Oral Corticosteroid Pregnancy: 88% of prednisolone is inactivated as it crosses the placenta. There is no evidence that corticosteroids increase the incidence of congenital abnormalities in man, but prolonged or repeated administration during pregnancy may increase the risk of intra-uterine growth retardation, and cataracts have been observed in infants born to mothers treated long-term. Prescribe only when the benefits to mother and child outweigh the risks. Excreted in small amounts in breast milk (5-25% of serum concentrations) and may suppress infant growth and endogenous glucocorticoid production — if maternal doses exceed 40 mg/day, monitor the infant for adrenal suppression.

Prednisolone (Oral — General Medicine)

Brand names: Prednisolone (generic)

Used in: Gout Inflammatory Bowel Disease Acute Red Eye

Oral prednisolone is a glucocorticoid corticosteroid used in general medicine for a wide range of inflammatory and immune-mediated conditions, including asthma and COPD exacerbations, inflammatory bowel disease, autoimmune disease and as part of immunosuppressive regimens.

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 5-60 mg daily, depending on the disorder being treated

Route: Oral (gastro-resistant tablets)

Frequency: Usually given in divided daily doses; a single dose in the morning on alternate days or at longer intervals is acceptable therapy for some patients and minimises pituitary-adrenal suppression

Corticosteroids are palliative symptomatic treatment, never curative. The appropriate individual dose must be determined by trial and re-evaluated regularly according to disease activity; maintain or adjust the initial dose until the anticipated response is seen, then reduce gradually to the lowest dose maintaining an adequate clinical response. INDICATION GUIDANCE (§4.2, guidance only): allergic and skin disorders — initial 5-15 mg daily; collagenosis — initial 20-30 mg daily (higher in more severe symptoms); rheumatoid arthritis — usual initial 10-15 mg daily, then the lowest maintenance dose compatible with tolerable symptomatic relief; blood disorders and lymphoma — initial 15-60 mg daily with reduction after adequate clinical or haematological response, higher doses may be needed to induce remission in acute leukaemia. Dosage reductions should not exceed 5-7.5 mg daily during chronic treatment. WITHDRAWAL: in patients who have had more than a physiological dose (approximately 7.5 mg prednisolone or equivalent) for more than 3 weeks, withdrawal should not be abrupt — once a daily dose equivalent to 7.5 mg prednisolone is reached, reduce more slowly to allow HPA-axis recovery. Abrupt withdrawal after up to 3 weeks of treatment is appropriate if relapse is considered unlikely, and abrupt withdrawal of up to 40 mg daily for 3 weeks is unlikely to cause clinically relevant HPA-axis suppression in most patients; gradual withdrawal should still be considered after courses of 3 weeks or less in patients with repeated courses, a short course within a year of stopping long-term therapy, other reasons for adrenocortical insufficiency, doses above 40 mg daily, or repeated evening dosing. Dosage may need temporary increase during periods of stress or disease exacerbation. CHILDREN: appropriate fractions of the adult dose may be used but dosage will usually be determined by clinical response as in adults; alternate-day dosing is preferable where possible — verify against a children's formulary before prescribing. The openFDA record in this bundle is PRED FORTE ophthalmic suspension (topical eye drops) and was NOT used — it is a different route and indication.

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 of the excipients
Systemic infections, unless specific anti-infective therapy is employed
Ocular herpes simplex, because of possible perforation
Rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption (lactose-containing tablets)

Side effects

Psychiatric reactions — irritability, depressed and labile mood, suicidal thoughts, psychotic reactions, mania, delusions, hallucinations, anxiety, sleep disturbance and cognitive dysfunction (common; severe reactions estimated at 5-6% in adults)
Suppression of the hypothalamo-pituitary adrenal axis, cushingoid facies, impaired carbohydrate tolerance, manifestation of latent diabetes mellitus
Sodium and water retention, hypokalaemic alkalosis, potassium loss, negative nitrogen and calcium balance, weight gain, hyperglycaemia, dyslipidaemia
Increased susceptibility to and severity of infections, opportunistic infections, recurrence of dormant tuberculosis, oesophageal candidiasis
Glaucoma, papilloedema, posterior subcapsular and nuclear cataracts; raised intracranial pressure with papilloedema
Calciphylaxis (very rare)

Clinical monograph

How it works

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

Prescribing in practice

Do not stop prolonged or high-dose treatment abruptly because of the risk of adrenal insufficiency; the dose must be tapered and patients should carry a steroid treatment card.
Long-term use causes osteoporosis, hyperglycaemia, hypertension, gastrointestinal and psychiatric effects and increased infection risk, so co-prescribe bone and gastric protection where indicated.
It can mask signs of infection and reactivate latent infections such as tuberculosis and chickenpox, so advise on avoiding contact and seeking prompt advice after exposure.

Monitoring

During longer courses monitor blood pressure, blood glucose, weight and bone health, and review for signs of infection and mood disturbance.

Counselling the patient

Never stop this steroid suddenly; always reduce it gradually as advised.
Carry a steroid treatment card and tell any healthcare professional you are taking it.
Seek advice promptly if you are exposed to chickenpox or shingles or feel unwell with infection.

Evidence & guidelines

Oral prednisolone is standard therapy across numerous inflammatory and respiratory conditions in NICE and specialist society guidance.

Reference: NICE guidance on glucocorticoid use; RCP Steroid Emergency Card guidance; 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