Prednisolone is a synthetic glucocorticoid medication renowned for its potent anti-inflammatory and immunosuppressive properties. As a cornerstone therapy in managing numerous autoimmune, allergic, and inflammatory disorders, it works by modulating the body’s immune response and reducing inflammation at the cellular level. This corticosteroid is available in multiple formulations, including oral tablets, liquid solutions, and ophthalmic preparations, offering flexibility in treatment approaches across various medical specialties from rheumatology to ophthalmology.

Features

• Synthetic glucocorticoid with approximately 4 times the anti-inflammatory potency of cortisol
• Available in immediate-release and delayed-release tablet formulations (1mg, 5mg, 10mg, 20mg, 25mg)
• Multiple administration routes: oral, ophthalmic, topical, and intravenous formulations
• Rapid onset of action with peak plasma concentrations within 1-2 hours for oral formulations
• Hepatic metabolism with elimination half-life of 2-4 hours
• Compatible with various combination therapies in treatment protocols

Benefits

• Provides rapid relief from inflammation and associated pain in acute conditions
• Effectively suppresses inappropriate immune responses in autoimmune disorders
• Reduces tissue swelling and edema through mineralocorticoid activity
• Prevents progression of inflammatory damage to organs and tissues
• Improves functional capacity and quality of life in chronic inflammatory conditions
• Offers flexible dosing regimens adaptable to various clinical scenarios

Common use

Prednisolone is extensively prescribed across multiple medical disciplines for conditions characterized by excessive inflammation or inappropriate immune activation. In rheumatology, it serves as first-line therapy for rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Pulmonologists utilize it for severe asthma exacerbations, COPD flare-ups, and sarcoidosis. Gastroenterologists employ prednisolone for inflammatory bowel disease flare management, particularly Crohn’s disease and ulcerative colitis. Dermatologists prescribe it for severe contact dermatitis, pemphigus vulgaris, and other blistering skin disorders. Additionally, it’s crucial in managing allergic reactions, certain hematologic conditions, and preventing transplant rejection. In ophthalmology, prednisolone eye drops effectively treat uveitis, keratitis, and postoperative inflammation.

Dosage and direction

Dosage must be individualized based on the condition being treated, severity, patient response, and concomitant medications. For anti-inflammatory effects, initial doses typically range from 5-60mg daily, often divided into 2-4 doses. Higher doses may be required for severe conditions. The medication should be taken with food to minimize gastrointestinal irritation. For chronic conditions, physicians often employ a single morning dose to coincide with the body’s natural cortisol rhythm. When discontinuing after prolonged therapy (more than two weeks), gradual tapering is essential to avoid adrenal insufficiency. Tapering protocols typically reduce the dose by 2.5-5mg every 3-7 days based on treatment duration and initial dosage. Never abruptly stop prednisolone without medical supervision.

Precautions

Patients require careful monitoring throughout treatment. Regular assessment of blood pressure, weight, blood glucose, electrolytes, and bone mineral density is recommended during prolonged therapy. Those with diabetes may require antidiabetic medication adjustments. Patients should carry steroid identification cards and inform all healthcare providers about their prednisolone use. Immunizations should be updated before initiation when possible, as live vaccines are contraindicated during treatment. Caution is advised when exposed to infections, particularly chickenpox or measles, in non-immune individuals. Stress-dose steroids may be necessary during surgical procedures or major illnesses. Ophthalmologic examinations are recommended every 3-6 months during long-term therapy to monitor for cataracts and glaucoma.

Contraindications

Prednisolone is contraindicated in patients with systemic fungal infections and those with known hypersensitivity to any component of the formulation. Additional absolute contraindications include recent live virus vaccination in immunocompromised patients, active untreated infections (unless appropriate anti-infective therapy is initiated), and idiopathic thrombocytopenic purpura when administered intramuscularly. Relative contraindications requiring careful risk-benefit assessment include congestive heart failure, hypertension, diabetes mellitus, glaucoma, osteoporosis, peptic ulcer disease, psychiatric disorders, renal insufficiency, and seizure disorders.

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 hyperglycemia requiring treatment in predisposed individuals, hypertension, osteoporosis with long-term use, increased susceptibility to infections, adrenal suppression, Cushingoid appearance, skin thinning and easy bruising, delayed wound healing, posterior subcapsular cataracts, glaucoma, menstrual irregularities, and hypothalamic-pituitary-adrenal axis suppression. Psychiatric reactions including euphoria, insomnia, mood swings, personality changes, severe depression, and frank psychotic manifestations may occur. Musculoskeletal effects include steroid myopathy with weakness, muscle wasting, and osteoporosis with vertebral compression fractures.

Drug interaction

Prednisolone interacts significantly with numerous medications. CYP3A4 inducers such as phenobarbital, phenytoin, and rifampin may decrease prednisolone levels, while inhibitors like ketoconazole may increase them. Concurrent use with NSAIDs increases the risk of gastrointestinal ulceration. Diuretics may enhance electrolyte imbalance, particularly hypokalemia. Anticoagulant effects may be altered, requiring more frequent monitoring. Live vaccines may have reduced efficacy and increased risk of complications. Insulin and oral hypoglycemic requirements may change significantly. The hypokalemic effect may be enhanced with amphotericin B or potassium-depleting diuretics. Anticholinesterase medications in myasthenia gravis patients may exhibit reduced effectiveness.

Missed dose

If a dose is missed, take it as soon as remembered unless it’s 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 the scheduled time, take the missed dose and resume the regular schedule. If beyond 12 hours, skip the missed dose and continue with the next scheduled dose. For multiple daily dosing, if remembered within a few hours, take the missed dose and continue with the regular schedule. If close to the next dose, skip the missed dose. Never take extra medication to compensate for a missed dose. Contact your healthcare provider for specific guidance regarding missed doses during tapering protocols.

Overdose

Acute overdose is unlikely to cause life-threatening symptoms in adults but may exacerbate typical side effects. Symptoms may include hypertension, hyperglycemia, fluid retention, psychiatric disturbances, and electrolyte imbalances. Management involves supportive care and symptomatic treatment. Gastrointestinal decontamination is generally not indicated due to rapid absorption. In cases of chronic overdose, gradual dose reduction is necessary to avoid adrenal insufficiency. There’s no specific antidote; treatment focuses on managing complications such as hyperglycemia, hypertension, and electrolyte abnormalities. Hemodialysis is not effective due to high protein binding. In severe cases, medical supervision with monitoring of vital signs, electrolyte status, and blood glucose may be required.

Storage

Store at room temperature (20-25°C or 68-77°F) in the original container, protected from light and moisture. Keep tightly closed and avoid freezing liquid formulations. Do not store in bathroom areas 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 dispose of unused medication through medication take-back programs or according to FDA guidelines. Do not flush medications down the toilet unless specifically instructed to do so.

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 comprehensive patient assessment. Dosage requirements vary significantly between individuals and conditions. Never initiate, adjust, or discontinue prednisolone without medical supervision. The information provided reflects current medical knowledge but may not encompass all possible variations in individual circumstances. Always consult with a healthcare provider for personalized medical advice and report any adverse effects promptly.

Reviews

Clinical studies consistently demonstrate prednisolone’s efficacy across numerous inflammatory conditions. In rheumatoid arthritis trials, 70-80% of patients show significant improvement in joint swelling and pain. For acute asthma exacerbations, systematic reviews confirm reduced hospitalization rates and improved lung function parameters. In inflammatory bowel disease, response rates of 60-80% are reported for induction of remission. Ophthalmologic studies show 85-90% success rates in controlling anterior uveitis. However, long-term use beyond 3-6 months demonstrates increasing adverse effect profiles, with approximately 50% of patients experiencing significant side effects requiring intervention or dose modification. Patient-reported outcomes indicate high satisfaction with symptom control but concerns regarding side effects, particularly weight gain and mood changes.