Indications
Prednisolone (here in its anhydrous form, meaning the dry form without bound water) is a corticosteroid, a medicine similar to the natural hormone cortisol. It is used to calm inflammation and overactive immune responses in many conditions, including:
- Asthma attacks and chronic obstructive lung disease flare-ups
- Severe allergies and skin conditions such as eczema and urticaria
- Rheumatoid arthritis, lupus and other inflammatory joint or connective tissue diseases
- Inflammatory bowel disease such as ulcerative colitis and Crohn’s disease
- Kidney conditions such as nephrotic syndrome
- Some blood disorders and cancers, as part of specialist treatment
- Adrenal insufficiency, together with other hormone replacement
How It Works
Prednisolone enters cells and switches off many of the genes that drive inflammation. This reduces swelling, redness, pain and the activity of the immune system. It also affects how the body handles sugar, salt, water and bone.
Dosage and Administration
The dose depends on the condition and is set by a doctor. Adults are commonly given 5 mg to 60 mg a day, usually as a single morning dose taken with or after food. Short courses (for example for asthma) may be stopped as directed, but after more than about 3 weeks of use, or high doses, the dose must be reduced slowly. Never stop suddenly. Children’s doses are worked out by weight and given as prescribed.
Interactions
- Painkillers such as Ibuprofen, Diclofenac or Aspirin increase the risk of stomach ulcers and bleeding.
- Rifampicin, Carbamazepine and Phenytoin can reduce its effect.
- Ketoconazole, Clarithromycin and Ritonavir can increase its effect.
- It can raise blood sugar, so diabetes medicines may need adjusting.
- Diuretics such as Furosemide may lower potassium further.
- Live vaccines should be avoided during high-dose treatment.
- It may change the effect of Warfarin.
Contraindications
- Allergy to prednisolone or any ingredient
- Untreated serious infections, including systemic fungal infections
- Receiving live vaccines while on immune-suppressing doses
Side Effects
Short courses are usually well tolerated. Common effects include increased appetite, weight gain, indigestion, trouble sleeping, mood changes and raised blood sugar. Longer use can cause a round face, thin skin, easy bruising, acne, muscle weakness, bone thinning (osteoporosis), high blood pressure, cataract, glaucoma and a higher chance of infections.
Get urgent medical help for black or bloody stools, vomiting blood, severe stomach pain, signs of serious infection (high fever, chills), severe mood changes or confused thinking, sudden vision problems, or signs of allergy such as swelling of the face or difficulty breathing.
Pregnancy and Lactation
Prednisolone may be used in pregnancy when the benefit outweighs the risk, as decided by a doctor. Only small amounts pass into breast milk, and breastfeeding is usually possible; at high doses, the doctor may advise timing feeds away from the dose.
Precautions and Warnings
- Do not stop long-term treatment suddenly; the body may not make enough of its own steroid hormone.
- Tell your doctor if you have diabetes, high blood pressure, heart failure, stomach ulcers, osteoporosis, glaucoma, tuberculosis, mental illness or liver disease.
- Avoid contact with chickenpox or measles if you are not immune, and seek advice if exposed.
- Carry a steroid card or tell any doctor or dentist that you take this medicine.
- Long-term use needs regular checks of blood pressure, blood sugar, eyes and bones.
Overdose
A single large dose is rarely dangerous, but contact a doctor or poison centre for advice. Long-term overuse causes the side effects listed above and needs medical review.
Therapeutic Class
Corticosteroid (glucocorticoid), anti-inflammatory and immunosuppressant.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.