Prednisolone is a synthetic glucocorticoid medication renowned for its potent anti-inflammatory and immunosuppressive properties. As a cornerstone therapy in managing numerous acute and chronic conditions, it mimics the action of cortisol, the body’s natural steroid hormone, but with enhanced therapeutic effects. This corticosteroid is widely prescribed across medical specialties, including rheumatology, pulmonology, dermatology, and hematology, due to its ability to rapidly control inflammation and modulate immune responses. Available in multiple formulations such as oral tablets, liquid solutions, and injectables, prednisolone offers flexibility in administration tailored to clinical needs and patient-specific factors.

Features

• Synthetic glucocorticoid with high anti-inflammatory potency
• Available in oral tablets (1mg, 5mg, 20mg), liquid solution, and injectable forms
• Rapid onset of action with predictable pharmacokinetics
• Demonstrated efficacy across a broad spectrum of inflammatory and autoimmune disorders
• Multiple strength options allow for precise dosing titration

Benefits

• Rapid reduction of inflammation and associated pain, swelling, and redness
• Effective suppression of inappropriate immune responses in autoimmune diseases
• Prevention of tissue damage in chronic inflammatory conditions
• Improvement in respiratory function in asthma and COPD exacerbations
• Management of acute allergic reactions and dermatological conditions
• Supportive care in certain hematologic malignancies and transplant rejection prophylaxis

Common use

Prednisolone is indicated for a wide range of medical conditions characterized by excessive inflammation or aberrant immune activity. In rheumatology, it is fundamental in managing rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Pulmonologists utilize it for severe asthma exacerbations, COPD flare-ups, and sarcoidosis. Dermatologists prescribe it for conditions such as severe psoriasis, allergic contact dermatitis, and pemphigus vulgaris. Additionally, it serves crucial roles in managing inflammatory bowel disease, certain types of cancer (particularly hematologic malignancies), adrenal insufficiency, and prevention of organ transplant rejection. Its use extends to ophthalmology for inflammatory eye conditions and to nephrology for certain glomerular diseases.

Dosage and direction

Dosage must be individualized based on the condition being treated, disease severity, patient response, and concomitant medications. For anti-inflammatory effects, typical adult doses range from 5-60mg daily, often administered as a single morning dose to mimic natural cortisol rhythm. Higher doses may be required for acute exacerbations or severe conditions. Pediatric dosing is weight-based, typically 0.14-2mg/kg/day divided into 2-4 doses. Always take with food or milk to minimize gastrointestinal irritation. Do not crush or chew delayed-release formulations. For patients on long-term therapy, gradual tapering is essential to avoid adrenal insufficiency; never discontinue abruptly. Follow specific tapering schedules provided by your healthcare provider, which may extend over weeks to months depending on treatment duration and dosage.

Precautions

Patients requiring prednisolone therapy require careful monitoring and specific precautions. Regular assessment of blood pressure, blood glucose, electrolytes, and weight is essential. Those with diabetes may require antidiabetic medication adjustments due to prednisolone’s hyperglycemic effects. Monitor for signs of infection, as immunosuppression may mask typical symptoms. Patients should receive education about adrenal suppression and carry steroid identification cards. Ophthalmologic examinations are recommended for those on prolonged therapy to monitor for cataracts and glaucoma. Bone density monitoring is advised for long-term users, with consideration for calcium and vitamin D supplementation. Special caution is required in elderly patients due to increased risk of hypertension, diabetes, and osteoporosis.

Contraindications

Prednisolone is contraindicated in patients with known hypersensitivity to prednisolone or any component of the formulation. Systemic fungal infections represent an absolute contraindication unless used for life-threatening conditions with appropriate antifungal coverage. Live virus vaccinations are contraindicated during therapy due to impaired immune response. Additional contraindications include active peptic ulcer disease, recent intestinal anastomoses, and uncontrolled psychiatric conditions. Relative contraindications require careful risk-benefit assessment and include congestive heart failure, hypertension, diabetes mellitus, osteoporosis, glaucoma, and renal insufficiency.

Possible side effect

Common side effects include fluid retention, weight gain, increased appetite, mood changes, insomnia, and gastrointestinal discomfort. More significant adverse effects may include hypertension, hyperglycemia, increased susceptibility to infections, osteoporosis, avascular necrosis, adrenal suppression, Cushingoid appearance, skin thinning, easy bruising, and delayed wound healing. Ophthalmologic effects can include cataracts, glaucoma, and increased intraocular pressure. Psychiatric effects range from euphoria and mood swings to severe depression or psychosis. Electrolyte imbalances, particularly hypokalemia, may occur. Long-term use increases risk of these effects, necessitating regular monitoring and preventive measures.

Drug interaction

Prednisolone interacts significantly with numerous medications. CYP3A4 inducers such as phenytoin, rifampin, and carbamazepine may decrease prednisolone efficacy, while inhibitors like ketoconazole may increase levels and toxicity. Concurrent use with NSAIDs increases risk of gastrointestinal ulceration. Diuretics may exacerbate electrolyte imbalances, particularly hypokalemia. Anticoagulant effects may be altered, requiring closer monitoring. Live vaccines may have reduced efficacy and increased risk of complications. Insulin and oral hypoglycemics may require dosage adjustments due to prednisolone’s hyperglycemic effects. Interactions with cardiac glycosides may increase risk of arrhythmias due to hypokalemia.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. For patients on multiple daily doses, if remembered within a few hours of the missed time, take the missed dose and continue with the regular schedule. If close to the next dose, skip the missed dose and resume the normal dosing schedule. Never take extra medication to compensate for a missed dose, as this increases risk of side effects. Consult your healthcare provider for specific guidance, particularly if on a tapering regimen, as missed doses may affect the tapering schedule.

Overdose

Acute overdose is uncommon but may manifest as severe side effects including hypertension, hyperglycemia, fluid retention, hypokalemia, and psychiatric symptoms. Management is primarily supportive and symptomatic. Gastric lavage may be considered if ingestion was recent. Monitor electrolyte levels, particularly potassium, and correct imbalances appropriately. Cardiovascular monitoring is recommended, with management of hypertension if severe. Hypokalemia may require potassium supplementation. Adrenal suppression may occur with chronic overdose, requiring gradual dose reduction rather than abrupt cessation. There is no specific antidote; treatment focuses on managing symptoms and complications. Contact poison control or seek immediate medical attention for suspected overdose.

Storage

Store at room temperature (15-30°C or 59-86°F) in a dry place protected from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathrooms or near sinks due to humidity. Keep all medications out of reach of children and pets. Do not freeze liquid formulations. Properly discard any medication that is expired or no longer needed through medication take-back programs or following FDA-recommended disposal methods. Do not flush medications unless specifically instructed to do so.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary significantly. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should make dosage decisions based on individual patient factors and current clinical guidelines. Not all possible uses, interactions, or precautions are listed here. Report any adverse effects to your healthcare provider promptly. This information is not exhaustive and should not replace professional medical judgment.

Reviews

“After struggling with severe rheumatoid arthritis for years, prednisolone provided the first significant relief I’ve experienced. The reduction in joint swelling and pain was noticeable within days, allowing me to resume daily activities. While I experienced some weight gain, the benefits far outweighed this side effect under my rheumatologist’s careful monitoring.” - Margaret T., 62

“As an asthma specialist, I’ve prescribed prednisolone for decades in acute exacerbations. Its rapid action in reducing airway inflammation is unparalleled, often preventing hospitalizations. I always emphasize proper tapering to my patients and monitor for potential metabolic effects, but it remains an essential tool in acute asthma management.” - Dr. Evan R., Pulmonologist

“The transition to prednisolone for my ulcerative colitis marked a turning point in my treatment. Where other medications failed, prednisolone controlled my symptoms effectively. The tapering process was gradual under my gastroenterologist’s guidance, and I’ve maintained remission with a maintenance therapy. Blood sugar monitoring was important during treatment.” - James K., 41