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Systemic Corticosteroid Pregnancy: Compatible — prednisolone used to treat IBD flares in pregnancy. Small risk of cleft palate in first trimester at high doses. Monitor fetal growth.

Prednisolone (IBD / GI Use)

Brand names: Deltacortril, Prednesol

Adult dose

Dose: UC / Crohn's acute flare: 40mg once daily for 4 weeks, then taper by 5mg/week. Autoimmune hepatitis: 30–40mg OD for 4 weeks, taper to maintenance 5–10mg OD.
Route: Oral (or IV hydrocortisone 400mg/day in severe UC)
Frequency: Once daily in the morning (mimics diurnal cortisol rhythm)
Max: 60mg/day
Acute severe UC (Truelove and Witts criteria): IV hydrocortisone 100mg QDS preferred — assess response at 72 hours (Oxford criteria). If no response at 72h: consider rescue therapy (infliximab or ciclosporin) or colectomy. Tapering: once remission achieved, reduce by 5mg/week. Do not stop abruptly if on >7.5mg/day for >3 weeks (adrenal suppression).

Paediatric dose

Dose: 1 mg/kg
Route: Oral
Frequency: Once daily in the morning
Max: 60mg/day
BNF for Children: IBD: 1–2mg/kg OD (max 60mg OD) for 4 weeks, then taper. Prescribe calcium + vitamin D supplementation. Source: BNF for Children 2024; ECCO Paediatric IBD Guidelines.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Reduced conversion to active form in severe hepatic impairment — may require increased dose or switch to prednisolone (which is the active form, unlike prednisone which requires hepatic conversion).

Paediatric weight-based calculator

BNF for Children: IBD: 1–2mg/kg OD (max 60mg OD) for 4 weeks, then taper. Prescribe calcium + vitamin D supplementation. Source: BNF for Children 2024; ECCO Paediatric IBD Guidelines.

Clinical pearls

  • Bone protection: prescribe calcium 1000mg + vitamin D 800 IU/day from day 1 if steroid course expected >3 months. Add bisphosphonate (alendronate) if ≥7.5mg prednisolone for ≥3 months (NICE TA161).
  • Steroid diabetes: check fasting glucose at baseline and after 2 weeks — afternoon glucose peak most significant. Refer to diabetes team if glucose >11mmol/L.
  • Acute severe UC: Oxford criteria for predicting need for colectomy — >8 stools/day or CRP >45mg/L + 3–8 stools/day at 72h = 85% colectomy risk. Reassess at 72h.
  • Steroid card: provide steroid emergency card for courses >3 weeks — patients must carry it for anaesthetic and surgical emergencies (adrenal crisis risk).

Contraindications

  • Systemic infection without antimicrobial cover
  • Live vaccine administration during systemic steroid use
  • Cushing's syndrome (relative)

Side effects

  • Hyperglycaemia (monitor glucose — new-onset steroid diabetes common)
  • Osteoporosis (calcium + vitamin D supplementation required for >3 months use)
  • Adrenal suppression (with courses >3 weeks at >7.5mg/day — taper slowly)
  • Cushingoid features (moon face, central obesity, striae)
  • Peptic ulceration (add PPI if concomitant NSAID or high risk)
  • Mood disturbance, insomnia
  • Increased infection susceptibility
  • Hypertension, fluid retention

Interactions

  • NSAIDs: additive GI ulceration risk — add PPI
  • Live vaccines: contraindicated during systemic steroid therapy
  • Rifampicin / carbamazepine / phenytoin: reduced prednisolone efficacy (CYP3A4 induction)
  • Warfarin: variable effect on INR — monitor
  • Hypoglycaemics: steroid-induced hyperglycaemia antagonises effect — increase monitoring

Monitoring

  • Blood glucose (day 1 and 2 weeks — steroid diabetes)
  • Blood pressure
  • Bone density (DXA if course >3 months)
  • Weight
  • Intraocular pressure (prolonged use — steroid glaucoma)
  • FBC (infection risk)
  • Potassium (hypokalaemia risk)

Reference: BNFc; BNF 90; NICE NG130 IBD; NICE TA161 Bisphosphonates; BSG UC Guidelines 2019; Oxford Criteria (Travis et al, Gut 1996). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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