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Systemic Corticosteroid Pregnancy: §4.6: 88% of prednisolone is inactivated as it crosses the placenta. There is no evidence that corticosteroids increase the incidence of congenital abnormalities such as cleft palate/lip in man, but when administered for prolonged periods or repeatedly during pregnancy they may increase the risk of intra-uterine growth retardation; neonatal hypoadrenalism may in theory follow prenatal exposure but usually resolves spontaneously after birth and is rarely clinically important. Corticosteroids should only be prescribed when the benefits to mother and child outweigh the risks; when they are essential, patients with normal pregnancies may be treated as though they were in the non-gravid state, and patients with pre-eclampsia or fluid retention require close monitoring. Breast-feeding: corticosteroids are excreted in small amounts in breast milk, but 'doses of up to 40mg daily of prednisolone are unlikely to cause systemic effects in the infant'; infants of mothers on higher doses may have a degree of adrenal suppression, but the benefits of breast feeding are likely to outweigh any theoretical risk. Fertility: corticosteroids may cause irregular menstruation or amenorrhoea.

Prednisolone (IBD / GI Use)

Brand names: Deltacortril, Prednesol

Used in: Gout Acute Red Eye

This page covers oral prednisolone used as a corticosteroid for inducing remission in active inflammatory bowel disease, including flares of ulcerative colitis and Crohn's disease.

Adult dose

Dose: ULCERATIVE COLITIS AND CROHN'S DISEASE — both are named licensed indications of the sourced product. §4.1 verbatim: 'Prednesol 5 mg Tablets are indicated in adults and children for the treatment of the following conditions: ... minimal change nephrotic syndrome, acute interstitial nephritis; ulcerative colitis, Crohn's disease; sarcoidosis ...'. THE SPC GIVES NO IBD-SPECIFIC REGIMEN — it bands its adult doses instead, and the only band that covers ulcerative colitis and Crohn's disease is the catch-all, §4.2 verbatim: 'Most other conditions: 10 to 100mg daily for one to three weeks, then reducing to the minimum effective dosage.' The band is explicitly guidance, not a fixed regimen: 'The dose used will depend upon the disease, its severity, and the clinical response obtained. The following regimens are for guidance only. Divided dosage is usually employed.' Two principles govern the whole of §4.2: 'The lowest dosage that will produce an acceptable result should be used ... when it is possible to reduce the dosage, this must be accomplished by stages', and 'During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage.' NOT COVERED HERE: autoimmune hepatitis, the second indication named on this page, is NOT among the licensed indications in §4.1 of this product and no dose for it is published; nor is any intravenous corticosteroid regimen for acute severe colitis — this SPC is an oral prednisolone tablet only and says nothing about hydrocortisone.
Route: Oral. §4.2 'Method of administration', verbatim: 'Prednesol/Soluble Prednisolone 5mg Tablets are best taken dissolved in water, but they can be swallowed whole without difficulty.' The tablet strength is 5 mg, fixed by the product name.
Frequency: §4.2: 'Divided dosage is usually employed.' §4.4 qualifies this for safety: 'Suppression of the HPA axis and other undesirable effects may be minimised by using the lowest effective dose for the minimum period, and by administering the daily requirement as a single morning dose or whenever possible as a single morning dose on alternate days. Frequent patient review is required to appropriately titrate the dose against disease activity.'
Max: The SPC states no absolute maximum. The top of the guidance band that covers these indications is 100 mg daily, given for one to three weeks before reducing to the minimum effective dosage. Two withdrawal thresholds in §4.4 bear on the upper part of that band: 'Abrupt withdrawal of doses of up to 40 mg daily of prednisolone, or equivalent for 3 weeks is unlikely to lead to clinically relevant HPA axis suppression, in the majority of patients', and gradual withdrawal should be considered even after courses of 3 weeks or less in 'Patients receiving doses of systemic corticosteroid greater than 40mg daily of prednisolone (or equivalent)'.
It was recorded when §4.1 was not in the bundle: the extractor could see the dose bands but could not confirm what the product was licensed FOR, and so refused to place inflammatory bowel disease in the 'most other conditions' bucket from its own pharmacological knowledge. §4.1 is now fetched and names ulcerative colitis and Crohn's disease outright, in a product that is one of this page's own brands (Prednesol), by this page's own route (oral), in this page's own population ('indicated in adults and children'). The bucket is therefore the label's, not the extractor's: §4.2 gives one named-condition regimen (rheumatoid arthritis), one duration-based regimen (short-term treatment) and one catch-all, and IBD is neither of the first two. THE OTHER TWO BANDS, verbatim, for context and NOT as this page's dose: 'Short-term treatment: 20 to 30mg daily for the first few days, subsequently reducing the daily dosage by 2.5 or 5mg every two to five days, depending upon the response'; 'Rheumatoid arthritis: 7.5 to 10mg daily. For maintenance therapy the lowest effective dosage is used.' WITHDRAWAL (§4.4): in patients who have had more than physiological doses (approximately 7.5 mg prednisolone or equivalent) for greater than 3 weeks, withdrawal should not be abrupt; 'Once a daily dose equivalent to 7.5 mg prednisolone is reached, dose reduction should be slower to allow the HPA axis to recover'; gradual withdrawal should also be considered after courses of 3 weeks or less in patients who have had repeated courses, in those given a short course within one year of stopping long-term therapy, in those with another reason for adrenocortical insufficiency, in those on more than 40 mg daily, and in those repeatedly taking doses in the evening. 'Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment.' STEROID CARD (§4.4): 'Patients should carry Steroid treatment cards which give clear guidance on the precautions to be taken to minimise risk and which provide details of prescriber, drug, dosage and the duration of treatment.' The only '30-40mg' and '2 mg/kg ... up to a maximum dose of 60mg' in §4.2 are paediatric ACUTE ASTHMA doses (see the paediatric notes) and must not be borrowed for IBD. Some sections of the product information we used were incomplete — check the full SPC.

Paediatric dose

Dose: Fractions of the adult dosage — §4.2 'Paediatric population', verbatim: 'Fractions of the adult dosage may be used (e.g. 75% at 12 years, 50% at 7 years and 25% at 1 year) but clinical factors must be given due weight.'
Route: Oral — the tablets are best taken dissolved in water, but can be swallowed whole
Frequency: As for the corresponding adult regimen — divided dosage is usually employed, with the daily requirement given as a single morning dose wherever possible
Max: No separate paediatric ceiling is stated for inflammatory bowel disease; the paediatric dose is the stated fraction of the adult dose for the child's age.
THERE IS NO PER-KILOGRAM IBD FIGURE IN THIS LABEL — dosePerKg is deliberately null and must stay null, so no weight calculator may be run from this entry. The paediatric dose here is a FRACTION OF THE ADULT DOSE by age. ⚠️ DO NOT BORROW THE OTHER PAEDIATRIC NUMBERS IN §4.2: everything after that sentence belongs to ACUTE ASTHMA, a different indication — 'Soluble Prednisolone Tablets may be given early in the treatment of acute asthma attacks in children. For children over 5 years use a dose of 30-40mg prednisolone. For children aged 2-5 years use a dose of 20mg prednisolone. Those already receiving maintenance steroid tablets should receive 2 mg/kg prednisolone up to a maximum dose of 60mg ... For children under 2 years ... at a dose of 10mg for up to three days.' None of those figures is an inflammatory-bowel-disease dose. §4.8 lists growth retardation in infancy, childhood and adolescence among the effects of long-term corticosteroid use, and §4.4 requires parents to be given the chickenpox-exposure advice when the patient is a child. Verify any paediatric IBD dose against a children's formulary and current specialist paediatric gastroenterology guidance.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
  • Systemic infections, unless specific anti-infective therapy is employed
  • Live virus immunisation

Side effects

  • Frequency for all of the following is stated by §4.8 as 'Not known (cannot be estimated from the available data)', and they are described as associated with long-term systemic corticosteroid use; the incidence correlates with potency, dosage, timing of administration and duration of treatment
  • Increased susceptibility to and severity of infections with suppression of clinical symptoms and signs, opportunistic infections, recurrence of dormant tuberculosis, candidiasis
  • HPA axis suppression; cushingoid facies; impaired carbohydrate tolerance with increased requirement for anti-diabetic therapy; manifestation of latent diabetes mellitus
  • Sodium and fluid retention, hypokalaemia, hypokalaemic alkalosis, negative protein and calcium balance, increased appetite, weight increased
  • Psychiatric reactions — schizophrenia, euphoric mood, drug dependence, depressed mood, insomnia
  • Peptic ulceration with perforation and haemorrhage, acute pancreatitis, oesophageal ulcer, dyspepsia, nausea, vomiting, abdominal distension, abdominal pain, diarrhoea
  • Myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, myalgia; growth retardation in infancy, childhood and adolescence
  • Glaucoma, papilloedema, subcapsular cataracts, central serous chorioretinopathy, exophthalmos, corneal or scleral thinning, exacerbation of ophthalmic viral or fungal disease, blurred vision
  • Increased intracranial pressure with papilloedema in children (pseudotumor cerebri), usually after treatment withdrawal; epilepsy; dizziness; headache; vertigo
  • Hypertension, embolism, congestive cardiac failure in susceptible patients, bradycardia, myocardial rupture following recent myocardial infarction
  • Skin atrophy, striae, acne, telangiectasia, hyperhidrosis, rash, pruritus, urticaria, hirsutism; impaired healing; contusion (bruising); tendon rupture
  • Menstrual irregularity, amenorrhoea; leukocytosis; hypersensitivity including anaphylaxis; Kaposi's sarcoma has been reported in patients receiving corticosteroid therapy
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • Frequent patient review to titrate the dose against disease activity, and clinical assessment of disease activity during withdrawal
  • Do not withdraw abruptly after more than physiological doses (approximately 7.5 mg prednisolone or equivalent) for more than 3 weeks; taper over weeks or months according to dose and duration
  • Increase the dose temporarily during intercurrent illness, trauma or surgical procedures, and consider temporary reintroduction if corticosteroids were stopped after prolonged therapy
  • Ensure the patient carries a steroid treatment card for the duration of treatment
  • Monitor frequently for worsening of diabetes mellitus, osteoporosis, hypertension, glaucoma and epilepsy in patients with these conditions or a family history of them
  • Take care with fluid retention in renal insufficiency, hypertension or congestive heart failure
  • Refer to an ophthalmologist for evaluation if blurred vision or other visual disturbance is reported
  • Advise patients without a definite history of chickenpox to avoid close contact with chickenpox or herpes zoster and to seek urgent medical attention if exposed; passive immunisation with varicella zoster immunoglobulin within 10 days of exposure is needed for exposed non-immune patients receiving systemic corticosteroids or who have used them within the previous 3 months
  • Avoid live vaccines in individuals with impaired immune responsiveness caused by high doses of corticosteroids; the antibody response to other vaccines may be diminished
  • Monitor closely where there is a history of severe affective disorders, previous steroid psychosis or previous steroid myopathy (this §4.4 sentence is cut off at the source-fetch limit)

Clinical monograph

How it works

Prednisolone is a glucocorticoid that binds intracellular receptors to suppress pro-inflammatory gene transcription, reducing cytokine production and mucosal inflammation in the gut.

Prescribing in practice

  • It is for short-term induction only and must not be stopped abruptly after more than a brief course; doses should be tapered to avoid adrenal insufficiency, and it is not a maintenance therapy for IBD.
  • Prolonged or repeated courses risk osteoporosis, hyperglycaemia, hypertension, mood disturbance and increased infection susceptibility, so bone protection and steroid-sparing strategies should be considered.
  • Provide a steroid treatment card and counsel on the risks of intercurrent illness and serious infections including chickenpox in non-immune patients.

Monitoring

Monitor blood glucose, blood pressure, weight and for signs of infection, with bone-health assessment when courses are prolonged or recurrent.

Counselling the patient

  • Take with food in the morning and never stop suddenly after a longer course.
  • Carry your steroid card and tell any healthcare professional you are taking steroids.
  • Seek advice promptly if you feel unwell, develop an infection or are exposed to chickenpox or shingles.

Evidence & guidelines

Corticosteroids are an established option for inducing remission in active IBD, as set out in NICE ulcerative colitis and Crohn's disease guidance.

Reference: NICE NG130 IBD; NICE TA161 Bisphosphonates; BSG UC Guidelines 2019; Oxford Criteria (Travis et al, Gut 1996); 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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