When Orapred Isn't Available, You Still Have Options

Your doctor prescribed Orapred, but you can't find it anywhere. Your pharmacy is out, the next pharmacy is out, and your child's asthma flare isn't going to wait. Sound familiar?

The good news is that Orapred isn't the only corticosteroid out there. There are several well-established alternatives that work in similar ways and may be much easier to find. The key is knowing what to ask your doctor about.

In this guide, we'll explain what Orapred is, how it works, and walk you through the most common alternatives — so you can have an informed conversation with your doctor or pharmacist.

What Is Orapred and How Does It Work?

Orapred is the brand name for Prednisolone Sodium Phosphate, a corticosteroid (commonly called a "steroid") that reduces inflammation and suppresses overactive immune responses. It comes primarily as a liquid oral solution (15 mg/5 mL), making it a go-to choice for children who can't swallow pills.

Prednisolone works by binding to glucocorticoid receptors inside your cells. This triggers a chain of events that reduces the production of inflammatory chemicals like prostaglandins, leukotrienes, and cytokines. The result is less swelling, less redness, less airway constriction, and less immune system overreaction.

Doctors prescribe it for asthma attacks, croup, severe allergies, autoimmune conditions, nephrotic syndrome, and more. For a complete overview, see our post on what Orapred is and how it's used.

Now let's look at the alternatives.

Alternative 1: Prednisone

Prednisone is the most widely prescribed oral corticosteroid in the United States and the most common alternative to Orapred. Here's what you need to know:

• How it relates to Orapred: Prednisone is actually a "prodrug" — your liver converts it into Prednisolone (the active ingredient in Orapred). So the end result in your body is essentially the same.
• Dosage forms: Prednisone comes as tablets (1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg) and as an oral solution or concentrate. The tablet form is extremely widely available.
• Cost: Generic Prednisone tablets are very affordable — often $4 to $10 for a short course at most pharmacies, including Walmart's $4 list.
• Availability: Because so many manufacturers make Prednisone tablets, it's rarely affected by shortages.
• Considerations: The main limitation is that tablets aren't ideal for young children. However, older children can sometimes take crushed tablets mixed with applesauce or a spoonful of pudding. Prednisone liquid is also available but may face similar availability issues as Prednisolone liquid.

Alternative 2: Dexamethasone

Dexamethasone is a more potent, longer-acting corticosteroid that's commonly used as a substitute for Prednisolone, especially in pediatrics.

• How it compares: Dexamethasone is about 6 to 7 times more potent than Prednisolone, milligram for milligram. This means smaller doses are needed, and a single dose can sometimes replace a multi-day course of Prednisolone.
• Dosage forms: Available as an oral solution (which is important for children), tablets, and injectable formulations.
• Common use: Dexamethasone has become a popular alternative for croup (where a single dose is often sufficient) and for short-course treatment of asthma exacerbations in children. Some studies show that a 1- to 2-day course of Dexamethasone is as effective as a 5-day course of Prednisolone for mild-to-moderate asthma flares.
• Cost: Generic Dexamethasone is affordable — typically $5 to $25 for a short course.
• Availability: Generally easier to find than Prednisolone liquid, though it can also face periodic shortages.

Alternative 3: Methylprednisolone (Medrol)

Methylprednisolone is another corticosteroid closely related to Prednisolone. The brand-name version is Medrol, and it's often dispensed as the Medrol Dosepak (a pre-packaged tapering course).

• How it compares: Methylprednisolone has slightly more anti-inflammatory potency than Prednisolone (about 1.25 times) and may cause slightly less sodium and water retention.
• Dosage forms: Tablets (4 mg, 8 mg, 16 mg, 32 mg) and injectable (Solu-Medrol). No liquid oral formulation is commercially available, which limits its use in very young children.
• Common use: Often prescribed for adults and older children with asthma exacerbations, allergic reactions, autoimmune flares, and inflammatory conditions.
• Cost: Generic Methylprednisolone tablets are affordable — about $10 to $30 for a course. The Medrol Dosepak may cost $15 to $40.
• Availability: Widely available as a generic tablet.

Alternative 4: Hydrocortisone

Hydrocortisone is a lower-potency corticosteroid that's identical to the cortisol your body naturally produces.

• How it compares: Hydrocortisone is about 4 times less potent than Prednisolone. Higher doses are needed for the same anti-inflammatory effect, which limits its use for conditions requiring strong immunosuppression.
• Dosage forms: Tablets (5 mg, 10 mg, 20 mg), injectable, and various topical formulations. Oral suspension can be compounded.
• Common use: Primarily used for adrenal insufficiency (cortisol replacement) and milder inflammatory conditions. Less commonly used as a substitute for Prednisolone in acute situations like asthma flares.
• Cost: Very affordable — generic Hydrocortisone tablets typically cost $5 to $15.
• When it might work: Your doctor might consider Hydrocortisone if you need a milder corticosteroid or for adrenal replacement therapy.

Quick Comparison Table

Here's how these alternatives stack up:

• Prednisone: Same potency as Orapred, widely available as tablets, $4-$10. Best overall substitute.
• Dexamethasone: 6-7x more potent, liquid available, $5-$25. Great for children and short courses.
• Methylprednisolone: Slightly more potent, tablets only, $10-$30. Good for adults and older children.
• Hydrocortisone: Lower potency, $5-$15. Best for adrenal replacement, less ideal for acute inflammation.

What to Ask Your Doctor

If you can't find Orapred, here's what to discuss with your provider:

1. "Can we switch to Prednisone?" — This is usually the simplest swap, especially if the patient can take tablets.
2. "Is Dexamethasone liquid available?" — Particularly relevant for young children who need a liquid formulation.
3. "What dose adjustment is needed?" — Different corticosteroids have different potencies, so the dose will change. Your doctor will calculate the equivalent dose.
4. "Should the duration of treatment change?" — For example, a shorter course of Dexamethasone may replace a longer course of Prednisolone.

Important: Never switch medications on your own. Always consult your doctor or pharmacist before taking a different corticosteroid than what was prescribed.

Still Looking for Orapred?

If you'd prefer to stick with Orapred or generic Prednisolone, use Medfinder to check which pharmacies near you have it in stock. You can also read our guide on how to find Orapred in stock near you for more tips.

Final Thoughts

Not being able to find Orapred is stressful, but you're not stuck. Prednisone, Dexamethasone, Methylprednisolone, and Hydrocortisone are all established corticosteroids that your doctor can prescribe as alternatives. The right choice depends on your specific condition, age, and whether you need a liquid formulation.

Talk to your doctor, explore your options, and know that effective treatment is still within reach — even when Orapred isn't on the shelf.