Prednisolone (Oral — Nasal Polyp Reduction)

How it works

Prednisolone is a systemic glucocorticoid that broadly suppresses mucosal inflammation and eosinophilic infiltration, reducing polyp oedema and bulk to restore nasal airflow and smell.

Prescribing in practice

• Reserve oral steroids for short, defined courses because the benefit on polyps is temporary while systemic risks — mood disturbance, hyperglycaemia, gastric irritation, and adrenal suppression if courses are repeated or prolonged — accumulate.
• Use with particular caution in diabetes, hypertension, peptic ulcer disease, glaucoma and significant infection, and prolonged courses must be tapered rather than stopped abruptly.
• It is usually combined with ongoing intranasal corticosteroid therapy, which is continued for maintenance after the oral course.

Monitoring

For short courses monitor mood, blood pressure and glucose (especially in diabetes), and assess polyp and symptom response to guide whether maintenance intranasal therapy or surgery is needed.

Counselling the patient

• This is a short course to shrink the polyps; the effect wears off, so keep using your steroid nasal spray afterwards.
• Take the tablets in the morning with food, and do not stop a longer course suddenly.
• Tell your clinician if you become very thirsty, notice mood changes or have a history of diabetes or stomach ulcers.

Evidence & guidelines

Short oral corticosteroid courses are an established option for rapid reduction of nasal polyp burden, recognised in NICE guidance and ENT practice, with steroid cautions detailed in the SPC.