Dexamethasone vs. prednisone: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Steroid medications are used in a wide variety of emergency medical situations as well as for many other acute and chronic inflammatory conditions and disease states. Dexamethasone and prednisone are two prescription steroids that are approved by the United States Food and Drug Administration (FDA).

Both drugs are corticosteroids, also known as glucocorticoids or steroids. They are used for a wide variety of inflammatory conditions in many organ systems. Corticosteroids work by causing metabolic effects and modifying the body’s immune response to stimuli. Although dexamethasone and prednisone are both steroids, they have some differences, which we will describe below.

Comparing dexamethasone vs. prednisone

What is dexamethasone?

Dexamethasone is a corticosteroid, or steroid, medication. Although dexamethasone is usually filled as a generic drug, some brand names that contain dexamethasone include Decadron, Hemady, and TaperDex. Oral dexamethasone is available as a tablet and oral solution. It is also available as an injection and in certain ophthalmic (eye) products. Dexamethasone is known as a long-acting drug. Its half-life is 36 to 72 hours.

What is prednisone?

Prednisone is also a steroid medication. Prednisone may be referred to as Deltasone, but the brand name is no longer available. Prednisone is available as a generic product in the forms of a tablet and oral solution. Prednisone is known as an intermediate-acting drug. Its half-life is about three to four hours. Oral prednisone is most commonly prescribed as an immediate-release tablet, but there is also a delayed-release prednisone tablet called Rayos.

Dexamethasone vs prednisone: What’s the difference?
	Dexamethasone	Prednisone
Drug class	Corticosteroid (steroid), also known as a glucocorticoid	Corticosteroid (steroid), also known as a glucocorticoid
Brand/generic status	Brand and generic	Generic with delayed-release brand name available
What is the brand name?	Decadron, Hemady, TaperDex	Deltasone (no longer  commercially available), Rayos (delayed-release tablets)
What form(s) does the drug come in?	Tablet, injection, oral solution, ophthalmic drops (alone and in combination with other ingredients), ophthalmic ointments (in combination with other ingredients)	Tablet, oral solution
What is the standard dosage?	Varies by indication and response to treatment	Varies by indication and response to treatment
How long is the typical treatment?	Short-term; varies	Short-term; varies
Who typically uses the medication?	Adults, sometimes in children	Adults, sometimes in children

What are dexamethasone and prednisone used for?

Dexamethasone and prednisone have similar indications. Both medications are indicated for use in a wide variety of inflammatory conditions for various systems. 

For example, both medications may be used for allergic conditions, when conventional treatment is not effective. The allergic and dermatologic conditions that dexamethasone and prednisone may treat include acute exacerbations of asthma, atopic or contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, Stevens-Johnson syndrome, and serum sickness.

Because each category has many indications, there are too many to list. In the chart below, we will list several examples for each category. Consult your doctor for more information. Also, some doctors prescribe these medications off-label for certain uses. Off-label prescribing is when a medicine is prescribed for an indication that is not FDA-approved. For example, steroids may be prescribed for certain cancers (in combination with other drugs), nausea and vomiting caused by chemotherapy, carpal tunnel syndrome (in combination with other drugs), and exacerbations of chronic obstructive pulmonary disease (COPD). 

Dexamethasone vs. prednisone uses
Condition	Dexamethasone	Prednisone
Allergic and dermatologic conditions (acute asthma exacerbations, dermatitis, rhinitis)	Yes	Yes
Endocrine disorders (adrenocortical insufficiency—in conjunction with a mineralocorticoid drug such as fludrocortisone, congenital adrenal hyperplasia)	Yes	Yes
Gastrointestinal diseases (enteritis, ulcerative colitis)	Yes	Yes
Hematology disorders (certain types of anemia, idiopathic thrombocytopenic purpura)	Yes	Yes
Neoplastic diseases (leukemia, lymphoma)	Yes	Yes
Nervous system (acute exacerbation of multiple sclerosis, cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury)	Yes	Yes
Ophthalmic diseases (temporal arteritis, uveitis)	Yes	Yes
Renal diseases (idiopathic nephrotic syndrome, lupus)	Yes	Yes
Respiratory diseases (certain types of tuberculosis or pneumonia)	Yes	Yes
Rheumatic disorders (certain types of arthritis, lupus)	Yes	Yes

Dexamethasone vs. prednisone potency and efficacy

Studies comparing the two drugs head to head mostly looked at dexamethasone vs. prednisone in young children with croup or acute asthma. A 2006 study treated children who had mild to moderate croup with one single dose of oral dexamethasone or one dose of prednisolone (the active form of prednisone). The study found that prednisolone was less effective than dexamethasone in lowering the number of patients who returned to the hospital. 

Both a 2014 review of studies in Pediatrics and a 2017 study in The Journal of Pediatrics, concluded that two doses of dexamethasone are an effective alternative to a 5-day prednisone treatment, in children with acute asthma. 

Because each drug can be used to treat a wide variety of medical conditions, it is difficult to say which drug is more effective. Your healthcare provider may choose dexamethasone if you need something that is longer-acting and more potent, or prednisone if you need something that is shorter-acting. The best drug for you can only be determined by your healthcare provider, who can take into account your medical history and conditions, and other medications you take that could potentially interact with dexamethasone or prednisone.

Dosage

When taking steroid medication, it is important to take it exactly as directed. Often, the directions will specify that you start with a higher dose and then taper down to a lower dose. Steroids like dexamethasone or prednisone should be taken with food to reduce stomach side effects. The tables below outline standard dosages for some of the conditions that these steroids treat. More detailed information on dosing can be found for dexamethasone and prednisone on our dosing pages.  

Dexamethasone vs. prednisone dosage for adults
Condition	Dexamethasone	Prednisone
General dosage	Initial dose: 0.75 to 9 mg per day depending on the condition being treated	Initial dose: 5 mg to 60 mg per day depending on the condition being treated
Adrenal insufficiency (Addison’s disease)	0.75 to 9 mg/day, given in 2 to 4 divided doses	5 mg in the morning and 2.5 mg in the evening
Rheumatic disorders including acute gouty arthritis, ankylosing spondylitis, rheumatoid arthritis, juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)	Initially, 0.75 to 9 mg/day, given in 2 to 4 divided doses. Adjust according to patient response.	Usual dosage range is 5 to 30 mg daily
Skin conditions such as atopic dermatitis	Initially, 0.75 to 9 mg/day, given in 2 to 4 divided doses. Adjust according to patient response.	5 to 60 mg/day, given in 1 to 4 divided doses (only given when the patient does not respond to topical treatment)
Asthma exacerbation	Initially, 0.75 to 9 mg/day, given in 2 to 4 divided doses. Adjust according to patient response.	40 to 50 mg/day or 1 mg/kg/day for 5 to 7 days; (Max: 50 mg/day) for 3 to 10 days.
Multiple myeloma	20-40 mg by mouth on specified day of chemotherapy cycle	Varies (used off-label)

Sources: Dexamethasone, Prednisone

Steroid dosing for children varies by weight and the condition being treated. The healthcare provider will decide the dosage based on the condition being treated, the severity of symptoms, the child’s weight, and any other contributing factors. 

Dexamethasone vs. prednisone dosage for children
Condition	Dexamethasone	Prednisone
All conditions that respond to steroids (general dosing)	0.08-0.3 mg/kg/day divided into 2-4 doses per day	0.05–2 mg/kg/day divided into 1-4 daily doses

Note: Doses listed in the tables above are standard doses per condition. Starting and maximum doses vary by drug and indication. The tables above are not a complete list of all possible indications or doses for dexamethasone or prednisone. Your healthcare provider will determine the best dosage for you based on your health condition and response to treatment.

COVID-19 Dosage

Patients with mild to moderate COVID-19

According to the Centers for Disease Control and Prevention (CDC), systemic corticosteroids (such as dexamethasone or prednisone) are not recommended in patients with mild or moderate COVID-19 who do not require oxygen. Unless the patient requires oxygen, using a steroid does not benefit the patient and can cause serious side effects such as high blood sugar, stomach bleeding, psychosis, infections, and other long-term effects.

Patients who are already taking a corticosteroid for another indication should continue treatment under supervision of their healthcare provider. 

Patients with severe COVID-19

In patients who are hospitalized and have suspected or confirmed severe COVID-19, and are on oxygen or a ventilator, a steroid may be used if the healthcare provider determines it will be useful. If dexamethasone is used, the dose is usually 6 mg (by mouth or IV) daily. If dexamethasone is not available and prednisone is used, the dosage is usually 40 mg daily. 

Tapering regimens and withdrawal potential

When taking a steroid such as dexamethasone or prednisone, your healthcare provider will provide instructions for gradually tapering the medication over some time (depending on how long you took the medicine). Steroids must always be tapered if taken for more than a few days. If your total time taking the steroid is a week or so, you will only taper for the last few days of the week. However, if you took steroids for many months, your healthcare provider will instruct you to taper much more gradually, over several weeks or even months. This is because prednisone affects the adrenal glands, so stopping the medicine slowly allows the adrenal glands to return to their normal function. Stopping a steroid too quickly can cause withdrawal symptoms such as extreme tiredness, weakness, lightheadedness, body aches, joint pain, nausea, and appetite loss.

Side effects

When you are prescribed a steroid medication, it is important to take the medication as directed, and taper the dose as directed by your healthcare provider when instructed to do so. Below is a list of potential side effects that may occur with either dexamethasone or prednisone. This is not a full list of side effects. Consult your healthcare provider for a full list of adverse events.

Prednisone vs. dexamethasone side effects
System	Potential side effects of prednisone or dexamethasone
Allergic	Allergic reaction, anaphylaxis, angioedema
Cardiovascular	Cardiac arrest/arrhythmia, cardiac enlargement, changes in heart rate, circulatory collapse, heart failure, hypertension, edema, syncope, tachycardia, thromboembolism
Dermatologic	Acne, allergic dermatitis, dry/scaly skin, erythema (redness), impaired wound healing, increased sweating, rash
Endocrine	Decreased carbohydrate/glucose tolerance, development of cushingoid state, hyperglycemia (high blood sugar), hirsutism (excess hair growth), menstrual irregularities, suppression of growth in pediatric patients
Fluid/electrolyte disturbances	Congestive heart failure, fluid retention, potassium loss, sodium retention
Gastrointestinal	Increased appetite, nausea, pancreatitis, peptic ulcer, perforation of the small and large intestine, ulcerative esophagitis
Musculoskeletal	Loss of muscle mass, muscle weakness, osteoporosis, long bones fracture, tendon rupture, vertebral compression fractures
Neurological/psychiatric	Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuropathy, paresthesia, personality changes, vertigo
Ophthalmic	Glaucoma, cataracts, blurred vision
Other	Abnormal fat deposits, increased susceptibility to infectious diseases, hiccups, moon face, weight gain

Source: DailyMed (dexamethasone), DailyMed (prednisone) 

Interactions

Patients taking an anticoagulant, such as warfarin, should be monitored while taking steroid medication. Medications used for diabetes may need to be adjusted because steroids may affect blood glucose levels. Certain medications that are metabolized by an enzyme called CYP3A4 may affect the metabolism of the steroid, requiring dosage adjustment. This is not a full list of drug interactions. Consult your healthcare provider for a full list of drug interactions.

Dexamethasone vs. prednisone drug interactions
Drug	Drug class	Dexamethasone	Prednisone
Warfarin	Anticoagulant	Yes	Yes
Digoxin	Cardiac glycoside	Yes	Yes
Glipizide Glyburide Insulin Metformin Pioglitazone	Antidiabetic agents	Yes	Yes
Carbamazepine Phenobarbital Phenytoin Rifampin	CYP3A4 enzyme inducers	Yes	Yes
Azithromycin Erythromycin Ketoconazole	CYP3A4 enzyme inhibitors	Yes	Yes
Aspirin Ibuprofen Meloxicam Naproxen	Nonsteroidal anti-inflammatory drugs (NSAIDs)	Yes	Yes

There are also some food interactions to take note of with steroids like dexamethasone and prednisone. These steroids should not be mixed with alcohol. Combining steroid medication with alcohol can lead to a higher risk of stomach ulcers, perforation, and bleeding. 

Dexamethasone (but not prednisone) interacts with grapefruit and grapefruit juices. The combination can lead to higher levels of dexamethasone in the body, which can cause serious side effects from the steroid. Avoid grapefruit and grapefruit juice while taking dexamethasone. Check labels of any products that may contain grapefruit products, such as fruit punch. 

Warnings of dexamethasone and prednisone

Warnings of corticosteroid treatment with dexamethasone or prednisone include:

• Rarely, an allergic or anaphylactic reaction may occur. Seek emergency medical treatment if this occurs.
• The use of dexamethasone or prednisone may increase blood pressure, causing retention of sodium and water, and loss of potassium. Steroids should be used with caution in patients with heart failure, high blood pressure, and/or kidney problems.
• Steroids may cause calcium loss. This may lead to slowed growth in children and osteoporosis at any age. Use with caution.
• There is an association between steroid use and left ventricular free wall rupture after a recent myocardial infarction. Steroids should be avoided or used with extreme caution in these patients.
• Steroids can cause reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, or adrenal insufficiency, along with potential glucocorticosteroid insufficiency, after treatment. Adrenocortical insufficiency, which may persist for months after discontinuation of the steroid, may occur if steroids are stopped too quickly. The risk may be reduced by slowly tapering the steroid medication. Also, the lowest possible dose should be used.
• Because steroids suppress the immune system, patients being treated with steroids are more susceptible to infections, especially with higher doses of steroids. Steroids may exacerbate systemic fungal infections and should not be used in these cases unless needed to control a life-threatening drug reaction.
• Chickenpox and measles can be more serious or even fatal in patients who take steroids, due to a suppressed immune system. Avoid exposure to chickenpox and measles. If you are exposed, seek medical attention right away.
• Patients receiving immunosuppressive doses of steroids should not receive a live vaccine.
• Steroids may cause increased intraocular pressure, cataracts, glaucoma, and/or eye infections. Patients who develop eye symptoms, or who use steroids for more than six weeks, should see an ophthalmologist. Oral steroids should not be used to treat optic neuritis or active ocular herpes simplex.
• Steroids should be used with caution in patients with gastrointestinal conditions and/or liver problems.
• Steroids may cause mood changes, personality changes, insomnia, or psychotic manifestations. Consult your healthcare provider immediately if you notice any changes in mood or behavior.
• Follow the dosing and tapering schedule for your corticosteroid therapy. Do not discontinue steroids abruptly or without supervision from your healthcare provider.
• Steroid use in pregnancy may cause the baby to have a cleft palate or problems with growth/weight gain. Steroids should only be used in pregnancy if benefits outweigh the risks and under close supervision of the healthcare provider. If you are already taking steroid medication and find out that you are pregnant, consult your healthcare provider immediately.

Insurance coverage and cost comparison

Generic medications are more often covered by insurance, including Medicare and Medicaid. However, the cost of dexamethasone and prednisone with any insurance provider will vary. Cost factors include:

• Whether your plan’s drug formulary covers these drugs and at what tier they fall on
• Your coverage stage (whether you’ve hit your deductible yet)
• The quantity, strength, and form of medication you need
• Which pharmacy you fill your prescription at

Note for Medicare consumers: Depending on the diagnosis, Medicare coverage of these steroids may fall under Part B or Part D.

The out-of-pocket price of dexamethasone without insurance is $24 for 10, 4 mg tablets. With a SingleCare coupon, dexamethasone costs less than $2 for 10, 4 mg tablets at participating pharmacies.

The out-of-pocket price of prednisone without insurance is $14 for 10, 20 mg tablets. Use a SingleCare coupon to get prednisone for $1 for 10, 20 mg tablets.

RELATED: Get the SingleCare prescription discount card

Dexamethasone vs. prednisone costs
	Dexamethasone	Prednisone
Cost without insurance	$24 per 10, 4 mg tablets of generic dexamethasone	$14 per 10, 20 mg tablets  of generic prednisone
SingleCare cost	$2 for 10, 4 mg tablets of generic dexamethasone	$1 for 10, 20 mg tablets of generic prednisone
SingleCare coupons	Dexamethasone coupons	Prednisone coupons

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices.

Frequently asked questions about dexamethasone vs. prednisone

What are corticosteroids? 

Corticosteroids, also known as steroids, are used for various conditions that cause inflammation. Steroids work by reducing inflammation and decreasing immune system activity. 

Are corticosteroids dangerous?

Like any type of drug, corticosteroids can have many side effects. Some side effects are common, such as stomach pain and headache. Others can be very serious, and not as common, especially when the steroid is taken for a long period of time. Your healthcare provider will tell you how to take the steroid, and how to taper off of the medication, without abruptly stopping it. 

When you hear about people misusing steroids, the steroids in question are not corticosteroids. They are anabolic steroids. While corticosteroids are used for inflammatory conditions, anabolic steroids are related to testosterone. While they can be prescribed for legitimate uses, some athletes and bodybuilders misuse anabolic steroids to try to improve their performance or appearance.

Are dexamethasone and prednisone the same?

Although they are similar, they are not exactly the same. The information above is a helpful comparison between the two drugs. Other steroid drugs you may have heard of include methylprednisolone, prednisolone, and hydrocortisone.

Are prednisone and Decadron the same?

Decadron is the brand name for dexamethasone and is the same drug as dexamethasone. However, prednisone and Decadron are not the same. Prednisone’s former brand-name version Deltasone sounds a bit similar to Decadron. Both are steroids, used in a variety of inflammatory and/or autoimmune conditions, but prednisone and Decadron have some differences, as outlined above. For example, Decadron is more potent and longer-acting than prednisone.

Is dexamethasone or prednisone better?

There is not much data comparing the two drugs directly. One review of studies concluded that either drug is acceptable for the treatment of children with acute exacerbation of asthma who were treated in the emergency department. Because there are so many different indications for the use of a steroid medication, your healthcare provider will take into account the condition being treated along with your medical history and other medications you take, when deciding which medication is better for you.

Dexamethasone vs. prednisone for COVID: Which is better?

When treatment with a steroid is needed for severe cases of COVID-19 requiring oxygen or ventilation, dexamethasone is the preferred steroid. NIH guidelines state that when dexamethasone is not available, an alternative steroid such as prednisone can be used instead. 

Which is better for asthma: prednisone or dexamethasone?

Studies that looked at steroids for asthma concluded that either steroid is effective. 

Is dexamethasone safer than prednisone?

All steroids come with the risk of side effects (see Warnings section), and some can be very serious. Your healthcare provider will decide which medication is safer for you and prescribe the shortest course of treatment possible. Often, you will taper off the steroid so that you do not stop suddenly. This helps your adrenal glands return to normal function.

Can I use dexamethasone or prednisone while pregnant or breastfeeding?

Corticosteroids such as dexamethasone or prednisone have been shown to harm the fetus in many species when given in doses equivalent to the dose a human would take, causing an increased incidence of cleft palate in the animal offspring. Steroids may also cause growth restriction and decreased birth weight. There have been no adequate, well-controlled studies of dexamethasone or prednisone in pregnant women. Therefore, dexamethasone or prednisone should be used in pregnancy only if the benefit outweighs the risk to the fetus, and under close supervision of the healthcare provider. Infants born to mothers who have received high doses of steroids during pregnancy should be observed for signs of hypoadrenalism.

Dexamethasone is not recommended for use in breastfeeding women due to lack of data. Prednisone may be used during breastfeeding if approved by the healthcare provider. Women who take more than 20 mg of prednisone per day may be advised to wait at least 4 hours after taking the medication, to breastfeed. 

Women who are pregnant, planning to become pregnant, or breastfeeding, should always consult their healthcare provider before taking any medication. 

Can I use dexamethasone or prednisone with alcohol?

Generally, alcohol should not be mixed with steroids. Consult your healthcare provider for medical advice.

Is dexamethasone a strong steroid?

Dexamethasone is long-acting medication and is considered to be a potent, or strong, steroid. It is 6 times more potent (strong) than prednisone. 

Can prednisone get you high? Is it addictive?

Corticosteroids like prednisone and dexamethasone are not controlled substances, and are generally not associated with abuse and dependence. Some people may experience euphoria (feeling intensely happy or excited) from corticosteroids, so they may misuse the medication to try to get this effect. However, in most cases, this is not an issue.

How quickly does dexamethasone work?

It depends on how the medication is administered. Given by injection, dexamethasone will begin working quickly. Oral dexamethasone may start working in  one hour (or up to several hours). Prednisone taken by mouth also takes about one or two hours to work. 

Can you switch from prednisone to dexamethasone?

It depends on the reason. If you are allergic to one corticosteroid, you will likely be allergic to another steroid. However, if for example, one steroid is not effective, and your healthcare provider wants you to try a different steroid, they can decide if that is the best option.