Prednisolone
📌 Related Subjects:
| Osteoporosis
⚠️ Avoid exposure to shingles or chickenpox in patients lacking acquired immunity and taking steroids.
Always check the BNF link here before prescribing.
💊 Action
- Glucocorticoid effect with anti-inflammatory & immunosuppressive activity.
- Mild mineralocorticoid activity (fluid retention, BP effects).
📋 Indications
- 🦠 Autoimmune & inflammatory: Rheumatoid arthritis, Inflammatory bowel disease.
- 🩸 Vasculitis: Giant cell arteritis (GCA), Polymyalgia rheumatica (PMR).
- 🧪 Renal: Minimal change disease, transplant rejection prevention.
- 🧬 Endocrine: Addison’s disease (replacement therapy).
- 🫁 Respiratory: Asthma, COPD exacerbations, pulmonary fibrosis.
💊 Dose (specify duration!)
- Typical adult dose: 5–60 mg once daily, depending on indication.
- BNF starting point: usually 10–20 mg once daily, taken in the morning after food.
- Giant Cell Arteritis: 1 mg/kg once daily while awaiting diagnostic confirmation.
- Polymyalgia Rheumatica: typically 15 mg once daily.
- Acute severe asthma: 40–60 mg once daily (or divided) for 3–10 days (“burst therapy”).
- 📌 For long courses: co-prescribe Calcium + Vitamin D and a Bisphosphonate for bone protection.
🔻 Tapering Guidance
- 📌 No taper needed if treatment is <3 weeks at standard doses (risk of adrenal suppression is minimal).
- ⚠️ Taper required if:
- Used for >3 weeks, OR
- ≥40 mg/day for >1 week, OR
- Recent repeated courses (esp. within 1 year), OR
- Evening dosing, OR
- Features of Cushing’s syndrome (suggesting suppression).
- 🧪 Tapering strategy: Gradually reduce dose to a physiological level (≈5–7.5 mg prednisolone), then wean slowly over weeks to months depending on duration of use and clinical indication.
- 🚨 If patient becomes acutely unwell during taper (e.g. infection, surgery) → may need to increase dose temporarily (“stress dosing”).
⚖️ Interactions
- See full list in the BNF.
- ⚠️ Important: NSAIDs (↑ ulcer risk), anticoagulants (altered INR), antidiabetics (↑ glucose), live vaccines (risk of infection).
⚠️ Cautions
- ⏳ Withdrawal must be gradual if used >3 weeks (risk of adrenal insufficiency).
- 🩺 Consider adding a PPI for GI protection if combined with NSAIDs or at risk of PUD.
- 📈 Monitor: BP, blood glucose, weight, mood, and bone density.
⛔ Contraindications
- 🚫 Untreated systemic infection (bacterial, viral, fungal, parasitic).
- 🚫 Recent live vaccine administration.
⚠️ Side Effects
- 🧬 Endocrine: Cushingoid features, adrenal suppression, steroid-induced diabetes.
- ❤️ Renal/CV: Hypertension, hypokalaemic alkalosis, oedema.
- 🧠 Neuropsychiatric: Insomnia, mood swings, psychosis.
- 🍽️ GI: Dyspepsia, gastritis, peptic ulcer disease → PPI often indicated.
- 🦴 MSK: Osteoporosis, osteopenia, avascular necrosis, proximal myopathy.
- 👁️ Eye: Cataracts, glaucoma.
- 🩹 Skin: Thinning, striae, easy bruising, moon face, buffalo hump.
- 🦠 Immunosuppression: Increased infection risk (esp. opportunistic infections, sepsis).
