Prednisolone (Systemic)

Corticosteroids are palliative symptomatic treatment by virtue of their anti-inflammatory effects; they are never curative. The appropriate individual dose must be determined by trial and error and re-evaluated regularly according to disease activity. In general the initial dosage should be maintained or adjusted until the anticipated response is observed, then gradually reduced to the lowest dose that maintains an adequate clinical response. Dosage reductions should not exceed 5-7.5 mg daily during chronic treatment. Other indication-specific initial doses given in the SPC: collagenosis 20-30 mg daily (higher doses may be needed for more severe symptoms); rheumatoid arthritis usual initial dose 10-15 mg daily; blood disorders and lymphoma initial daily dose 15-60 mg, with higher doses possibly needed to induce remission in acute leukaemia. Acute or severe disease may require initial high-dose therapy with reduction to the lowest effective maintenance dose as soon as possible. Intermittent regimen: a single morning dose on alternate days or at longer intervals is acceptable for some patients and minimises pituitary-adrenal suppression. WITHDRAWAL: in patients who have received more than a physiological dose (approximately 7.5 mg prednisolone or equivalent) for greater than 3 weeks, withdrawal should not be abrupt; once a daily dose equivalent to 7.5 mg is reached, reduction should be slower to allow HPA-axis recovery. Abrupt withdrawal of doses up to 40 mg daily for 3 weeks is unlikely to lead to clinically relevant HPA-axis suppression in most patients. Gradual withdrawal should be considered even after courses of 3 weeks or less in: patients who have had repeated courses (particularly if taken for more than 3 weeks); a short course prescribed within one year of cessation of long-term therapy; patients who may have other reasons for adrenocortical insufficiency; patients on more than 40 mg daily of prednisolone (or equivalent); and patients repeatedly taking doses in the evening. During prolonged therapy the dosage may need to be temporarily increased during periods of stress or exacerbation. Elderly: treatment, particularly if long-term, should be planned bearing in mind the more serious consequences of the common side-effects of corticosteroids in old age. Children: the SPC states that although appropriate fractions of the actual dose may be used, dosage will usually be determined by clinical response as in adults, and alternate day dosage is preferable where possible — NO numeric paediatric dose is given, so verify paediatric dosing against a children's formulary.