Is it acceptable to substitute prednisolone with prednisone in patients (pts) with Acute Myeloid Leukemia (AML)?

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Last updated: May 17, 2025 • View editorial policy

From the Guidelines

Prednisone can be substituted for prednisolone in patients with acute myeloid leukemia (AML), but this substitution should be done with caution and appropriate dose adjustment, as recommended by the most recent guidelines 1. The standard conversion is 5 mg of prednisone being equivalent to 5 mg of prednisolone. However, in patients with AML who may have compromised liver function due to disease infiltration or chemotherapy effects, this conversion might be impaired. In such cases, direct administration of prednisolone is preferred as it doesn't require hepatic activation. If substitution is necessary, liver function should be monitored closely, as suggested by recent studies 1, 2. Additionally, the timing of administration should remain consistent with the original regimen, as both medications follow similar dosing schedules. The pharmacokinetic profiles are similar once prednisone is converted, with both having intermediate durations of action (12-36 hours). Both medications work by reducing inflammation and suppressing immune responses, which can be beneficial in managing complications of AML or as part of specific treatment protocols. Some key points to consider when substituting prednisone for prednisolone in AML patients include:

  • Monitoring liver function closely due to potential impairment of prednisone conversion to prednisolone
  • Maintaining consistent timing of administration with the original regimen
  • Being aware of the similar pharmacokinetic profiles and durations of action of both medications
  • Considering the potential benefits of reducing inflammation and suppressing immune responses in AML management. It's also important to note that recent advances in AML treatment have resulted in an expansion of options, including targeted therapies and low-intensity regimens, as discussed in recent guidelines 1, 2.

From the Research

Substitution of Prednisolone with Prednisone in Acute Myeloid Leukemia

  • The provided studies do not directly address the substitution of prednisolone with prednisone in patients with acute myeloid leukemia (AML) 3, 4, 5, 6, 7.
  • However, it is known that corticosteroids, such as prednisolone and prednisone, are used in the treatment of various types of leukemia, including AML 5, 6, 7.
  • The studies suggest that corticosteroids can induce differentiation and apoptosis of myeloid leukemic cells, and can also stimulate myelopoiesis 5.
  • Prednisone and prednisolone are both corticosteroids with similar mechanisms of action, but they have different potencies and pharmacokinetic profiles.
  • In the absence of direct evidence, it is unclear whether prednisone can be safely substituted for prednisolone in patients with AML, and this decision should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.

Key Considerations

  • The use of corticosteroids in AML treatment is complex and depends on various factors, including the specific subtype of AML, the patient's overall health, and the treatment goals 6, 7.
  • Differentiation syndrome, a potentially life-threatening condition, can occur in patients with AML who are treated with differentiating agents, including corticosteroids 6.
  • The management of AML requires a comprehensive approach, incorporating patient and caregiver goals of care, comorbidities, and disease characteristics 7.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.