Prednisone vs. Budesonide

• Prednisone and budesonide are types of steroids used to treat Crohn’s disease and ulcerative colitis.
• Prednisone is also used to treat arthritis, asthma, bronchitis, skin problems, and allergies. It is also are commonly used to suppress the immune system and prevent the body from rejecting transplanted organs, and as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of cortisol.
• Prednisone is a corticosteroid and budesonide is a glucocorticoid.
• Brand names of prednisone include Deltasone, Rayos, and Prednisone Intensol.
• Brand names of budesonide include Entocort EC and Uceris.
• Side effects of prednisone and budesonide that are similar include fluid retention (edema), low potassium, headache, nausea, vomiting, and acne.
• Side effects of prednisone that are different from budesonide include weight gain, high blood pressure, muscle weakness, thinning skin, restlessness, and problems sleeping.
• Side effects of budesonide that are different from prednisone include upper respiratory tract infection, diarrhea, abdominal pain, back pain, dizziness, fatigue, indigestion, flatulence (gas), joint pain, constipation, bloating, urinary tract infections (UTIs), viral infections, and fatigue.
• Suddenly stopping prednisone after prolonged use may cause withdrawal symptoms including nausea, vomiting, weakness, fatigue, decreased appetite, weight loss, diarrhea, abdominal pain, and shock.

• Prednisone is a man-made corticosteroid used for suppressing the immune system and inflammation. It has effects similar to other corticosteroids such as methylprednisolone (Medrol), prednisolone (Prelone), triamcinolone (Kenacort), and dexamethasone (Decadron). These synthetic corticosteroids mimic the action of cortisol (hydrocortisone), a naturally-occurring hormone produced in the body. Corticosteroids are used for their anti-inflammatory effects to treat arthritis, ulcerative colitis, Crohn’s disease, asthma, bronchitis, skin problems, allergies, systemic lupus, and severe psoriasis.
• Budesonide is a man-made steroid of the glucocorticoid family that is used to treat mild-to-moderately-active Crohn's disease. It is also used for the induction of remission in patients with active, mild to moderate ulcerative colitis. Budesonide mimics cortisol (hydrocortisone) and has anti-inflammatory actions.

Prednisone side effects

Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible organ damage, and they occur more frequently with higher doses and more prolonged treatment.

Common side effects include:

• Retention of sodium (salt) and fluid
• Weight gain
• High blood pressure
• Loss of potassium
• Headache
• Muscle weakness
• Nausea
• Vomiting
• Acne
• Thinning skin
• Restlessness
• Problems sleeping

Serious side effects include:

• Hiccups
• Puffiness of the face (moon face)
• Growth of facial hair
• Thinning and easy bruising of the skin
• Impaired wound healing
• Glaucoma
• Cataracts
• Ulcers in the stomach and duodenum
• Worsening of diabetes
• Irregular menses
• Rounding of the upper back ("buffalo hump")
• Obesity
• Retardation of growth in children
• Convulsions
• Anaphylaxis (severe allergic reactions like hives, itching, skin rash, swollen lips/tongue/face)
• Vision changes
• Congestive heart failure
• Heart attack
• Pulmonary edema
• Syncope
• Tachycardia
• Thrombophlebitis
• Vasculitis
• Allergic dermatitis
• Low blood pressure
• Amenorrhea (lack of menstruation)
• Newly onset diabetes
• Hyperglycemia
• Hypothyroidism
• Pancreatitis
• Anemia
• Amnesia

This drug also causes psychiatric disturbances, which include:

• Depression
• Euphoria
• Insomnia
• Mood swings
• Personality changes
• Psychotic behavior

Other possible serious side effects of this drug include:

• Prednisone and diabetes: Prednisone is associated with new onset or manifestations of latent diabetes, and worsening of diabetes. Diabetics may require higher doses of diabetes medications while taking prednisone,
• Allergic reaction: Some people may develop a severe allergic reaction (anaphylaxis) to prednisone that includes swelling of the airways (angioedema) that may result in shortness of breath or airway blockage.
• Immune suppression: Prednisone suppresses the immune system and, therefore, increases the frequency or severity of infections and decreases the effectiveness of vaccines and antibiotics.
• Osteoporosis: Prednisone may cause osteoporosis that results in fractures of bones. Patients taking long-term prednisone often receive supplements of calcium and vitamin D to counteract the effects on bones. Calcium and vitamin D probably are not enough, however, and treatment with bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel) may be necessary. Calcitonin (Miacalcin) also is effective. The development of osteoporosis and the need for treatment can be monitored using bone density scans.
• Adrenal insufficiency and weaning off prednisone: Prolonged use of prednisone and other corticosteroids causes the adrenal glands to atrophy (shrink) and stop producing the body's natural corticosteroid, cortisol.
• Necrosis of hips and joints: A serious complication of long-term use of corticosteroids is aseptic necrosis of the hip joints. Aseptic necrosis is a condition in which there is death and degeneration of the hip bone. It is a painful condition that ultimately can lead to the need for surgical replacement of the hip. Aseptic necrosis also has been reported in the knee joints. The estimated incidence of aseptic necrosis among long-term users of corticosteroids is 3%-4%. Patients taking corticosteroids who develop pain in the hips or knees should report the pain to their doctors promptly.

What are the Prednisone withdrawal symptoms and signs?

Patients should be slowly weaned off prednisone. Abrupt withdrawal of prednisone after prolonged use causes side effects because the adrenal glands are unable to produce enough cortisol to compensate for the withdrawal, and symptoms of corticosteroid insufficiency (adrenal crisis) may occur. These symptoms include:

• Nausea
• Vomiting
• Weakness
• Fatigue
• Decreased appetite
• Weight loss
• Diarrhea
• Abdominal pain
• Shock

Therefore, weaning off prednisone should occur gradually so that the adrenal glands have time to recover and resume production of cortisol. Until the glands fully recover, it may be necessary to treat patients who have recently discontinued corticosteroids with a short course of corticosteroids during times of stress (infection, surgery, etc.), times when corticosteroids are particularly important to the body.

Budesonide side effects

The most common side effects of budesonide are:

• Headache
• Upper respiratory tract infection
• Nausea
• Diarrhea
• Abdominal pain
• Back pain
• Dizziness
• Fatigue
• Indigestion
• Vomiting
• Flatulence (intestinal gas, farting)
• Arthralgia
• Constipation
• Abdominal distension
• Acne
• Urinary tract infections (UTIs)
• Viral infections
• Low potassium
• Fatigue

Excessive corticosteroid use causes:

• Acne
• Easy bruising
• Moon (rounded) face
• Buffalo hump
• Excessive hair growth
• Swollen ankles

Serious side effects of budesonide include:

• Adrenal suppression
• Suppression of the immune system
• Infections
• Intracranial hypertension
• Serious allergic reactions

Prednisone dosage

The initial dosage of prednisone varies depending on the condition being treated and the age of the patient.

• It's recommended that you take this medication with food.
• The starting dose may be from 5 mg to 60 mg per day, and often is adjusted based on the response of the disease or condition being treated.
• Corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment.
• When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover.

Budesonide dosage

• The recommended dose for active Crohn's disease is 9 mg once daily in the morning for up to 8 weeks.
• The 8 week course may be repeated for recurring episodes.
• The dose for maintenance of remission is 6 mg once daily for 3 months.
• The recommended dosage for the induction of remission in adult patients with active, mild to moderate ulcerative colitis is one 9 mg extended release tablet to be taken once daily in the morning for up to 8 weeks.
• The recommended dose for the spray is 1 spray administered twice daily for 2 weeks followed by 1 spray once daily for 4 weeks.

Prednisone drug interactions

Prednisone interacts with many drugs, examples include:

• Prednisone may interact with estrogens and phenytoin (Dilantin). Estrogens may reduce the action of enzymes in the liver that break down (eliminate) the active form of prednisone, prednisolone. As a result, the levels of prednisolone in the body may increase and lead to more frequent side effects.
• Phenytoin increases the activity of enzymes in the liver that break down (eliminate) prednisone and thereby may reduce the effectiveness of prednisone. Thus, if phenytoin is being taken, an increased dose of prednisone may be required.
• The risk of hypokalemia (high potassium levels in the blood) increases when corticosteroids are combined with drugs that reduce potassium levels (for example, amphotericin B, diuretics), leading to serious side effects such as heart enlargement, heart arrhythmias and congestive heart failure.
• Corticosteroids may increase or decrease the response warfarin (Coumadin, Jantoven). Therefore, warfarin therapy should be monitored closely.
• The response to diabetes drugs may be reduced because prednisone increases blood glucose.
• Prednisone may increase the risk of tendon rupture in patients treated with fluoroquinolone type antibiotics. Examples of fluoroquinolones include ciprofloxacin (Cipro) and levofloxacin (Levaquin).
• The elderly are especially at risk and tendon rupture may occur during or after treatment with fluoroquinolones.
• Combining aspirin, ibuprofen (Motrin) or other nonsteroidal anti-inflammatory agents (NSAIDS) with corticosteroids increases the risk of stomach related side effects like ulcers.
• Barbiturates, carbamazepine, rifampin and other drugs that increase the activity of liver enzymes that breakdown prednisone may reduce blood levels of prednisone. Conversely, ketoconazole, itraconazole (Sporanox), ritonavir (Norvir), indinavir (Crixivan), macrolide antibiotics such as erythromycin, and other drugs that reduce the activity of liver enzymes that breakdown prednisone may increase blood levels of prednisone.

Budesonide drug interactions

Medicines which block the liver enzymes that break down budesonide may lead to higher blood concentrations and more side effects of budesonide. Such medications include:

• ketoconazole (Nizoral),
• fluconazole (Diflucan),
• itraconazole (Sporanox),
• clarithromycin (Biaxin),
• erythromycin,
• verapamil (for example, Calan; Isoptin; Covera HS),
• diltiazem (for example, Cardizem; Dilacor),
• ritonavir (Norvir; Kaletra),
• indinavir (Crixivan), and
• saquinavir (Invirase, Fortovase).
• Grapefruit juice has a similar effect and should not be consumed by patients taking budesonide.

Prednisone safety

• Corticosteroids cross the placenta into the fetus. Compared to other corticosteroids, however, prednisone is less likely to cross the placenta. Chronic use of corticosteroids during the first trimester of pregnancy may cause cleft palate.
• Corticosteroids are secreted in breast milk and can cause side effects in the nursing infant. Prednisone is less likely than other corticosteroids to be secreted in breast milk, but it may still pose a risk to the infant.

Budesonide safety

• There are no adequate studies in pregnant women. Budesonide should only be used in pregnant women if the benefits outweigh the unknown risk. Use of budesonide during pregnancy may suppress the adrenal glands of the infant.
• Budesonide is secreted in human breast milk. Because of the potential for adverse reactions in nursing infants from any corticosteroid, a decision should be made whether to discontinue nursing or discontinue the budesonide.