Methylprednisolone: Methylprednisolone sodium succinate for injection/Methylprednisolone

Prednisone: dehydrocortisone/prednisone/prednisone

Dexamethasone: Dexamethasone

Methylprednisolone and prednisone are intermediate-acting preparations, and dexamethasone is a long-acting preparation.

For dose conversions: Demi 0.75mg = Prednisone 5mg = Methylprednisolone 4mg = Hydrocortisone 20mg

The simple answer is that they all have side effects. All drugs have side effects. Looking at the title, the questioner should have some knowledge of these three medications, and know that all three are glucocorticoid medications, so their side effects are all glucocorticoid side effects.

In the current situation, only hydrocortisone, prednisone, prednisolone and dexamethasone tablets are available in the clinic, while hydrocortisone needs to be given twice a day for long-term treatment due to its short half-life , and dexamethasone is not suitable for long-term treatment due to its strong inhibition of HPA. The production of prednisolone in China is also very small due to technical reasons. Therefore, 90% of the tablets prescribed by domestic clinicians are prednisone. Prednisone, as we know, is an inactive precursor drug due to its ketone group at the C11 position, i.e., prednisone must be converted into prednisolone (a medium-acting glucocorticosteroid) by cholinesterase enzyme in the liver to be able to play a real role. Therefore, the in vivo pharmacokinetics of prednisone should be modeled after those of prednisolone. In addition, due to the inactivation of the hepatic first-pass effect and the bioavailability of the oral drug, the oral dose is not fully converted to prednisolone. This will not only further reduce the biotransformation of prednisolone in patients with poor hepatic function, but will also further increase the burden on the liver.

Glucocorticosteroids have no significant adverse effects when physiologic doses are applied for replacement therapy, but adverse effects mostly occur when pharmacologic doses are applied and are closely related to the course of treatment, dosage, usage, and route of administration. Common adverse reactions include the following categories: 1. Long-term use can cause the following side effects: medical Cushing's syndrome face and posture, weight gain, lower extremity swelling, purple lines, easy bleeding tendency, poor wound healing, acne, menstrual disorders, ischemic necrosis of the humerus or femoral head, osteoporosis and fracture (including vertebral compression fracture, pathological fracture of the long bones), muscle weakness, muscular atrophy, hypokalemic syndrome, Gastrointestinal irritation (nausea, vomiting), pancreatitis, peptic ulcer or perforation, growth inhibition in children, glaucoma, cataracts, benign elevated intracranial pressure syndrome, hypoglycemia and aggravation of diabetes. 　　2. Psychiatric symptoms: euphoria, agitation, delirium, restlessness, disorientation, or inhibition. Psychiatric symptoms are more likely to occur in people with chronic wasting disease and those who have had mental disorders in the past. 　　3. Complicated infection is the main adverse reaction of adrenocorticotropic hormone. Fungus, tuberculosis, staphylococcus, Aspergillus, Pseudomonas aeruginosa and various herpes viruses are the main ones. 　　4. Glucocorticoid withdrawal syndrome. Sometimes patients appear dizziness, fainting tendency, abdominal pain or back pain, low fever, loss of appetite, nausea, vomiting, muscle or joint pain, headache, fatigue, weakness after stopping the drug, after careful examination, if you can exclude adrenocortical hypoplasia and the resurgence of the original disease, then it can be considered as a glucocorticoid dependence syndrome.

(Oncology, Pharmacist Fan)

Of course they do. These three drugs all belong to glucocorticoids, and usually when we say hormones, we usually refer to these drugs. These glucocorticoids have many physiological functions, mainly anti-inflammatory, anti-shock, immunosuppressive, antitoxin and so on, and are often used in the treatment of some inflammatory diseases, autoimmune diseases, serious infections, allergic diseases and so on.

For example, in the treatment of asthma, which is an inflammatory disease within the airways, the current drug of choice is glucocorticoids, but inhaled hormones are the mainstay, not oral hormones. Here prednisone, methylprednisolone, dexamethasone are not inhaled, prednisone is oral, methylprednisolone has oral, intravenous, dexamethasone is intravenous. The usual budesonide and fluticasone are inhaled hormones, they are all in the same class of drugs, but used in different ways.

These drugs certainly have adverse reactions, they can be hormones ah, hormones are double-edged sword, the effect is very good, while the adverse effects are not small, if it is a long-term use of large doses, then the side effects will be even greater. Common adverse reactions are that they can lead to obesity, hirsuteness, acne, elevated blood sugar (even leading to diabetes), hypertension, edema, decreased blood potassium, mental excitement, peptic ulcers, osteoporosis, poor wound healing, and so on.

A few examples:

1. A diabetic patient with a wound on the foot, which itself is difficult to heal, if he is taking oral hormones at this time to treat other diseases, then these hormones (whether it is prednisone, methylprednisolone, or dexamethasone) will affect the healing of the wound, resulting in the wound on the foot being even more difficult to heal.

2, an asthma patient, if inappropriate use of oral and intravenous hormone therapy, over time, will lead to increased blood glucose, blood pressure, hirsutism, acne a lot, obesity and other adverse reactions, and even cause endocrine metabolic disorders, which are very common, and I have often seen such patients with asthma, which is deplorable. The treatment of asthma should be long-term inhaled hormones, not long-term oral or intravenous hormones, which have considerable adverse effects.

3, a rheumatoid arthritis patients, may be long-term oral prednisone treatment, prednisone anti-inflammatory effect is very good, but long-term use may lead to a lot of adverse reactions, the above adverse reactions may occur, especially osteoporosis. There was once a patient, a man in his 40s, who fractured his bone after a fall, which is a pathologic fracture, which is easy to fracture after long-term oral hormone-induced osteoporosis, or else how can a person in his 40s fracture his bone so easily.

Hormones are a double-edged sword, and patients should never use them without authorization. Especially oral prednisone, methylprednisolone these. The problem is that many ancestral recipes may be added inside the prednisone powder, the patient if you do not know, long-term oral use may lead to many adverse reactions.

Prednisone, methylprednisolone, and dexamethasone all belong to the same class of drugs, glucocorticoids (GCS). This is a class of drugs with anti-inflammatory, anti-viral, anti-shock and immunosuppressive effects.GCS mainly binds to the glucocorticoid receptor in the cytoplasm and thus exerts its physiological effects, which have inhibitory effects on many functions of the immune cells and many aspects of the immune response, with a more prominent effect on cellular immunity.

The main endogenous GCS in our body are hydrocortisone (cortisol) and cortisone (corticosterone), both of which are short-acting (biological half-life of 8-12h). Exogenous GCS include prednisone (prednisone), prednisolone (prednisolone), methylprednisolone, betamethasone, and dexamethasone. Of these, prednisone, prednisolone, and methylprednisolone are intermediate-acting (biological half-life of 18-36h), and betamethasone and dexamethasone are long-acting (biological half-life of 36-54h). Generally all the adverse effects of GCS are time and dose dependent [1], so it is better to choose short-term medication for acute diseases and long-term medication only for chronic diseases.

Long-term use should pay attention to the following adverse reactions: induce and aggravate infections (especially tuberculosis infection), cause gastrointestinal bleeding or perforation, increase blood glucose, lead to hyperlipidemia, hypertension, osteoporosis, hemorrhagic tendency, aggravate the condition of patients with hypothyroidism, and medically induced hyperadrenocorticism. Too rapid reduction or sudden discontinuation of drugs in long-term users can also lead to adrenal insufficiency or crisis, which is manifested by nausea, vomiting, fatigue, hypotension and shock, and requires prompt resuscitation. Long-term users of GCs may develop dependence on GCs, and sudden discontinuation or too rapid reduction may lead to recurrence or deterioration of the original disease, which often requires an increase in the dose of GCs, and then a gradual reduction of the dose after stabilization.

In short, try to have a short course of treatment, low doses and no braking. Patients who use hormones for more than 5-7 d should be aware of the inhibition of the hypothalamic-pituitary-adrenocortical axis and possible adverse reactions, so such drugs should be applied under the supervision of a doctor or pharmacist.

参考文献：[1] Richter A, Listing J, Schneider M, et al. Impact of treatment with biologic MARDS on the risk of sepsis or mortality after serious infection in patients with eumatoidarthritis. Ann Rheum Dis. 2016. 75(9): 1667-1673.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Prednisone, Dexamethasone. Dosage: Take the entire day's dose in the morning, once a day. Stabilization of the disease to slowly reduce the drug, can not be stopped at once. In addition to the common side effects of drug toxicityCushing's syndrome andThere are also other than hypoadrenocorticism, hyperglycemia, calcium loss, femoral head necrosis, alopecia, seborrheic dermatitis, neurodermatitis, etc., gynecomastia, feminization of masculinization and even testicular atrophy, desiccation and so on. Precocious puberty at a young age, inhibition of pituitary growth hormone secretion, dwarfism and so on. The side effects of these drugs are very large hormone drugs

All have side effects, and all three to be in the glucocorticoid class of drugs.Prednisone and methylprednisolone are medium-acting glucocorticoids and dexamethasone is a long-acting glucocorticoid.

Glucocorticoids are known to regulate the biosynthesis and metabolism of sugars, fats, and proteins, as well as suppressing the immune response, anti-inflammatory, and antiresorptive effects.

Glucocorticoids are used in the treatment of primary or secondary (pituitary) hypoadrenocorticism, mainly in physiologic doses of hydrocortisone or cortisone as supplemental or replacement therapy. It is also used for various allergic reactions such as angioedema, acute urticaria, contact dermatitis, serum sickness, anaphylaxis, severe transfusion reactions, thrombocytopenic purpura, and severe bronchial asthma.

However, the adverse effects of glucocorticoid drugs are also evident, 'full moon face, buffalo back, centripetal obesity', 'osteoporosis', 'glaucoma' and so on:

1. It will cause muscle weakness and muscle atrophy, thinning of skin, centripetal obesity, full moon face, buffalo back, sitting sores, hirsutism, swelling, hypertension, high blood pressure, high blood fat, low blood potassium and diabetes.

2. Glucocorticoids can reduce the body's defense function, long-term can induce infection or make the body potentially infected foci spread and worsen, such as viruses, fungi, tuberculosis foci.

3. It can induce or aggravate gastric and duodenal ulcers, and even bleeding and perforation.

4. Glucocorticoids can directly inhibit osteoblasts, activate osteoclasts, reduce bone production, increase bone resorption, and promote calcium and phosphorus excretion, which will lead to osteoporosis. Calcium or vitamin D can be supplemented for prevention.

5. It also causes delayed wound healing, muscle atrophy, slow growth in children, mental disorders, cataracts and glaucoma, etc., all of which require attention.

Therefore, in the glucocorticoid medication drug extra attention, according to the patient, the condition and adverse reaction characteristics to determine the preparation, dosage, method of medication and course of treatment. The body's adrenal secretion of hydrocortisone has a circadian rhythm, the highest at 8~10 am, so it is not a bad idea to use the drug at 7~8 am in the morning.