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Systemic Corticosteroid Pregnancy: Caution — short courses acceptable in pregnancy for severe nasal obstruction; systemic betamethasone used for fetal lung maturation (different dose/indication); discuss risks

Prednisolone (Oral — Nasal Polyp Reduction)

Brand names: Deltacortril, Prednisolone 5 mg tablets

Adult dose

Dose: 0.5 mg/kg/day (typically 25–30 mg/day) for 10–14 days; taper not usually required for short courses
Route: Oral
Frequency: Once daily in the morning (with food)
Max: 60 mg/day
Short oral steroid course for acute nasal polyp exacerbation or pre-operative polyp debulking; repeat courses up to 2 per year for chronic management; limit long-term use; provide steroid warning card if repeated courses

Paediatric dose

Dose: 1–2 mg/kg/day for 3–5 days (acute exacerbation) mg/kg
Route: Oral
Frequency: Once daily
Max: 40 mg/day
Short courses only; specialist ENT referral if recurrent need

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Short courses only; specialist ENT referral if recurrent need

Clinical pearls

  • Oral steroids are the most potent short-term treatment for nasal polyposis — shrink polyps rapidly (often within 5-7 days), restore olfaction, and reduce nasal obstruction; effects temporary (polyps regrow after stopping) but provide meaningful short-term relief
  • EPOS 2020 guidance: short oral steroid courses (10-14 days) recommended for acute exacerbations of CRSwNP before considering surgical or biologic options; ≤2 courses per year to limit systemic effects
  • Olfaction restoration: sense of smell often dramatically improves within 48-72 hours of starting oral steroids — a useful prognostic indicator; if no smell improvement on oral steroids, this suggests a more severe or structural cause of anosmia
  • Qualification for biologics (dupilumab/mepolizumab/omalizumab): NICE criteria for CRSwNP biologics include ≥2 oral steroid courses in past year OR contraindication to oral steroids — documenting steroid prescriptions and response is therefore critical for future biologic eligibility
  • Steroid card: provide in patients receiving ≥2 courses within 12 months; adrenal suppression risk with cumulative steroid exposure; inform patients not to stop abruptly if concurrently on long-term steroids for other conditions

Contraindications

  • Active systemic infection (relative)
  • Live vaccines within 3 months (relative)
  • Uncontrolled diabetes (relative — short course acceptable with monitoring)

Side effects

  • Insomnia
  • Mood changes/agitation
  • Gastric upset (take with food)
  • Blood glucose elevation
  • Blood pressure rise
  • Oedema
  • Adrenal suppression (prolonged/repeated courses)

Interactions

  • NSAIDs — additive GI toxicity; prescribe with PPI cover
  • Antidiabetics — monitor glucose; increased insulin requirements
  • Anticoagulants (warfarin) — variable effect; monitor INR

Monitoring

  • Blood glucose (especially in diabetics)
  • Blood pressure
  • Symptom response (olfaction, obstruction)
  • Number of courses per year (document for biologic qualification)

Reference: BNFc; BNF 90; EPOS 2020; NICE TA654/662/671 (biologic criteria); BAO-HNS Rhinosinusitis Guideline; NICE CKS Nasal Polyps. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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