May 20, 2021
4 min. read

RX Deepdive: Dexamethasone vs. Prednisolone for Multiple Sclerosis


If you have multiple sclerosis, or MS, your provider may have prescribed steroids to treat episodes of new or returning symptoms, which are commonly referred to as flare-ups, relapses, exacerbations, or attacks. When steroids are prescribed they are done so in hopes of shortening the length of a flare-up, though steroids are not necessary for all types of flare-ups.

Generally, this treatment is reserved for very severe flare-ups that interfere with a patient’s ability to function in their daily life, when patients experience such symptoms as severe weakness, balance issues, and visual disturbances.

Steroid treatments are known for their potency, and can cause various side effects depending on the patient. You’ll want to talk with your provider about the pros and cons of steroid use, as well as the different types of steroids available for treatment. Read our latest blog below to get a primer on two commonly prescribed steroids, prednisone or dexamethasone, and how they are used to treat MS.

What is multiple sclerosis?

Multiple sclerosis, or MS, is a potentially disabling disease of the central nervous system, or the brain and spinal cord. In those with MS, the immune system attacks the myelin that serves as a protective sheath covering nerve fibers. This causes communication problems between the brain and the rest of the body. Eventually, the disease can cause permanent damage or deterioration of the nerves. The signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. At this time, there is no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

multiple sclerosis what is

How is MS treated?

Because there is no cure for MS, treatment usually focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary. Treatments for MS attacks include prescription corticosteroids and plasma exchange.

For treatments to modify the progression of the disease, ocrelizumab (Ocrevus) is the only FDA-approved disease-modifying therapy (DMT) for primary-progressive MS. Those who receive this treatment are slightly less likely to progress than those who are untreated. For relapsing-remitting MS, several disease-modifying therapies are available, including injectable and oral medications.

There are also various treatments available for the signs and symptoms of MS, like physical therapy, muscle relaxants, medications to reduce fatigue, medication to increase walking speed, and other medications for the treatment of things like depression or insomnia.

What is prednisone?

Prednisone is an oral medication that’s available as both a generic and brand name drug, under the names Prednisone Intensol and Rayos. This medication can be used in place of IV steroids, which is helpful especially if you’re having a mild to moderate flare-up. Prednisone can also be used to help you taper off steroids after receiving IV steroids as well.

What is dexamethasone?

Dexamethasone, unlike prednisone, can be administered both orally and via injection. The generic form of the drug is the only form that the Food and Drug Administration (FDA) has approved for the treatment of MS. For patients taking dexamethasone, taking a daily dose of 30 mg for 1 week has been shown to be effective in treating MS flare-ups. This may be followed by 4 to 12 mg every other day for as long as 1 month. Your doctor will determine the right starting dose for you.

MS treatment

What are the similarities of prednisone and dexamethasone?

Both prednisone and dexamethasone are corticosteroids, also known as glucocorticoids or steroids. They are both used for a wide variety of inflammatory conditions in many different organ systems, and work by causing metabolic effects and modifying the body’s immune response to stimuli.

What are the differences of prednisone and dexamethasone?

Dexamethasone used to be known as the brand-name drug Decadron, but that product is no longer commercially available. It is, however, available as a generic product, as a tablet, injectble, oral solution, and in ophthalmic products. It’s known as a long-acting drug and has a half-life of 36-72 hours.

Prednisone also used to be available under the brand-name Deltasone, but is now prescribed as a generic product, as a tablet and oral solution. It is known as an intermediate-acting drug with a half-life of 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.

Which is more effective?

Most studies comparing the effectiveness of prednisone and dexamethasone focused on young children with acute asthma. One particular study concluded that evidence supports the use of either drug. The review mentioned that dexamethasone may be better tolerated, but that more research is needed.

Each drug can be used to treat such a wide variety of medical conditions that it is difficult to say which drug is more effective. Your provider may choose one drug over another based on reasoning other than effectiveness. For example, 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.

To find out which will be the best drug for your treatment, work with your provider and consider your medical history and conditions, as well as other medications that could potentially interact with dexamethasone or prednisone.

Resources Mayo Clinic Healthline Single Care

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