Oral Corticosteroid Pregnancy: Compatible for significant indications — crosses placenta minimally (prednisolone metabolised to inactive form by placenta); monitor for neonatal adrenal insufficiency

Prednisolone (Oral — General Medicine)

Brand names: Prednisolone (generic)

Adult dose

Dose: Inflammatory/autoimmune conditions: 30–60 mg OD initially (or as per condition-specific protocol). Reduce by 5–10 mg every 1–2 weeks when improving. Maintenance: lowest effective dose.

Route: Oral

Frequency: Once daily in the morning (with food)

Max: 60–80 mg/day (acute high-dose); 5–15 mg/day maintenance

Always prescribe 'Prednisolone' — do not use 'steroids' alone on prescriptions. Prescribe with gastric protection (PPI) if at risk of peptic ulcer. Bone protection if >3 months use (bisphosphonate).

Paediatric dose

Dose: 1 mg/kg

Route: Oral

Frequency: OD–BD

Max: 60 mg/day

Concentration: 1 mg/mL or 5 mg/mL oral solution mg/ml

Asthma exacerbation: 1–2 mg/kg/day (max 40 mg) for 3–5 days. Nephrotic syndrome: 60 mg/m²/day or 2 mg/kg/day.

Dose adjustments

Renal

No dose adjustment required; may cause fluid retention in renal failure

Hepatic

Caution — increased risk of infection; active hepatitis is a relative contraindication without antiviral cover

Paediatric weight-based calculator

Patient weight (kg)

Asthma exacerbation: 1–2 mg/kg/day (max 40 mg) for 3–5 days. Nephrotic syndrome: 60 mg/m²/day or 2 mg/kg/day.

Clinical pearls

Sick day rules: never suddenly stop after >3 weeks use — adrenal suppression. Reduce gradually.
Bone protection: start bisphosphonate (alendronate) + calcium/vitamin D if course >3 months anticipated (FRAX-guided)
Steroid card: carry blue steroid card during any course >3 weeks or doses equivalent to >6 mg prednisolone/day
Hyperglycaemia: check random blood glucose after starting; may unmask T2DM or require insulin adjustment

Contraindications

Active systemic fungal infection (without antifungal cover)
Live vaccines contraindicated with immunosuppressive doses

Side effects

Hyperglycaemia (steroid-induced diabetes)
Hypertension
Weight gain/moon face/truncal obesity
Osteoporosis (long-term)
Adrenal suppression
Psychiatric effects (mania, depression, psychosis)
GI bleeding
Cataracts (long-term)
Increased infection susceptibility
Growth suppression (children)

Interactions

NSAIDs — additive GI bleeding risk
Anticoagulants — variable effect on INR (monitor)
Rifampicin — reduces prednisolone levels
Live vaccines — contraindicated
ACEi — hyperkalaemia risk
Antidiabetics — higher doses required

Monitoring

Blood glucose
Blood pressure
Weight
Bone density (long-term — DEXA)
Eye pressure (prolonged high-dose — glaucoma risk)
Signs of infection
Growth in children

Reference: BNFc; BNF; NICE guidance on glucocorticoid use; RCP Steroid Emergency Card guidance. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways