Glucocorticoid (intermediate-acting) Pregnancy: 88% of prednisolone is inactivated crossing the placenta; no evidence of increased congenital abnormalities in man, but prolonged/repeated use may increase risk of intra-uterine growth retardation. Prescribe only when benefits to mother and child outweigh risks (§4.6).

Prednisolone

Brand names: Deltacortril, Prednesol

Used in: COPD Asthma Gout Inflammatory Bowel Disease

Prednisolone is a synthetic glucocorticoid corticosteroid used widely for its anti-inflammatory and immunosuppressive effects across endocrine, respiratory, rheumatological and other inflammatory conditions, and as physiological replacement in adrenal insufficiency.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initial dose 5 mg to 60 mg daily depending on the disorder being treated; usually given in divided daily doses

Route: Oral

Frequency: Divided daily doses (or single morning dose on alternate days for intermittent regimens)

Dose determined individually and re-evaluated regularly; reduce gradually to the lowest dose maintaining adequate clinical response. Indication-specific starting doses: allergic and skin disorders 5-15 mg daily; collagenosis 20-30 mg daily; rheumatoid arthritis 10-15 mg daily; blood disorders and lymphoma 15-60 mg daily (higher may be needed to induce remission in acute leukaemia). Dosage reductions should not exceed 5-7.5 mg daily during chronic treatment. Do not withdraw abruptly after more than physiological dose (~7.5 mg prednisolone or equivalent) for over 3 weeks; gradual withdrawal also considered in other at-risk groups. Children: appropriate fractions of the actual dose may be used, but dosage is usually determined by clinical response as in adults; alternate-day dosing preferable where possible - verify against a children's formulary. Elderly: plan treatment bearing in mind more serious consequences of side-effects.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to prednisolone or any excipient
Systemic infections unless specific anti-infective therapy is employed
Ocular herpes simplex (risk of perforation)
Rare hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption

Side effects

Psychiatric reactions - irritability, depressed/labile mood, suicidal thoughts, psychotic reactions, mania, delusions, hallucinations (common)
Suppression of the hypothalamic-pituitary-adrenal axis, cushingoid facies, impaired glucose tolerance/manifestation of latent diabetes
Sodium and water retention, hypokalaemic alkalosis, potassium loss; weight gain, hyperglycaemia, dyslipidaemia
Increased susceptibility to and severity of infections, opportunistic infections, recurrence of dormant tuberculosis
Glaucoma, papilloedema, posterior subcapsular cataracts; calciphylaxis (very rare)

Clinical monograph

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.

Reference: NICE NG137; UK guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways

📚 MRCEM Revision

Featured in these MRCEM clinical pathways

Prednisolone is a core drug in the following exam-focused workups on our sister siteReviseMRCEM.

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.