonia trials were small and used several corticosteroids and dosing schedules, so they do not test oral treatment alone [14].
Moderate

Migraine returning after emergency treatment

Shown to lower headache recurrence within 72 hours of emergency migraine treatment, with 9 treated to prevent one, using one injected dose of dexamethasone.

The numbers and sources
Effect
Added to standard migraine treatment, a single dose of dexamethasone did not change pain relief at the time (difference 0.37, 95% CI -0.20 to 0.94) and lowered recurrence within 72 hours (RR 0.74, 95% CI 0.60 to 0.90), a number needed to treat of 9. Side effects were similar to placebo [15].
Population
Adults with acute migraine in 7 randomized trials [15].
Sources
[15]
Caveats
The trials gave dexamethasone by injection, not by mouth.
Moderate

Athletic performance

Shown to improve maximal and aerobic performance by a small amount in 15 small trials, with no change in anaerobic performance.

The numbers and sources
Effect
Glucocorticoids had a small effect on maximal physical performance against placebo (standardized difference 0.300, 95% CI 0.080 to 0.520). The effect was seen with oral dosing (0.361, 95% CI 0.124 to 0.598), with prolonged treatment (0.428, 95% CI 0.148 to 0.709) and for aerobic performance (0.371, 95% CI 0.173 to 0.569). Anaerobic performance and energy use during submaximal exercise did not change [16].
Population
175 subjects in 15 randomized trials [16].
Sources
[16]
Caveats
Few participants, and two studies were at high risk of bias. The authors describe the estimates as uncertain [16].

Not shown to help1

Moderate

Gout flares, compared with NSAIDs

Not shown to differ from indomethacin or naproxen in pain relief for a gout flare in two randomized trials.

The numbers and sources
Effect
In emergency departments, pain fell by about 25 mm at rest and 45 mm with activity on a 100 mm scale over 14 days on both prednisolone and indomethacin. Minor adverse events in the emergency department were less frequent on prednisolone (6% against 19%) and equal over 14 days (37% each) [7]. In primary care, pain at 90 hours had fallen 44.7 mm on prednisolone and 46.0 mm on naproxen (difference 1.3 mm, 95% CI -9.8 to 7.1), with similar adverse effects [8].
Population
416 adults with acute gout in 4 Hong Kong emergency departments, 376 completing [7]; 120 primary care patients with crystal-confirmed gout, given prednisolone 35 mg or naproxen 500 mg twice a day for 5 days [8].
Sources
[7], [8]
Caveats
Neither trial had a placebo group. In the larger trial gout was usually diagnosed on clinical criteria [7].

Doses studied

The sciatica trial gave prednisone for 15 days, 5 days each at 60 mg, 40 mg and 20 mg, 600 mg in all [9]. The gout trial gave prednisolone 35 mg a day for 5 days [8]. The rheumatoid arthritis reviews covered prednisolone at no more than 15 mg a day, and the 2-year trial used prednisone 10 mg a day [4][6]. The sore throat trials gave one dose of dexamethasone of up to 10 mg, and the COVID-19 trial gave dexamethasone 6 mg a day for up to 10 days [11][13]. COPD flare-ups were treated for a median of 14 days [3].

The fracture cohort grouped people by daily prednisolone dose: under 2.5 mg, 2.5 to 7.5 mg, and 7.5 mg or more [17]. The blood sugar trial in healthy men used prednisolone 7.5 mg or 30 mg a day for 2 weeks [18].

Risks

Reported risks14

ModerateVery common

Infections

Shown to raise infections, in 12.7% on systemic corticosteroids against 8.0% of controls across 71 trials, with no rise below 10 mg a day of prednisone.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Pooling 71 controlled trials, infectious complications occurred in 12.7% of people assigned systemic corticosteroids and 8.0% of controls (RR 1.6, 95% CI 1.3 to 1.9). The rate was not raised at a daily dose under 10 mg or a cumulative dose under 700 mg of prednisone [19]. The prednisone label states that live or live attenuated vaccines are contraindicated at immunosuppressive doses, and warns people on corticosteroids to avoid exposure to chickenpox and measles [20].
Population
2,111 people assigned systemic corticosteroids and 2,087 controls in 71 trials [19].
Sources
[19], [20]
Caveats
Published in 1989. Infection rates also rose with dose among people given placebo, which the authors attribute to the underlying illness [19].
ModerateVery common

Side effects during a short course

Shown to raise side effects during short courses, with at least one adverse event in 49.2% on 15 days of prednisone against 23.9% on placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In the sciatica trial, at least one adverse event by 3 weeks was reported by 49.2% on prednisone and 23.9% on placebo [9]. In COPD flare-ups, adverse events were more frequent on systemic corticosteroids (OR 2.33, 95% CI 1.59 to 3.43), one extra for every 6 people treated [3].
Population
269 adults with sciatica [9]; 1,787 people with COPD flare-ups in 16 studies [3].
Sources
[9], [3]
Caveats
Trials of single doses for sore throat and back pain found no clear rise in adverse events, with imprecise estimates [11][10].
ModerateVery common

High blood sugar and new diabetes

Shown to raise blood sugar, with fasting glucose rising within 2 weeks in healthy men and new diabetes in 14.7% of patients on long courses.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In healthy men, prednisolone 7.5 mg and 30 mg a day for 2 weeks raised fasting plasma glucose against placebo in a dose-dependent way, and lowered the ability of insulin to suppress glucose production by 17% and 46% [18]. In COPD flare-ups, high blood sugar was more frequent on systemic corticosteroids (OR 2.79, 95% CI 1.86 to 4.19) [3]. Among patients without diabetes given more than 20 mg a day of prednisolone equivalent for at least 4 weeks, 34 of 231 (14.7%) developed steroid-induced diabetes [21]. The prednisone label states that corticosteroids may raise blood glucose and that doses of diabetes medicines may need adjusting [20].
Population
32 healthy men aged about 22 [18]; 1,787 people in 16 COPD studies [3]; 231 patients with respiratory disease, median treatment 193 days [21].
Sources
[18], [3], [21], [20]
Caveats
The healthy-volunteer abstract reports the direction of the glucose change and not its size [18]. The diabetes figure comes from one retrospective hospital series with no comparison group [21].
LimitedVery common

Weight gain, cataracts and other effects of long-term use

Linked to weight gain in 70% of long-term users in one survey, with cataracts reported by 15% and fractures by 12%.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Among long-term users surveyed by mail, more than 90% reported at least one adverse event and 55% found at least one very bothersome. Weight gain was reported by 70%, cataracts by 15% and fractures by 12%, and every effect rose with cumulative dose [29]. The label lists posterior subcapsular cataracts, glaucoma, fluid retention, muscle weakness and loss of muscle mass among adverse reactions [20].
Population
2,446 long-term glucocorticoid users, mean dose 16 mg a day of prednisone equivalent, 38% of those mailed the survey [29].
Sources
[29], [20]
Caveats
Self-reported, with no comparison group, and 62% did not respond.
ModerateCommon

Stomach and intestinal bleeding, and use with NSAIDs

Shown to raise gastrointestinal bleeding or perforation, 2.9% against 2.0% on placebo, mainly in hospital patients. Ulcer risk was far higher with an NSAID.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Across 159 trials, gastrointestinal bleeding or perforation occurred in 2.9% on corticosteroids and 2.0% on placebo (OR 1.43, 95% CI 1.22 to 1.66). The rise was significant in hospitalized patients and not in ambulatory care, where 11 events occurred among 8,651 patients (0.13%) [24]. In a case-control study, current oral corticosteroid users who also took NSAIDs had a relative risk of peptic ulcer disease of 4.4 (95% CI 2.0 to 9.7), those not taking NSAIDs 1.1 (95% CI 0.5 to 2.1), and people on both drugs had 15 times the risk of people on neither [25]. The label states that aspirin or other NSAIDs taken with corticosteroids increase the risk of gastrointestinal side effects [20].
Population
33,253 participants in 159 trials [24]; 1,415 people hospitalized for ulcer or upper gastrointestinal bleeding and 7,063 controls in Tennessee Medicaid [25].
Sources
[24], [25], [20]
Caveats
The pooled trial rate is driven by hospital patients [24]. The NSAID finding is observational, from 1984 to 1986 [25].
ModerateHow often is not known

Fractures and bone loss

Linked to fractures that rise with dose, with hip fracture 1.61 times and spine fracture 2.60 times as frequent as in matched non-users.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Against matched controls, the relative rate during oral corticosteroid treatment was 1.33 for non-spine fracture (95% CI 1.29 to 1.38), 1.61 for hip fracture (1.47 to 1.76) and 2.60 for spine fracture (2.31 to 2.92). Hip fracture risk was 0.99 below 2.5 mg of prednisolone a day, 1.77 at 2.5 to 7.5 mg and 2.27 at 7.5 mg or more, and spine fracture risk was 1.55, 2.59 and 5.18. Risk fell toward baseline after treatment stopped [17]. In the 30 days after starting a short course, the fracture rate was higher (rate ratio 1.87, 95% CI 1.69 to 2.07) [22]. The label states that corticosteroids decrease bone formation and increase bone resorption and may lead to osteoporosis at any age [20].
Population
244,235 adult oral corticosteroid users and 244,235 matched controls in UK general practice [17]; 327,452 US adults given a short course [22].
Sources
[17], [22], [20]
Caveats
Observational. The illnesses treated with corticosteroids may themselves affect bone.
ModerateHow often is not known

Adrenal suppression

Shown to suppress the adrenal glands, with adrenal insufficiency in 1.4% of asthma patients after under 28 days of use and 27.4% after more than a year.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 74 studies of corticosteroids by any route, the share with adrenal insufficiency after use ranged by dose from 2.4% (95% CI 0.6 to 9.3) at low doses to 21.5% (95% CI 12.0 to 35.5) at high doses. In asthma patients it ranged by duration from 1.4% under 28 days to 27.4% beyond a year [23]. The prednisone label states that corticosteroids can suppress the hypothalamic-pituitary-adrenal axis, that insufficiency may follow too rapid withdrawal, and that it may persist for up to 12 months after stopping [20].
Population
3,753 participants in 74 studies [23].
Sources
[23], [20]
Caveats
The review pooled inhaled, nasal, injected and oral routes, and the abstract gives no single pooled figure for oral use. The band here is taken from the lower end of the reported range.
LimitedHow often is not known

Sepsis and blood clots after a short course

Linked to more sepsis and blood clots in the 30 days after starting a short course, with rate ratios of 5.30 and 3.33.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Within 30 days of starting a short course, rates rose for sepsis (incidence rate ratio 5.30, 95% CI 3.80 to 7.41) and venous thromboembolism (3.33, 95% CI 2.78 to 3.99), and fell back over the next 31 to 90 days. The rise held below 20 mg a day of prednisone equivalent (4.02 and 3.61). One in five adults in the insurance plan received a short course over 3 years [22].
Population
1,548,945 privately insured US adults, of whom 327,452 received a short course of oral corticosteroids [22].
Sources
[22]
Caveats
Observational. The illness that prompted the prescription, most often a respiratory infection, spinal condition or allergy, may account for part of the rise. The study gives rate ratios and no share of users affected.
LimitedHow often is not known

Heart disease, blood pressure and potassium

Linked to more cardiovascular events at 7.5 mg a day or more of prednisolone, and to more new high blood pressure as the total dose rises.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Cardiovascular events occurred at 23.9 per 1,000 person-years in glucocorticoid users and 17.0 in non-users. At 7.5 mg a day or more of prednisolone equivalent the rate was 76.5 and the adjusted relative risk 2.56 (95% CI 2.18 to 2.99) [26]. In people with chronic inflammatory diseases, new hypertension occurred at 44.4 per 1,000 person-years in periods off glucocorticoids and 55.6 at a cumulative dose of 3,055 mg or more (HR 1.30, 95% CI 1.25 to 1.35) [27]. The prednisone label states that corticosteroids can raise blood pressure, cause salt and water retention and increase potassium loss, and lists hypokalemia among adverse reactions [20].
Population
68,781 glucocorticoid users and 82,202 non-users in Scotland [26]; 71,642 people with chronic inflammatory diseases, median follow-up 6.6 years [27].
Sources
[26], [27], [20]
Caveats
Observational. The diseases treated with high doses also raise cardiovascular risk.
LimitedHow often is not known

Mood changes, mania, delirium and suicide attempts

Linked to suicide attempts, mania, delirium and depression, with hazard ratios of 6.89, 4.35, 5.14 and 1.83 against untreated people with the same illness.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Against people with the same underlying disease not given glucocorticoids, the hazard ratio was 6.89 for suicide or suicide attempt (95% CI 4.52 to 10.50), 4.35 for mania (3.67 to 5.16), 5.14 for delirium, confusion or disorientation (4.54 to 5.82), 1.83 for depression (1.72 to 1.94) and 1.45 for panic disorder. Risk was higher at higher doses and in people with a previous neuropsychiatric history. Across 786,868 courses there were 109 suicides or attempts and 10,220 severe neuropsychiatric cases [28].
Population
372,696 patients given oral glucocorticoids in primary care [28].
Sources
[28]
Caveats
Observational. The label lists psychiatric reactions among adverse effects and gives no rate [20].
LimitedHow often is not known

Raised white blood cell count

One study of 80 patients found prednisone raised the white blood cell count, in some above 20,000 per cubic millimeter, mainly through neutrophils.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 80 patients, the white blood cell count rose on prednisone, passing 20,000 per cubic millimeter as early as the first day in some, peaking within 2 weeks in most and then falling without returning to pretreatment levels. The rise was mainly in neutrophils, with fewer eosinophils and a variable fall in lymphocytes. More than 6% band forms was rare, which the authors offer as a way to tell the change from infection [30].
Population
80 patients treated with prednisone [30].
Sources
[30]
Caveats
One uncontrolled study from 1981. The abstract gives no mean change.
LimitedStudied in pregnancyHow often is not known

Use in pregnancy

Linked to oral cleft in babies exposed in the first trimester, with odds 3.35 times as high in case-control studies.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Pooling case-control studies, first-trimester exposure was associated with oral cleft (OR 3.35, 95% CI 1.97 to 5.69). For major malformations overall the pooled odds ratio from cohort studies was 1.45 (95% CI 0.80 to 2.60), and the authors' own prospective cohort found no difference [31]. The prednisone label states there are no adequate and well-controlled studies in pregnant women and that animal studies found more cleft palate [20].
Population
Pregnant women in a prospective cohort and in the cohort and case-control studies pooled with it [31].
Sources
[31], [20]
Caveats
Observational, published in 2000. The illness being treated may contribute.
LimitedStudied in childrenHow often is not known

Growth in children

The label warns that children treated with corticosteroids by any route may grow more slowly.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The prednisone label states that pediatric patients treated with corticosteroids by any route may experience a decrease in growth velocity, and that corticosteroids may inhibit bone growth [20].
Population
Children treated with corticosteroids, as described in the label [20].
Sources
[20]
Caveats
The label gives no rate and no size of effect.
LimitedHow often is not known

With blood thinners, diuretics and drugs that change liver clearance

The label warns that corticosteroids interact with warfarin, potassium-lowering diuretics, and drugs that speed or slow the CYP3A4 liver enzyme.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The prednisone label states that corticosteroids usually inhibit the response to warfarin and that clotting tests need frequent monitoring. With potassium-depleting drugs such as diuretics it calls for watching for low potassium. It states that CYP3A4 inducers such as barbiturates, phenytoin, carbamazepine and rifampin may speed corticosteroid clearance, and that inhibitors such as ketoconazole, itraconazole, ritonavir and macrolide antibiotics such as erythromycin may raise corticosteroid levels. Ketoconazole is reported to lower the clearance of some corticosteroids by up to 60% [20].
Population
People taking these drugs together, as described in the label [20].
Sources
[20]
Caveats
The label gives no rate.

Claims tested and not found

  1. That a steroid course for a herniated disk avoids surgery. Surgery rates at 52 weeks did not differ between a 15-day prednisone course and placebo in 269 adults [9], and pooled trials found no difference (RR 1.00, 95% CI 0.68 to 1.47) [10].
  2. That steroids lower deaths in COPD flare-ups. Deaths within 30 days did not differ from placebo across 12 studies with 1,319 people (OR 1.00, 95% CI 0.60 to 1.66) [3].
  3. That dexamethasone helps people hospitalized with COVID-19 who do not need oxygen. In that group 17.8% died on dexamethasone and 14.0% on usual care (rate ratio 1.19, 95% CI 0.92 to 1.55) [13].

Related

NSAIDs

Sources

  1. Rowe BH, Spooner C, Ducharme F, Bretzlaff J, Bota G. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database of Systematic Reviews. 2001. https://doi.org/10.1002/14651858.CD002178
  2. Rowe BH, Spooner C, Ducharme F, Bretzlaff J, Bota G. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database of Systematic Reviews. 2007. https://doi.org/10.1002/14651858.CD000195.pub2
  3. Walters JA, Tan DJ, White CJ, Gibson PG, Wood-Baker R, Walters EH. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.CD001288.pub4
  4. Gøtzsche PC, Johansen HK. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2005. https://doi.org/10.1002/14651858.CD000189.pub2
  5. Kirwan JR, Bijlsma JW, Boers M, Shea B. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2007. https://doi.org/10.1002/14651858.CD006356
  6. van Everdingen AA, Jacobs JW, Siewertsz van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Annals of Internal Medicine. 2002. https://doi.org/10.7326/0003-4819-136-1-200201010-00006
  7. Rainer TH, Cheng CH, Janssens HJ, et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Annals of Internal Medicine. 2016. https://doi.org/10.7326/M14-2070
  8. Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. The Lancet. 2008. https://doi.org/10.1016/S0140-6736(08)60799-0
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