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Prednisolone

Prednisolone is a corticosteroid used across an unusually wide range of conditions. Its UK summary of product characteristics lists uses spanning endocrine, gastrointestinal, respiratory and infectious disease, and the fact that most affects how it is taken is about stopping rather than starting.

Prednisolone Tablets

Inflammatory Conditions, Allergic States

5mg · 10mg · 20mg · 40mg

Utilised to manage systemic inflammatory states to alleviate physical pain and support immune system normalisation.

From$0.50/ tabletView

Orapred

Rheumatoid Arthritis, Asthma, Allergic States

2.5mg · 5mg · 10mg · 20mg · 40mg

Formulated to target inflammatory responses, this therapy is indicated to alleviate symptoms of chronic inflammatory conditions and support immune system management.

From$0.72/ tabletView

Key points

  • After treatment for more than 3 weeks at 5 mg prednisolone or equivalent, withdrawal should not be abrupt.
  • Clinical assessment of disease activity may be needed during withdrawal, so the taper is guided rather than fixed.
  • Its endocrine uses include primary and secondary adrenal insufficiency and congenital adrenal hyperplasia.
  • In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated.

How it works

Prednisolone is a corticosteroid, suppressing inflammation and immune activity. Because it replaces or supplements the body’s own steroid signalling, sustained treatment reduces the body’s own production, which is the reason stopping abruptly after a long course is a problem rather than merely a preference.

That same mechanism explains the stress rule: someone whose own steroid response is suppressed cannot mount the surge that illness, injury or surgery would normally produce, so the dose has to be increased for them.

Safety specific to prednisolone

Withdrawal. After treatment for more than 3 weeks at 5 mg prednisolone or equivalent, withdrawal should not be abrupt, and clinical assessment of disease activity may be needed during withdrawal. A course that has run beyond three weeks is therefore not something to stop when the symptoms settle or the tablets run out.

Unusual stress. In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated. In practice that means anyone on long-term steroids needs whoever treats them for an illness, injury or operation to know they are taking it.

Alternate-day therapy. In less severe disease processes where corticosteroid therapy is indicated, it may be possible to initiate treatment with alternate-day therapy.

When to seek urgent care

Someone on long-term prednisolone who becomes acutely unwell, is injured, or cannot keep tablets down needs medical advice promptly rather than simply missing doses, because of the stress-dose requirement described above.

Further reading

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