Prednisolone is a synthetic glucocorticoid medication renowned for its potent anti-inflammatory and immunosuppressive properties. As a cornerstone in managing numerous inflammatory and autoimmune conditions, it provides rapid symptomatic relief and disease control. This intermediate-acting corticosteroid is a bioactivated metabolite of prednisone, offering direct therapeutic action without requiring hepatic conversion, making it particularly valuable in patients with liver impairment. Its wide therapeutic index and established safety profile have solidified its position as a first-line treatment across multiple medical specialties.

Features

• Synthetic glucocorticoid with approximately 4 times the anti-inflammatory potency of cortisol
• Available in multiple formulations: oral tablets, liquid solutions, ophthalmic suspensions, and topical preparations
• Intermediate duration of action with biological half-life of 18-36 hours
• High oral bioavailability (80-90%) with peak plasma concentrations within 1-2 hours
• Minimal mineralocorticoid activity compared to other corticosteroids
• Multiple strength options ranging from 1mg to 25mg tablets for precise dosing

Benefits

• Rapid reduction of inflammation and swelling across various tissue types
• Effective suppression of inappropriate immune responses in autoimmune disorders
• Significant improvement in symptoms of allergic reactions and asthma exacerbations
• Prevention of organ rejection in transplant patients through immunosuppression
• Management of hematologic malignancies and cancer-related symptoms
• Restoration of normal endocrine function in adrenal insufficiency

Common use

Prednisolone is extensively utilized across medical disciplines for conditions characterized by excessive inflammation or aberrant immune activation. In rheumatology, it forms the backbone of treatment for rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Pulmonologists employ it for severe asthma exacerbations, COPD flare-ups, and sarcoidosis. Gastroenterologists prescribe it for inflammatory bowel disease flare-ups, particularly ulcerative colitis and Crohn’s disease. Dermatologists use it for severe contact dermatitis, pemphigus vulgaris, and other blistering disorders. Hematologists utilize it in combination chemotherapy regimens for leukemias and lymphomas. Additionally, it serves as critical therapy for adrenal insufficiency, allergic reactions unresponsive to conventional treatment, and prevention of organ transplant rejection.

Dosage and direction

Dosage must be individualized based on disease severity, patient response, and treatment duration. For anti-inflammatory effects, initial doses typically range from 5-60mg daily, divided into 2-4 doses. Higher doses (1-2mg/kg/day) are used for immunosuppression in autoimmune conditions. For adrenal insufficiency, maintenance doses of 4-5mg/m²/day are standard. Always take with food or milk to minimize gastrointestinal irritation. The medication should be taken at the same time(s) daily to maintain stable blood levels. For once-daily dosing, morning administration is preferred to coincide with the body’s natural cortisol rhythm. Never abruptly discontinue therapy; gradual tapering is essential to prevent adrenal insufficiency. Dosage reduction should be gradual, typically decreasing by 2.5-5mg every 3-7 days based on treatment duration and initial dose.

Precautions

Patients require close monitoring for hyperglycemia, hypertension, weight gain, and fluid retention. Regular ophthalmologic examinations are necessary to detect cataract formation or glaucoma. Bone density monitoring is recommended for patients on long-term therapy. Vaccination with live vaccines is contraindicated during treatment. Patients should carry steroid identification cards and be educated about adrenal insufficiency symptoms. Caution is advised in patients with diabetes, hypertension, heart failure, osteoporosis, peptic ulcer disease, or psychiatric disorders. Special consideration is needed for pediatric patients due to growth suppression risks and elderly patients who may be more susceptible to adverse effects.

Contraindications

Absolute contraindications include systemic fungal infections and known hypersensitivity to prednisolone or any component of the formulation. Relative contraindications require careful risk-benefit assessment and include active peptic ulcer disease, recent intestinal anastomoses, uncontrolled hypertension, congestive heart failure, Cushing’s syndrome, primary glaucoma, herpes simplex keratitis, and untreated bacterial or viral infections. Special caution is warranted in patients with latent tuberculosis or strongyloides infestation due to risk of disease reactivation.

Possible side effect

Common side effects include insomnia, increased appetite, weight gain, fluid retention, mood changes, and gastrointestinal discomfort. More significant adverse effects include hypertension, hyperglycemia, increased susceptibility to infections, osteoporosis, avascular necrosis, myopathy, cutaneous atrophy, and delayed wound healing. Ophthalmologic complications may include posterior subcapsular cataracts, glaucoma, and exacerbation of corneal infections. Endocrine effects can include hypothalamic-pituitary-adrenal axis suppression, Cushingoid features, and growth suppression in children. Psychiatric manifestations range from euphoria and insomnia to severe depression or psychosis.

Drug interaction

Significant interactions occur with CYP3A4 inducers (rifampin, phenytoin, carbamazepine) which reduce prednisolone efficacy. CYP3A4 inhibitors (ketoconazole, clarithromycin) may increase prednisolone levels and toxicity. Concurrent use with NSAIDs increases gastrointestinal ulcer risk. Diuretics may enhance potassium wasting, while anticoagulant effects may be altered. Live vaccines may have reduced efficacy and increased complication risk. Insulin and oral hypoglycemic requirements may increase due to corticosteroid-induced hyperglycemia. The hypokalemic effects may be potentiated with amphotericin B or β2-agonists.

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 a missed one. If taking multiple daily doses and a dose is missed, take the next dose at the regular time. For once-daily regimens, if remembered within a few hours, take the missed dose; if remembered later, skip the missed dose and resume the regular schedule. Never take extra medication to compensate for a missed dose. Consistent dosing is important for maintaining therapeutic effects and minimizing withdrawal symptoms.

Overdose

Acute overdose is unlikely to cause life-threatening symptoms but may exacerbate typical side effects. Management is supportive and symptomatic. Gastric lavage or activated charcoal may be considered if ingestion occurred within one hour. Monitor electrolytes, glucose, and blood pressure. Hypokalemia may require potassium supplementation. Hyperglycemia may need insulin therapy. There is no specific antidote; hemodialysis is not effective due to high protein binding. Chronic overdose manifests as Cushing’s syndrome and requires gradual dose reduction under medical supervision.

Storage

Store at room temperature (15-30°C or 59-86°F) in the original container, protected from light and moisture. Keep the container tightly closed and away from excessive heat or humidity. Do not store in bathroom cabinets where moisture levels fluctuate. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly discard any unused medication that has changed color, appearance, or odor.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual treatment decisions must be made by qualified healthcare professionals based on specific patient circumstances. The prescribing physician should be consulted for personalized dosage recommendations and monitoring requirements. Never initiate, adjust, or discontinue prednisolone without medical supervision due to risks of serious adverse effects and withdrawal complications.

Reviews

Clinical studies consistently demonstrate prednisolone’s efficacy across multiple indications. In rheumatoid arthritis trials, 70-80% of patients achieve significant symptom improvement. For asthma exacerbations, systematic reviews show reduced hospitalization rates and improved lung function parameters. In inflammatory bowel disease, response rates of 60-80% are reported for induction of remission. Long-term observational studies confirm effectiveness but highlight the importance of monitoring for cumulative adverse effects. Patient-reported outcomes indicate high satisfaction with symptom control but concerns about side effects, particularly with prolonged use. The risk-benefit profile remains favorable when used appropriately with adequate monitoring.