Prednisolone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Prednisolone: clinical details
Prescribing considerations
- Confirm the indication and distinguish anti-inflammatory or immunosuppressive use from corticosteroid replacement.
- Assess infection and vaccination status, previous corticosteroid exposure and risk of hypothalamic–pituitary–adrenal suppression.
- Review diabetes, hypertension, cardiovascular or gastrointestinal disease, osteoporosis, glaucoma, psychiatric history, epilepsy and hepatic impairment.
- Provide appropriate steroid-card and sick-day information when adrenal suppression is a concern.
- Plan withdrawal individually; abrupt cessation can cause relapse, withdrawal symptoms or adrenal crisis.
Contraindications and cautions
- Hypersensitivity to prednisolone or product excipients.
- Systemic infection unless appropriate specific anti-infective therapy is used.
- Ocular herpes simplex because of corneal-perforation risk.
- Selected lactose-containing products are unsuitable for specified rare hereditary disorders of galactose metabolism or absorption.
Monitoring
- For clinically significant or prolonged systemic exposure, consider blood pressure, weight, glucose, potassium, lipids, bone health and ocular assessment.
- Monitor for infection, psychiatric effects, gastrointestinal complications and adrenal suppression.
- Monitor growth and development in children receiving prolonged treatment.
- In systemic sclerosis, monitor blood pressure and renal function because corticosteroids can precipitate scleroderma renal crisis.
Clinical pharmacology
Prednisolone is an orally active glucocorticoid with anti-inflammatory, immunosuppressive and metabolic effects. It is rapidly absorbed, extensively metabolised in the liver and excreted mainly in urine as metabolites; hepatic disease and low albumin can increase active exposure.
Formulation and product differences
- The selected standard tablet is scored, contains lactose and is intended for oral administration after food.
- The selected gastro-resistant tablet has an acid-resistant coating, contains lactose and should be swallowed whole.
- Gastro-resistant absorption may be less reliable with diarrhoea or rapid intestinal transit; its product information advises particular caution in Crohn’s disease.
- Some antacids can reduce absorption of gastro-resistant prednisolone.
Prednisolone preparations and strengths
Gastro-resistant tablet
Route: Oral
Strengths: 1 mg, 2.5 mg, 5 mg
Tablet
Route: Oral
Strengths: 1 mg, 5 mg
Prednisolone interactions
Check prescription, pharmacy and herbal products with a pharmacist or prescriber before combining them with prednisolone.
NSAIDs, including ibuprofen and aspirin
May increase stomach ulceration or bleeding risk.
Warfarin and other coumarin anticoagulants
The anticoagulant response can increase or decrease, so closer monitoring may be required.
Insulin and other diabetes medicines
Prednisolone can raise blood glucose and alter medicine requirements.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.