Deltasone® / Rayos®
Prednisone
Version 2025-04 · Last reviewed April 1, 2025 · Methodology
List Price
$30
With Insurance
$4-15
Supplement Questions
How It Works
Prednisone is a prodrug — the liver converts it to prednisolone, the active form. Prednisolone (and all glucocorticoids) works by entering cells and binding to the glucocorticoid receptor (GR). The glucocorticoid-receptor complex then moves to the cell nucleus and powerfully suppresses the genes that produce inflammatory mediators: cytokines, prostaglandins, and leukotrienes. This is why it works so rapidly and broadly across virtually every inflammatory condition — but also why it has widespread metabolic and systemic effects.
Why the side effects happen
The metabolic side effects of prednisone — blood sugar elevation, fat redistribution, weight gain, bone loss — are not accidental. They are direct consequences of glucocorticoid receptor activation in metabolic tissues. The glucose elevation is essentially the same mechanism as Cushing's syndrome (the disease caused by excess cortisol). Short courses carry these risks transiently; long-term use produces cumulative harm proportional to dose and duration. The adrenal suppression risk is why tapering is critical — stopping abruptly can leave the body without any cortisol at a time of physiological stress.
When Will I Feel It?
Anti-inflammatory effects begin within hours. Blood sugar elevation begins with the first dose. Some effects accumulate over weeks to months of use.
Anti-inflammatory effect begins within 2-6 hours. Blood glucose rises substantially — often peaking in the afternoon and evening (not fasting morning glucose, which is why steroid-induced hyperglycemia is frequently missed). Sleep disruption and increased energy/appetite begin.
Full anti-inflammatory effect established. Blood glucose elevation continues. Fluid retention may produce visible swelling and weight gain. Mood changes (euphoria, irritability) common.
For short courses ending here: adrenal suppression and bone loss are limited but possible. For ongoing courses: metabolic effects (weight, glucose, blood pressure) continue accumulating.
Significant bone density loss documented at this stage — bisphosphonate consideration warranted. Cushingoid fat redistribution (moon face, central obesity) becomes visible. Adrenal suppression increasingly significant.
Adherence Note
Taking prednisone in the morning aligns with the body's natural cortisol rhythm and reduces sleep disruption. Blood glucose monitoring should occur in the afternoon (2-4 hours after the dose) — not fasting — to capture when elevation is most pronounced. Research and clinical guidelines document that missing doses or changing the dose after extended use requires medical coordination, as abrupt changes carry risk of adrenal insufficiency.
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Common Side Effects
While taking this medication, you may experience the following common side effects. We've included tips on how to manage them.
Elevated blood glucose
20-50%Blood sugar rises within hours of the first dose. Diabetics must monitor more frequently and may need medication adjustment. Even non-diabetics can experience significant glucose elevation.
Increased appetite / weight gain
30-50%Prednisone stimulates appetite through direct CNS effects and shifts fat storage toward the abdomen and face (cushingoid distribution). This is a pharmacological effect — not a behavioral one.
Insomnia / sleep disruption
30%Take prednisone in the morning with food to reduce nighttime stimulation. Discuss melatonin or sleep hygiene strategies with your provider if needed.
Mood changes / irritability / euphoria
20-30%Corticosteroids directly affect mood — ranging from irritability to euphoria to, at high doses, psychiatric symptoms. Tell your provider if mood changes are significant.
Fluid retention / swelling
20%Prednisone causes sodium and water retention. Reducing sodium intake during steroid courses may help minimize swelling.
Increased blood pressure
15-20%Related to sodium retention and vascular effects. Monitor blood pressure during steroid courses, especially with existing hypertension.
Heartburn / GI irritation
15%Always take prednisone with food. A PPI (omeprazole) is often prescribed alongside for courses >2 weeks or if NSAIDs are also being used.
Muscle weakness (myopathy)
5-10% with long-term useCorticosteroid myopathy affects proximal muscles (thighs, shoulders) and is dose- and duration-dependent. Resistance training may partially mitigate.
Acne / skin thinning
10%Dose-dependent; usually resolves after stopping. Skin thinning with long-term use is more persistent.
Bone loss (osteoporosis)
Significant with >3 months useGlucocorticoid-induced osteoporosis is one of the leading causes of medication-related fracture. Calcium, vitamin D, and weight-bearing exercise are important; bisphosphonates may be added for long-term courses.
Serious Adverse Effects
- • Adrenal insufficiency on abrupt discontinuation (potentially life-threatening)
- • Avascular necrosis (bone death, particularly at the hip) — associated with longer-term courses
- • Severe infections — prednisone suppresses immune function; infections can be masked and progress rapidly
- • Cataracts and glaucoma — with prolonged use
- • Psychiatric symptoms (steroid psychosis) — at high doses
- • Osteoporotic fractures — with chronic use
- • Hyperglycemia-induced diabetic ketoacidosis in predisposed patients
Drug Interactions
Major Interactions (Avoid)
Moderate Interactions (Caution)
Food Interactions
When to Contact Your Doctor
This medication requires ongoing medical supervision. The following situations warrant a prompt conversation with your prescribing physician — do not wait for your next scheduled appointment.
Contact soon if you notice
- Adrenal insufficiency on abrupt discontinuation (potentially life-threatening)
- Avascular necrosis (bone death, particularly at the hip) — associated with longer-term courses
- Severe infections — prednisone suppresses immune function; infections can be masked and progress rapidly
- Cataracts and glaucoma — with prolonged use
- Profound, unusual fatigue or weakness
Also discuss if you want to
- Review whether this medication is still appropriate for you
- Consider dosage adjustments based on response
- Explore lifestyle or non-drug alternatives
- Understand stopping or tapering options
- Plan monitoring labs and follow-up
In the US, call 911 or go to the nearest emergency room for severe symptoms. Poison Control: 1-800-222-1222.
Special Populations
Safety classifications for specific groups — discuss with your provider before use.
Prednisone is used in pregnancy for specific conditions (severe asthma, lupus flares, hyperemesis) when benefit outweighs risk. Associated with cleft palate risk in first trimester at high doses and with premature birth. Monitor closely.
Low-dose prednisone (≤20mg/day) is generally considered compatible with breastfeeding; waiting 4 hours after a dose further reduces infant exposure.
Estrogen loss at menopause already increases bone loss, central fat deposition, and insulin resistance. Prednisone amplifies all three of these effects. Even short courses of prednisone carry greater metabolic consequence in postmenopausal women, particularly regarding bone density and blood glucose. Discuss calcium, vitamin D, and blood glucose monitoring with your provider before and during any steroid course.
Prednisone suppresses growth in children with extended use — even at relatively low doses. Use the shortest course at the lowest effective dose.
Older adults are at significantly higher risk of steroid-related complications: osteoporosis, glucose dysregulation, delirium, tendon rupture, and falls. Any prednisone course in an older patient warrants careful monitoring.
Fluid retention from prednisone may worsen existing kidney disease and hypertension. Monitor kidney function and blood pressure during courses.
FDA Adverse Event Reports
Patient-filed reports from the FDA FAERS database · refreshed daily
Community Reports
User-reported experiences — anonymous & anecdotal
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Metabolic & Lifestyle Alternatives
Supporting Metabolic Health During and After Prednisone Use
Prednisone is often necessary and there is no direct substitute for its anti-inflammatory effect. However, specific nutritional and lifestyle strategies may help mitigate its metabolic consequences during a course — and are important to discuss with your provider.
Important context: Evidence quality varies across these approaches. Some are well-studied with randomized controlled trial data; others are based on observational or smaller studies. These interventions are not guaranteed to replace medication for all patients. Discuss with your doctor whether any of these are appropriate for your clinical situation.
Low-glycemic / low-carbohydrate diet during course
Prednisone raises blood glucose by stimulating hepatic gluconeogenesis and reducing insulin sensitivity. Limiting refined carbohydrate and sugar intake during a steroid course may reduce the degree of blood glucose elevation.
No large RCTs specific to steroid-induced hyperglycemia and diet, but the mechanism is well-understood and low-carb approaches are commonly recommended by endocrinologists during steroid courses
Calcium (1000-1200mg/day) + Vitamin D3 (1500-2000 IU/day)
Prednisone reduces calcium absorption and increases bone resorption. Calcium and D3 supplementation is a standard recommendation during any steroid course to partially mitigate bone loss.
ACR guidelines recommend calcium and vitamin D for any patient on ≥5mg prednisone/day for ≥3 months
Resistance training
Prednisone causes glucocorticoid myopathy — muscle breakdown, particularly in proximal muscles. Weight-bearing exercise and resistance training are protective of bone density and muscle mass during steroid use.
Exercise is protective against glucocorticoid-induced osteoporosis and myopathy; study data generally come from long-term steroid users in RA and transplant populations
Blood glucose monitoring
StrongNot a treatment, but critical patient education: checking blood sugar during prednisone courses allows early detection of steroid-induced hyperglycemia before it becomes severe. Even non-diabetics may develop significant glucose elevation.
Steroid-induced hyperglycemia is underdiagnosed and undertreated in hospital and outpatient settings; monitoring allows appropriate intervention
Key Studies
How It Compares
Prednisone is the most commonly used oral glucocorticoid. It is a prodrug converted to prednisolone in the liver. Other glucocorticoids differ in potency, duration of action, and mineralocorticoid (sodium-retaining) activity.
Strengths
- Extraordinarily rapid and broad anti-inflammatory efficacy — unmatched for acute severe inflammation
- Inexpensive generic — available in every pharmacy worldwide
- Flexible oral dosing allows precise titration
- Well-understood pharmacology from 70 years of clinical use
- Effective for dozens of conditions across specialties
Weaknesses
- Extensive metabolic side effect profile with even short courses
- HPA axis suppression requires careful tapering — abrupt discontinuation can be life-threatening
- Immunosuppression increases infection risk — and masks fever/signs of infection
- Bone loss is dose- and duration-dependent; significant with any course > 3 months
- Blood glucose elevation significant and rapid — requires monitoring in diabetics
- Long-term use produces Cushing's syndrome-like picture
Clinically Preferred Alternatives
Global Prescribing & Pricing
Corticosteroids are among the most universally used drug classes globally; prescribing culture varies but the drug itself is universally accessible as a generic
United States
$10–25/mo
Frequently prescribed for short courses — dental, sinus, back pain, poison ivy. Long-term use with biologics increasingly scrutinized.
No specific restrictions; steroid-sparing strategies now emphasized in most major disease guidelines
Covered universally as generic
United Kingdom
~$2–5/mo
NICE guidelines emphasize short course use; steroid cards issued for patients on long-term steroids to prevent adrenal crisis
NHS requires steroid alert cards for patients on prolonged corticosteroid therapy
Covered by NHS
Germany
~$3–8/mo
Similar prescribing culture; emphasis on documenting cumulative corticosteroid exposure and bone protection
German guidelines recommend bone protection (calcium, D3, bisphosphonates) concurrent with long-term steroid courses
Covered by GKV
Japan
~$3–10/mo
High prevalence of glucocorticoid use in Japan for rheumatic conditions; close monitoring standard practice
Japanese guidelines have established strict protocols for glucocorticoid-induced osteoporosis prevention
Covered by JHIS
Brazil
~$1–5/mo
Widely used; some concern about over-the-counter availability in informal markets
Prescription required but availability varies; misuse including athletic use is documented
Covered by SUS for indicated conditions
The UK's practice of issuing steroid alert cards — and the associated patient and provider awareness about adrenal crisis risk from abrupt discontinuation — represents a clear patient safety advance. Most US patients finish a prednisone burst pack with no understanding that their adrenal glands may have been suppressed, and no guidance on warning signs of adrenal insufficiency.
Clinical Trials & Funding
Understanding who funds research helps contextualize results. Industry-funded trials are not automatically invalid — they undergo the same FDA review — but declared conflicts and sponsor effects are worth knowing. All linked trials can be verified on ClinicalTrials.gov.
Funding Sources
Prednisone itself is a 70-year-old, off-patent drug — there is no manufacturer incentive to fund large new prednisone trials. Most prescribing norms come from studies of the conditions being treated (lupus, RA, asthma, IBD) funded by disease-specific foundations, NIH, and pharmaceutical companies with competing newer immunosuppressants. The delayed-release formulation (Rayos) was developed by Horizon Therapeutics with the primary commercial goal of extending the market — the clinical differentiation from generic prednisone is modest.
Declared Conflicts of Interest
While prednisone itself has no promotional conflict of interest, the culture of corticosteroid prescribing has been influenced by pharmaceutical industry promotion of conditions where prednisone is first-line. Biologic manufacturers (Humira, Enbrel) have a financial interest in demonstrating prednisone's side effect burden to support switching to biologics — creating an incentive on both sides.
Key Efficacy Results
Effective at rapidly reducing inflammation across many conditions. Short courses (< 3 weeks) carry lower systemic risk than long-term use. Even short courses can suppress adrenal function in some patients. Long-term use carries substantial cumulative risk for metabolic, bone, and immune complications.
Referenced Studies
Each study carries a Cochrane RoB-2 risk-of-bias badge — tap the badge for details.
Evidence & Transparency
Cochrane RoB-2 (Risk of Bias)
Badges reflect an editorial assessment using Cochrane's RoB-2 tool domains: randomization, intervention deviation, missing data, outcome measurement, and selective reporting. These are not certified Cochrane reviews. Learn more ↗
CMS Open Payments
Manufacturer payment disclosures are reported via the CMS Sunshine Act. Disclosure is legally required and does not imply bias or misconduct. Language uses "may," "suggests," or "appears" — never definitive clinical claims. CMS Open Payments ↗
Live Clinical Trials
Live from ClinicalTrials.gov · refreshed every 4 hours
Currently enrolling, active, and recently completed studies involving Prednisone. Data is pulled directly from the U.S. National Library of Medicine.
Recent Research
Live from PubMed · peer-reviewed literature · refreshed every 4 hours
Most recently indexed clinical trials and systematic reviews mentioning Prednisone in PubMed.
Source Documentation
Structured citations for referenced clinical trials
Each referenced trial is listed with its registry ID, funding source, and bias assessment. Use the copy button to generate a formatted citation.
| Trial | Registry ID | Cite |
|---|---|---|
| Early RA: Prednisone Disease Modification (Lancet 1995) | PMID:3887627 | |
| HPA Axis Suppression with Short Courses | PMID:11687956 | |
| Corticosteroids & Fracture Risk Meta-analysis | PMID:23669244 |
Bias ratings use Cochrane RoB-2 methodology. Editorial assessment — not a certified Cochrane review.
Our MethodologyMedical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Stopping This Medication Safely
Exogenous prednisone suppresses the adrenal gland's own cortisol production through negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis. Stopping abruptly after any course longer than approximately 3 weeks leaves the body without adequate cortisol — potentially causing adrenal crisis, which can be life-threatening. Even short "dose pack" courses have been associated with HPA suppression in susceptible individuals.
What Published Research Shows About Stopping This Medication
This summarizes what published research documents — it is not personal medical advice. Any changes to your medication require discussion with your prescribing physician.
- ·Research documents that abrupt discontinuation after any course exceeding 2-3 weeks carries risk of adrenal insufficiency — medical guidance for stopping is consistently supported
- ·For short courses (< 2 weeks at moderate doses), published guidance describes stepping down within the pack as usually sufficient; monitoring for fatigue and weakness is recommended
- ·For longer courses, published protocols describe reducing by 1-2.5mg every 1-2 weeks, with slower reductions for longer courses or higher starting doses
- ·Research suggests blood glucose monitoring is useful during stopping — rapidly falling glucose levels can indicate adrenal recovery
- ·Morning cortisol testing 4-6 weeks after stopping is documented as a method to confirm HPA axis recovery in high-risk patients
Warning Symptoms — Contact Your Doctor If You Experience:
- Profound, unusual fatigue or weakness
- Nausea, vomiting, or abdominal pain without other explanation
- Dizziness or fainting (low blood pressure)
- Fever unexplained by infection
- Severe muscle or joint pain — inflammatory condition may also be returning
Never change or stop a medication without consulting your prescribing physician.
Questions for Your Doctor
Questions to Ask
- 1.What is the specific condition being treated, and how long do I realistically need this medication?
- 2.Is there a steroid-sparing agent that could reduce how much prednisone I need long-term?
- 3.Should I be monitoring my blood sugar during this course — especially if I am diabetic or pre-diabetic?
- 4.What bone protection measures should I take if this is going to be more than 3 weeks?
- 5.What are the signs of adrenal insufficiency, and do I need a steroid alert card?
Lab Tests to Request
- Fasting blood glucose (before and during course)
- Bone density scan (DEXA) if long-term use anticipated
- Blood pressure monitoring
- Calcium and Vitamin D levels
- Morning cortisol (if stopping after extended use — to assess adrenal recovery)
- Eye pressure check (tonometry) for long-term users due to glaucoma risk
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Frequently Asked Questions About Deltasone® / Rayos®
- What is Deltasone® / Rayos® used for?
- Deltasone® / Rayos® (Prednisone) is a Corticosteroid / Glucocorticoid manufactured by Various Generic / Horizon Therapeutics (Rayos). FDA-approved indications include: Inflammatory conditions (RA, lupus, IBD, asthma); Allergic reactions and anaphylaxis; Skin conditions (eczema, psoriasis flares); Organ transplant rejection prevention; Adrenal insufficiency (physiologic replacement); COPD exacerbations; Certain cancers (in combination regimens).
- What are the common side effects of Deltasone® / Rayos®?
- Common side effects of Deltasone® / Rayos® include: Elevated blood glucose (20-50%); Increased appetite / weight gain (30-50%); Insomnia / sleep disruption (30%); Mood changes / irritability / euphoria (20-30%); Fluid retention / swelling (20%).
- How much does Deltasone® / Rayos® cost?
- Deltasone® / Rayos® list price is approximately $30. With insurance it typically costs $4-15; without insurance approximately $10-25.
- Who funded the clinical trials for Deltasone® / Rayos®?
- Prednisone itself is a 70-year-old, off-patent drug — there is no manufacturer incentive to fund large new prednisone trials. Most prescribing norms come from studies of the conditions being treated (lupus, RA, asthma, IBD) funded by disease-specific foundations, NIH, and pharmaceutical companies with competing newer immunosuppressants. The delayed-release formulation (Rayos) was developed by Horizon Therapeutics with the primary commercial goal of extending the market — the clinical differentiation from generic prednisone is modest.
- How strong is the clinical evidence for Deltasone® / Rayos®?
- Key studies: Multiple disease-specific RCTs; no single landmark trial — prednisone is used across dozens of conditions. Effective at rapidly reducing inflammation across many conditions. Short courses (< 3 weeks) carry lower systemic risk than long-term use. Even short courses can suppress adrenal function in some patients. Long-term use carries substantial cumulative risk for metabolic, bone, and immune complications. Potential conflicts of interest: While prednisone itself has no promotional conflict of interest, the culture of corticosteroid prescribing has been influenced by pharmaceutical industry promotion of conditions where prednisone is fi.
- Are there non-drug alternatives to Deltasone® / Rayos®?
- Prednisone is often necessary and there is no direct substitute for its anti-inflammatory effect. However, specific nutritional and lifestyle strategies may help mitigate its metabolic consequences during a course — and are important to discuss with your provider. See the Alternatives tab for full details.
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