1. Introduction
Prednisolone is a corticosteroid used to reduce inflammation and suppress the immune system in various conditions. It is commonly prescribed for autoimmune diseases, allergic reactions, inflammatory disorders, and certain cancers. Prednisolone works by mimicking the effects of cortisol, a natural hormone produced by the adrenal glands, to reduce inflammation and immune responses.
2. Indications
- Asthma and chronic obstructive pulmonary disease (COPD) exacerbations
- Rheumatoid arthritis and other autoimmune diseases (e.g., lupus, vasculitis)
- Inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis)
- Allergic reactions, including severe anaphylaxis and angioedema
- Skin conditions (e.g., eczema, psoriasis)
- Certain cancers (e.g., leukaemia, lymphoma)
- Organ transplant rejection prevention
- Adrenal insufficiency (as replacement therapy)
3. Dosage
Adults:
- Inflammatory conditions: 5–60 mg once daily, depending on the severity of the disease.
- Severe asthma/COPD exacerbations: 30–40 mg daily for 5–14 days.
- Autoimmune diseases: Initial dose 10–20 mg daily, adjusted based on response.
Children:
- Acute conditions: 1–2 mg/kg/day (maximum: 60 mg/day), tapered based on clinical response.
- Chronic conditions: 0.1–2 mg/kg/day in divided doses.
Elderly:
- Use the lowest effective dose due to an increased risk of side effects.
4. Administration
- Take orally with food to reduce the risk of gastrointestinal upset.
- If prescribed as a single daily dose, take in the morning to mimic the natural cortisol rhythm.
- For liquid formulations, use a proper measuring device for accuracy.
5. Forms Available
- Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg
- Oral solution: 5 mg/5 mL, 15 mg/5 mL
- Eye drops: 1% solution
- Injection: 10 mg/mL, 25 mg/mL, 50 mg/mL
6. Side Effects
6.1 Common Side Effects:
- Increased appetite and weight gain
- Mood changes (e.g., irritability, anxiety)
- Insomnia
- Facial puffiness (“moon face”)
- Stomach upset
6.2 Less Common Side Effects:
- Muscle weakness
- Osteoporosis with long-term use
- Acne
- Delayed wound healing
6.3 Rare but Serious Side Effects:
- Adrenal suppression
- Increased susceptibility to infections
- High blood pressure and fluid retention
- Cataracts or glaucoma with prolonged use
- Gastrointestinal perforation (rare but serious in patients with ulcers or inflammatory bowel disease)
7. Warnings
- Adrenal Suppression: Prolonged use can suppress adrenal gland function; taper the dose gradually when discontinuing.
- Infections: Prednisolone suppresses the immune system, increasing the risk of infections or masking symptoms.
- Osteoporosis: Long-term use increases the risk of bone fractures; consider bone health monitoring and supplementation.
8. Precautions
- Use cautiously in patients with diabetes, hypertension, or a history of psychiatric disorders.
- Monitor for signs of gastrointestinal bleeding, especially in patients with a history of ulcers or those on NSAIDs.
- Avoid live vaccines during treatment, as immunosuppression increases the risk of complications.
9. Interactions
- NSAIDs (e.g., ibuprofen): Increased risk of gastrointestinal bleeding.
- Antidiabetic medications: Reduced efficacy; monitor blood glucose closely.
- Warfarin: Altered anticoagulant effects; monitor INR levels closely.
- Antifungals (e.g., ketoconazole): May increase prednisolone levels.
10. Monitoring Parameters
- Monitor blood pressure, blood glucose levels, and weight regularly.
- Assess bone mineral density for long-term use.
- Check for signs of infection or adrenal suppression.
11. Use in Children
- Prednisolone is safe in children when used at appropriate doses. Long-term use may affect growth, so growth parameters should be monitored regularly.
12. Use in Pregnancy
- Prednisolone is classified as Category C. It can be used if the benefits outweigh the risks, particularly in autoimmune conditions.
- Minimal placental transfer occurs, making it safer than some other corticosteroids.
13. Use in Elderly
- Use cautiously in elderly patients due to an increased risk of side effects, including osteoporosis, hypertension, and infections.
14. Use in Kidney Disease
- No dose adjustment is required in renal impairment.
15. Use in Liver Disease
- Reduced hepatic metabolism may increase prednisolone levels; adjust the dose accordingly in severe liver impairment.
16. Patient Counselling Points
- Take prednisolone with food or milk to reduce stomach upset.
- Do not stop the medication abruptly without consulting your doctor, especially if taken for more than 2 weeks.
- Inform your doctor if you develop signs of infection (e.g., fever, sore throat).
- Maintain a healthy diet and exercise routine to reduce weight gain and minimise bone loss.
- Report any vision changes, swelling, or unusual mood changes to your healthcare provider.
17. Table of Brand Names, Manufacturer, and Prices in USD
| Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
|---|---|---|---|
| Deltacortril | Pfizer | 5 mg Tablet | $15 (30 tablets) |
| Omnacortil | Macleods | 10 mg Tablet | $10 (30 tablets) |
| Generic Prednisolone | Various | 20 mg Tablet | $5 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Prednisolone used for?
Prednisolone is used to treat inflammatory and autoimmune diseases, allergic reactions, asthma, and certain cancers.
2. How does Prednisolone work?
It suppresses the immune system and reduces inflammation by mimicking cortisol.
3. Can Prednisolone cause weight gain?
Yes, weight gain due to increased appetite and fluid retention is a common side effect.
4. How long does Prednisolone take to work?
Symptom relief is typically seen within hours to a few days, depending on the condition.
5. Can children take Prednisolone?
Yes, it is safe when dosed appropriately, but long-term use should be monitored for growth suppression.
6. Is Prednisolone safe during pregnancy?
It can be used if necessary, especially for autoimmune conditions, with careful monitoring.
7. Can Prednisolone cause mood changes?
Yes, it can cause mood swings, irritability, or anxiety in some patients.
8. What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double the dose.
9. Can Prednisolone cause osteoporosis?
Yes, long-term use increases the risk of osteoporosis and fractures.
10. How should Prednisolone be stored?
Store at room temperature, away from moisture and heat.
11. Can I stop Prednisolone suddenly?
No, stopping abruptly can cause adrenal insufficiency. Taper the dose as directed by your doctor.
12. Can Prednisolone be taken with other medications?
Yes, but inform your doctor about all medications to avoid interactions, such as with NSAIDs or anticoagulants.
13. Does Prednisolone increase infection risk?
Yes, it suppresses the immune system, making you more susceptible to infections.
14. How is Prednisolone different from Prednisone?
Prednisolone is the active form, while prednisone is a prodrug converted to prednisolone in the liver.
15. Can Prednisolone affect blood sugar levels?
Yes, it can cause elevated blood sugar levels, especially in diabetic patients.
