Do cortisone and prednisone do the same thing?

October 8, 2025 •

4 min read

Approximately 1% of the adult population in the UK receives oral glucocorticoid therapy at any given time. While both are corticosteroids used to reduce inflammation and suppress the immune system, the question "Do cortisone and prednisone do the same thing?" can be definitively answered: no. Their key distinctions lie in how they are activated within the body and their relative potencies.

Quick Summary

Cortisone and prednisone are both synthetic corticosteroids, but they are not identical. Both are prodrugs that require activation in the liver, where enzymes convert them into their active forms. Prednisone becomes prednisolone, a more potent and longer-acting drug, while cortisone is converted into hydrocortisone (cortisol), a weaker, shorter-acting version. The choice between them depends on the patient's condition, required potency, and liver function.

Key Points

Prodrug Activation: Both cortisone and prednisone are inactive prodrugs that must be converted by the liver into their active forms to work.
Different Active Forms: Cortisone becomes hydrocortisone (cortisol), while prednisone becomes prednisolone.
Prednisone is More Potent: Prednisone (prednisolone) is significantly more potent than cortisone (hydrocortisone).
Distinct Durations: Cortisone has a shorter biological half-life than prednisone, meaning its effects last for a shorter period.
Clinical Application Differences: The choice between them depends on the required potency and duration, with prednisone often used for systemic issues and cortisone for more localized or replacement therapy.
Liver Health is Key: Patients with impaired liver function may not effectively convert these prodrugs, potentially making prednisolone (the active form of prednisone) a more reliable alternative.
Gradual Tapering is Necessary: Due to adrenal suppression, discontinuing either medication requires a gradual tapering process under medical supervision to avoid withdrawal symptoms.

Understanding Corticosteroids: How Cortisone and Prednisone Work

Corticosteroids are a class of drugs that mimic the natural hormones produced by the adrenal glands, known as cortisol and cortisone. These powerful medications are a cornerstone of treatment for a wide range of inflammatory and autoimmune conditions, such as arthritis, asthma, lupus, and severe allergies. Although they serve a similar purpose, understanding the critical pharmacological differences between cortisone and prednisone is essential for appreciating why a doctor may prescribe one over the other.

The 'Prodrug' Difference: Activation in the Liver

The most significant distinction between cortisone and prednisone is that both are prodrugs—inactive compounds that are metabolized into their active forms within the body. This metabolic process, which primarily occurs in the liver, is where their paths diverge.

Cortisone is converted to hydrocortisone (also known as cortisol) by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Hydrocortisone is the body's primary endogenous glucocorticoid. Prednisone, on the other hand, is converted to its active metabolite, prednisolone, by a different enzymatic process, also in the liver.

The reliance on liver metabolism has important clinical implications. In patients with impaired liver function, the conversion of these prodrugs to their active forms can be inefficient. For such individuals, a doctor might choose to prescribe prednisolone directly, bypassing the need for hepatic conversion to ensure consistent therapeutic effects.

Potency and Duration of Action: Not All Steroids Are Equal

Beyond their activation pathways, cortisone and prednisone have distinct potencies and durations of action. These differences influence their clinical applications.

Steroid conversion charts indicate that different amounts of cortisone and prednisone are required to achieve an equivalent glucocorticoid effect compared to hydrocortisone. This suggests that prednisone is more potent than cortisone.

Cortisone (as active hydrocortisone): Considered a short-acting corticosteroid, with a biological half-life of 8 to 12 hours.
Prednisone (as active prednisolone): An intermediate-acting corticosteroid, with a biological half-life of 18 to 36 hours.

Clinical Applications and Side Effects

The variations in potency and duration directly affect how these drugs are used clinically. Because of its lower potency and shorter half-life, cortisone is often reserved for adrenal insufficiency (as a replacement for natural cortisol) or for local use, such as a cortisone injection into a joint to treat inflammation. However, more potent synthetic corticosteroids are frequently used for other inflammatory conditions.

Prednisone, due to its higher potency and longer-lasting effect, is more commonly prescribed orally to treat systemic inflammation and a wide array of autoimmune disorders, including rheumatoid arthritis, lupus, and inflammatory bowel disease. While the side effect profiles of these two drugs are similar because their active metabolites function similarly, the higher potency of prednisone can be associated with a greater risk of adverse effects, especially with long-term use. Side effects can include weight gain, fluid retention, mood changes, increased blood sugar, and a suppressed immune system.

Comparison Table: Cortisone vs. Prednisone


Feature	Cortisone	Prednisone
Classification	Short-acting corticosteroid	Intermediate-acting corticosteroid
Mechanism	A prodrug activated in the liver to form hydrocortisone (cortisol).	A prodrug activated in the liver to form prednisolone.
Active Metabolite	Hydrocortisone	Prednisolone
Relative Potency	Lower; different amounts are needed compared to hydrocortisone for equivalent effects.	Higher; different amounts are needed compared to hydrocortisone for equivalent effects.
Duration of Action	8–12 hours (as hydrocortisone).	18–36 hours (as prednisolone).
Common Uses	Adrenal insufficiency, intra-articular injections.	Systemic inflammation, autoimmune diseases like lupus, arthritis, and asthma.
Liver Dependence	Requires liver enzymes to become active.	Requires liver enzymes to become active.
Clinical Considerations	Achieving an equivalent systemic anti-inflammatory effect may require careful consideration of potency differences.	Higher potency requires careful consideration to manage systemic side effects.

Can they be used interchangeably?

Because of their different potencies, durations of action, and metabolic pathways, cortisone and prednisone are not used interchangeably on a one-to-one basis. A doctor will select the appropriate medication based on the specific condition, its severity, and the desired duration of effect. While both target inflammation and the immune response, the nuanced differences in their pharmacology and pharmacokinetics make them suitable for different clinical situations.

The Importance of Doctor Guidance

Ultimately, the use of either cortisone or prednisone requires careful medical supervision. Treatment plans must be customized for each patient, with gradual tapering of the dose often necessary to prevent side effects and allow the body's natural adrenal function to recover. Abruptly stopping treatment can lead to withdrawal symptoms and adrenal insufficiency. A healthcare provider's guidance is crucial for safely navigating corticosteroid therapy and ensuring the best possible outcome.

Conclusion: Similar Goals, Different Routes

To conclude, while cortisone and prednisone are both corticosteroids that aim to reduce inflammation and suppress the immune system, they do not do the same thing pharmacologically speaking. They are both inactive prodrugs that are converted into distinct active metabolites, hydrocortisone and prednisolone, respectively. These active forms differ significantly in their potency and duration of action. Prednisone is a more potent and longer-acting anti-inflammatory agent, making it suitable for a wide range of systemic conditions, while cortisone is weaker and shorter-acting, often used for localized treatment or hormone replacement. The decision to use one over the other is a careful clinical judgment based on the specific needs of the patient and their liver function. Both medications demand respect and expert guidance to minimize risks and maximize therapeutic benefits.

For more information on the pharmacology of corticosteroids and other related topics, you can visit the National Institutes of Health (NIH) website.

Frequently Asked Questions

A prodrug is an inactive medication that requires conversion by the body, typically in the liver, to become active. For cortisone and prednisone, this is crucial because it means their effectiveness depends on the liver's ability to convert them into their active forms, hydrocortisone and prednisolone, respectively.

Prednisone is stronger and more potent than cortisone.

The active form of cortisone is hydrocortisone, which is also known as cortisol, the body's natural glucocorticoid. The active form of prednisone is prednisolone.

Since both medications are activated in the liver, patients with liver disease may have trouble converting them into their active forms. In these cases, a doctor might prescribe prednisolone directly to ensure consistent drug activity and avoid reliance on liver metabolism.

No, they are different. A cortisone shot is typically a localized injection into a joint or tendon to treat inflammation in a specific area. Oral prednisone is a systemic treatment, affecting the entire body to treat more widespread inflammation or autoimmune conditions.

No, you should never stop these medications suddenly, especially after prolonged use. Abruptly stopping can cause withdrawal symptoms and lead to a potentially dangerous condition called adrenal insufficiency. Your doctor will provide a tapering schedule to gradually reduce the dose.

These medications are used for a variety of conditions, including arthritis, asthma, severe allergies, inflammatory bowel disease, lupus, multiple sclerosis, and adrenal insufficiency.