Prednisolone (Systemic)

Source: UK SPC §4.2 for Prednisolone 1 mg Gastro-resistant Tablets (Deltacortril). Indication-specific initial doses given as guidance only: allergic and skin disorders 5–15 mg daily; collagenosis 20–30 mg daily (higher if more severe); rheumatoid arthritis usual initial dose 10–15 mg daily, then lowest maintenance dose compatible with tolerable symptomatic relief; blood disorders and lymphoma initial 15–60 mg daily with reduction after adequate clinical/haematological response (higher doses may be necessary 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; dosage reductions should not exceed 5–7.5 mg daily during chronic treatment. Withdrawal: in patients who have received more than a physiological dose (approximately 7.5 mg prednisolone or equivalent) for more than 3 weeks, withdrawal should not be abrupt; once a daily dose equivalent to 7.5 mg is reached, reduce more slowly to allow HPA-axis recovery. Abrupt withdrawal of up to 40 mg daily for 3 weeks or less is unlikely to cause clinically relevant HPA-axis suppression in most patients, but gradual withdrawal should still be considered after courses of 3 weeks or less in patients who have had repeated courses, a short course within one year of stopping long-term therapy, other reasons for adrenocortical insufficiency, doses above 40 mg daily, or repeated evening dosing. During prolonged therapy the dose may need to be temporarily increased during periods of stress or disease exacerbation. Children: although appropriate fractions of the adult dose may be used, dosage is usually determined by clinical response as in adults; alternate-day dosage is preferable where possible — no numeric paediatric dose is given in this SPC, verify against a children's formulary. Elderly: plan treatment, particularly long-term, bearing in mind the more serious consequences of common corticosteroid side-effects in old age. eMC §4.5 (interactions) was not captured in this bundle. Note: the US label in this bundle is PRED FORTE (prednisolone acetate ophthalmic suspension) — a different route and product; it has not been used for any dosing here.