Prednisolone is a potent synthetic corticosteroid medication widely prescribed to manage a range of inflammatory and autoimmune disorders. It mimics the effects of cortisol, a natural hormone produced by the adrenal glands, to suppress immune system overactivity and reduce inflammation. This makes it a cornerstone therapy in conditions where excessive immune response causes tissue damage. Available in various formulations including tablets, oral solution, and eye drops, it offers flexibility in treatment approaches tailored to specific patient needs and clinical scenarios.

Features

• Synthetic glucocorticoid with high anti-inflammatory and immunosuppressive potency
• Available in multiple formulations: tablets (1mg, 5mg, 20mg), oral solution, soluble tablets, eye drops, and injection forms
• Rapid onset of action with peak plasma concentrations reached within 1-2 hours after oral administration
• Intermediate duration of action with biological half-life of 18-36 hours
• Hepatic metabolism primarily via cytochrome P450 3A4 system
• Excretion primarily renal (50-70%) with some fecal elimination

Benefits

• Rapid reduction of inflammation and swelling in acute allergic reactions and disease flares
• Effective suppression of inappropriate immune responses in autoimmune disorders
• Symptom control in chronic inflammatory conditions improving quality of life
• Prevention of organ rejection in transplant patients when used in combination regimens
• Management of various hematologic conditions through immunomodulatory effects
• Treatment of certain endocrine disorders when natural hormone production is inadequate

Common use

Prednisolone is indicated for a broad spectrum of medical conditions requiring anti-inflammatory or immunosuppressive effects. In rheumatology, it’s used for rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Pulmonologists prescribe it for severe asthma exacerbations, COPD exacerbations, and sarcoidosis. Dermatologists utilize it for severe psoriasis, pemphigus vulgaris, and contact dermatitis. In gastroenterology, it treats inflammatory bowel disease flares including Crohn’s disease and ulcerative colitis. Hematologists employ it for autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, and lymphoid malignancies. Ophthalmologists use ophthalmic preparations for uveitis, keratitis, and allergic conjunctivitis. Additionally, it serves as replacement therapy in adrenal insufficiency and management of cerebral edema.

Dosage and direction

Dosage must be individualized based on the condition being treated, severity of disease, patient response, and concomitant medications. For anti-inflammatory/immunosuppressive effects: Adults typically receive 5-60mg daily in divided doses. Pediatric dosing is usually 0.14-2mg/kg/day in 3-4 divided doses. For adrenal insufficiency: Maintenance dose is usually 4-5mg/m²/day orally in divided doses.

Administration should be with food or milk to minimize gastrointestinal irritation. Tablets should be swallowed whole with water; do not crush or chew unless specifically instructed. For once-daily dosing, take in the morning to coincide with the body’s natural cortisol rhythm. Tapering is essential after prolonged therapy (more than 2 weeks); never abruptly discontinue. The tapering schedule depends on treatment duration and dosage, typically reducing by 2.5-5mg every 3-7 days until physiological dose is reached, then slower reduction.

Precautions

Patients require careful monitoring throughout therapy. Regular assessment of blood pressure, weight, blood glucose, electrolytes, and bone mineral density is recommended. Ophthalmologic examinations should be performed periodically for patients on prolonged therapy. Caution is required in patients with diabetes mellitus, hypertension, heart failure, renal impairment, liver disease, osteoporosis, peptic ulcer disease, and thyroid disorders. Vaccination with live vaccines should be avoided during treatment. Stress dosing may be required during surgical procedures or significant illness. Patients should carry steroid identification cards. Growth monitoring is essential in pediatric patients. Psychiatric monitoring is advised as mood changes can occur.

Contraindications

Prednisolone is contraindicated in patients with known hypersensitivity to prednisolone or any component of the formulation. Systemic fungal infections represent an absolute contraindication. Live virus vaccines are contraindicated in patients receiving immunosuppressive doses. Relative contraindications include active peptic ulcer disease, recent intestinal anastomoses, uncontrolled infections, uncontrolled hypertension, severe osteoporosis, and psychotic disorders. Cautious use in pregnancy requires careful risk-benefit assessment as corticosteroids cross the placenta.

Possible side effect

Endocrine: Cushingoid state, hypothalamic-pituitary-adrenal axis suppression, growth suppression in children, menstrual irregularities Cardiovascular: Hypertension, congestive heart failure in susceptible patients Musculoskeletal: Osteoporosis, vertebral compression fractures, myopathy, tendon rupture Gastrointestinal: Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention Dermatologic: Impaired wound healing, thin fragile skin, petechiae and ecchymoses Ophthalmologic: Posterior subcapsular cataracts, increased intraocular pressure, glaucoma Metabolic: Fluid and electrolyte disturbances, hypokalemia, hyperglycemia Neurologic: Convulsions, increased intracranial pressure, vertigo Psychiatric: Euphoria, insomnia, mood swings, depression, psychotic features

Drug interaction

Enzyme inducers (phenytoin, rifampin, carbamazepine) may increase prednisolone clearance requiring dosage adjustment. CYP3A4 inhibitors (ketoconazole, erythromycin) may increase prednisolone levels. Concurrent use with NSAIDs increases risk of GI ulceration. Diuretics may enhance hypokalemic effects. May decrease effectiveness of antidiabetic agents. Live vaccines may have reduced efficacy and increased risk of complications. May increase requirements for anticoagulant dosage adjustments. Concurrent use with other immunosuppressants increases infection risk. Amphotericin B and potassium-depleting diuretics may exacerbate hypokalemia.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for the missed one. For once-daily regimens: If remembered within 12 hours of scheduled time, take missed dose; if beyond 12 hours, skip and resume regular schedule. For multiple daily dosing: If close to next dose time, skip missed dose and continue regular schedule. Never take extra medication to compensate. Contact healthcare provider if multiple doses are missed, particularly when tapering, as this may require schedule adjustment.

Overdose

Acute overdose is unlikely to cause serious problems in single instances, but chronic excessive administration leads to hypercorticism. Symptoms may include hypertension, edema, hypokalemia, hyperglycemia, and euphoria or psychosis. Treatment involves immediate discontinuation and supportive care. Gastric lavage may be considered if ingestion was recent. Electrolyte imbalance and hyperglycemia should be corrected. Dialysis is not effective due to high protein binding. In cases of adrenal suppression, corticosteroid replacement may be necessary until HPA axis function recovers.

Storage

Store at controlled room temperature 20-25°C (68-77°F). Protect from light and moisture. Keep container tightly closed. Do not store in bathroom due to humidity variations. Keep all medications out of reach of children and pets. Do not flush medications down toilet or pour into drain unless instructed. Properly discard expired or no longer needed medication through take-back programs or medication disposal systems.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should make treatment decisions based on individual patient circumstances. This card does not contain all possible information about this medication and should not be used as a substitute for professional medical advice.

Reviews

Clinical studies demonstrate prednisolone’s efficacy across multiple indications. In rheumatoid arthritis trials, 60-70% of patients showed significant improvement in joint swelling and pain. Asthma studies indicate reduced hospitalization rates by 40-60% during exacerbations when used appropriately. Dermatological applications show 80% improvement rates in severe contact dermatitis. However, many reviews note the significant side effect profile requiring careful monitoring. Long-term studies emphasize the balance between therapeutic benefits and adverse effects, particularly regarding bone density and metabolic parameters. Patient-reported outcomes frequently mention improved quality of life during disease flares but express concerns about weight gain and mood changes.