Prednisolone

How it works

It binds intracellular glucocorticoid receptors to modulate gene transcription, suppressing inflammatory mediators and immune cell activity while exerting metabolic and mineralocorticoid effects.

Prescribing in practice

• Never stop prolonged or high-dose therapy abruptly; the dose must be tapered to avoid acute adrenal crisis, and patients require a steroid emergency card and sick-day rules.
• Chronic use predisposes to osteoporosis, hyperglycaemia, hypertension, weight gain, infection and adrenal suppression; consider bone and gastric protection where appropriate.
• Take with food, ideally in the morning to mimic the circadian cortisol rhythm and reduce sleep disturbance.

Monitoring

Monitor weight, blood pressure, blood glucose, signs of infection and, with long-term use, bone density and growth in children.

Counselling the patient

• Do not suddenly stop taking your steroid tablets, even if you feel well.
• Carry your steroid emergency card at all times and increase the dose during illness as advised.
• Tell your team if you develop signs of infection or have chickenpox or measles contact, as steroids blunt your immune response.

Evidence & guidelines

MHRA advises all patients on systemic corticosteroids carry a steroid emergency card, reflecting the established risk of adrenal crisis on abrupt withdrawal or intercurrent illness.