Class Explorer · Endocrine

Systemic corticosteroids

Bind the glucocorticoid receptor and rewrite transcription across every tissue. Powerfully anti-inflammatory, and there is no such thing as an organ they miss.

Members

PrednisoneThe most useful drug on the ward, and the one that quietly does the most damage.DexamethasoneHigh potency, long duration, and almost no mineralocorticoid effect.

Also in this class: Hydrocortisone · Methylprednisolone · Budesonide. Full pages arrive as the library grows.

Compare the members

Drug	Relative potency	Duration	Where it is chosen
Prednisone	4x hydrocortisone	12 to 36 h	The default oral course
Dexamethasone	~25x hydrocortisone	36 to 72 h	Single doses, cerebral oedema, antiemesis

Prednisone

Relative potency: 4x hydrocortisone
Duration: 12 to 36 h
Where it is chosen: The default oral course

Dexamethasone

Relative potency: ~25x hydrocortisone
Duration: 36 to 72 h
Where it is chosen: Single doses, cerebral oedema, antiemesis

Shared across the class

Indications: Inflammatory and autoimmune disease · Asthma and COPD exacerbations · Adrenal insufficiency (hydrocortisone) · Antiemetic and anti-oedema roles (dexamethasone)
Adverse effects: Hyperglycemia · Insomnia, mood change, frank psychosis · Osteoporosis · Infection risk · Adrenal suppression · Skin thinning, bruising · Weight gain, Cushingoid habitus
Contraindications: Systemic fungal infection · Live vaccines at immunosuppressive doses
Monitoring: Glucose, in anyone diabetic or borderline, from the first days · Blood pressure and weight · Bone protection when the course will exceed roughly three months · Mood, especially at high dose and in the first week

What makes each agent different

Potency and duration are what separate them: dexamethasone is roughly six to seven times prednisone's glucocorticoid potency and lasts much longer, which is why it suits a single-dose antiemetic or cerebral-oedema role.
Mineralocorticoid activity falls as you move from hydrocortisone to prednisone to dexamethasone: only hydrocortisone reliably replaces both axes in adrenal insufficiency.
Budesonide has high first-pass metabolism, so it can act on gut or airway with fewer systemic effects.

Any course beyond about three weeks, or repeated short courses, means the adrenal axis is suppressed and the drug must be tapered rather than stopped.

Steroid-induced hyperglycemia is characteristically afternoon and evening: a morning-only fasting glucose can miss it entirely.

A patient on long-term steroids who becomes unwell needs more steroid, not less. Sick-day rules are part of the prescription.

Last reviewed 2026-08-16 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.