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Corticosteroid — Asthma Exacerbation / Croup / Nephrotic Syndrome / IBD Pregnancy: §4.6 verbatim: 'The ability of corticosteroids to cross placenta varies between individual drugs, however, 88% of prednisolone is inactivated as it crosses the placenta. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate, intra-uterine growth retardation and effects on brain growth and development. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate/lip in man. However, when administered for prolonged periods or repeatedly during pregnancy, corticosteroids may increase the risk of intra-uterine growth retardation. Hypoadrenalism may, in theory, occur in the neonate following prenatal exposure to corticosteroids but usually resolves spontaneously following birth and is rarely clinically important. As with all drugs, corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks. When corticosteroids are essential however, patients with normal pregnancies may be treated as though they were in the non-gravid state. Patients with pre-eclampsia or fluid retention require close monitoring. Depression of hormone levels has been described in pregnancy but the significance of this finding is not clear.' BREAST-FEEDING, §4.6 verbatim: 'Corticosteroids are excreted in small amounts in breast milk. However doses of up to 40mg daily of prednisolone are unlikely to cause systemic effects in the infant. Infants of mothers taking higher doses than this may have a degree of adrenal suppression but the benefits of breast feeding are likely to outweigh any theoretical risk.' FERTILITY, §4.6 verbatim: 'Corticosteroids may cause irregular menstruation or amenorrhoea.'

Prednisolone (Paediatric)

Brand names: Prednesol, Deltacortril, Millipred

Prednisolone is an oral glucocorticoid used in children for conditions such as acute asthma, croup, nephrotic syndrome and inflammatory and autoimmune disease.

Adult dose

Dose: Short-term treatment: 20 to 30 mg daily for the first few days, subsequently reducing the daily dosage by 2.5 or 5 mg every two to five days, depending upon the response. Rheumatoid arthritis: 7.5 to 10 mg daily. Most other conditions: 10 to 100 mg daily for one to three weeks, then reducing to the minimum effective dosage. §4.2 verbatim: '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. 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. Most other conditions: 10 to 100mg daily for one to three weeks, then reducing to the minimum effective dosage.'
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.'
Frequency: Daily. §4.2: 'Divided dosage is usually employed.' §4.4 verbatim: '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.'
⚠️ ADULT FIGURES ARE A REFERENCE ONLY — this page's population is paediatric; the prescribing regimen is in paedDose. || maxDose is left blank deliberately: the SPC states no adult ceiling. '10 to 100mg daily' is the top of a stated guidance RANGE, not a labelled maximum, and the 40 mg figures at §4.4 are WITHDRAWAL thresholds, not dose caps — '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 in 'patients receiving doses of systemic corticosteroid greater than 40mg daily of prednisolone (or equivalent)'. Neither is a ceiling on the dose shown. || GOVERNING PRINCIPLES (§4.2 verbatim): '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. During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage; if corticosteroids have been stopped following prolonged therapy they may need to be temporarily re-introduced.' || WITHDRAWAL (§4.4 verbatim): 'In patients who have received more than physiological doses of systemic corticosteroids (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.' 'Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment. Withdrawal of corticosteroids after prolonged therapy must therefore always be gradual to avoid acute adrenal insufficiency, being tapered off over weeks or months according to the dose and duration of treatment.'

Paediatric dose

Route: Oral — soluble tablets. §4.2 verbatim: 'Prednesol/Soluble Prednisolone 5mg Tablets are best taken dissolved in water, but they can be swallowed whole without difficulty.' §4.2 also states: 'The dose of prednisolone may be repeated for children who vomit; but intravenous steroids should be considered in children who are unable to retain orally ingested medication.'
Frequency: Once daily for up to three days in acute asthma. §4.2 verbatim: 'Treatment for up to three days is usually sufficient, but the length of course should be tailored to the number of days necessary to bring about recovery. There is no need to taper the dose at the end of treatment.' §4.4 adds that HPA suppression is minimised 'by administering the daily requirement as a single morning dose'.
Max: Maximum 60 mg — §4.2, for a child already on maintenance steroid tablets: '...up to a maximum dose of 60mg.' This is the only explicit ceiling in the paediatric section of this SPC. The 40 mg figure in the over-5 band is the top of a stated range (30-40 mg), not a cap.
⚠️ dosePerKg IS DELIBERATELY NULL — DO NOT set it. The SPC's paediatric acute-asthma regimen is AGE-BANDED, not weight-based, and the single per-kg figure it contains applies to one subgroup only (children already on maintenance steroid tablets), so it is not valid across the paediatric range; driving a weight calculator from it would over-dose most children (a 30 kg child would be computed 60 mg against the SPC's 30-40 mg age band). || §4.2 PAEDIATRIC PARAGRAPH, VERBATIM IN FULL: '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. 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. The dose of prednisolone may be repeated for children who vomit; but intravenous steroids should be considered in children who are unable to retain orally ingested medication. Treatment for up to three days is usually sufficient, but the length of course should be tailored to the number of days necessary to bring about recovery. There is no need to taper the dose at the end of treatment. For children under 2 years, Soluble Prednisolone Tablets can be used early in the management of moderate to severe episodes of acute asthma in the hospital setting, at a dose of 10mg for up to three days.' || SO, ACUTE ASTHMA BY AGE: under 2 years — 10 mg for up to three days, hospital setting only, moderate to severe episodes; 2 to 5 years — 20 mg; over 5 years — 30 to 40 mg; already on maintenance steroid tablets — 2 mg/kg to a maximum of 60 mg. || concentration is null because Prednesol is a 5 mg soluble TABLET: the SPC states no mg/mL, and the page's own note says an oral solution is not commercially available in the UK. Any mg/mL entered here would be unsourced and would drive a false volume calculation. || ⚠️ INDICATION SCOPE — READ BEFORE PUBLISHING: this SPC doses ACUTE ASTHMA in children and nothing else paediatric. This page's category also names CROUP, NEPHROTIC SYNDROME and IBD, and NONE of those is dosed anywhere in this bundle. Publish the asthma bands above as this page's sourced paediatric regimen and state that scope; do not retain the other indications' numbers without their own source. || Verify all under-18 dosing against a children's formulary.

Dose adjustments

Renal

Not stated. The fetched eMC sections contain no renal impairment section and no renal dose adjustment for oral prednisolone. (§4.4 is truncated at the source-fetch limit, so a renal statement further down that section would not have been retrieved.)

Hepatic

Not stated. The fetched eMC sections contain no hepatic impairment section and no hepatic dose adjustment. Some sections of the product information we used were incomplete — check the full SPC.

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

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

Side effects

  • Musculoskeletal (§4.8): 'Growth retardation in infancy, childhood and adolescence.' Also myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, myalgia.
  • Nervous system (§4.8): 'Increased intracranial pressure with papilloedema in children (pseudotumor cerebri) - usually after treatment withdrawal.' Also epilepsy, dizziness, headache.
  • Endocrine (§4.8): 'HPA axis suppression. Cushingoid facies. Impaired carbohydrate intolerance with increased requirement for anti-diabetic therapy, manifestation of latent diabetes mellitus.'
  • Infections and infestations (§4.8): 'Increased susceptibility and severity of infections with suppression of clinical symptoms and signs, opportunistic infections, recurrence of dormant tuberculosis. Candidiasis.'
  • Psychiatric (§4.8): 'Schizophrenia, euphoric mood, drug dependence, depressed mood, insomnia.'
  • Metabolism and nutrition (§4.8): 'Sodium and fluid retention, hypokalaemia, alkalosis hypokalaemic, negative protein and calcium balance, increased appetite.' Investigations: 'Weight increased.'
  • Eye (§4.8): 'Glaucoma, papilloedema, cataracts subcapsular, central serous chorioretinopathy, exophthalmos, corneal or scleral thinning, exacerbation of ophthalmic viral or fungal diseases and vision blurred.'
  • Gastrointestinal (§4.8): 'Pancreatitis acute, oesophageal ulcer. Peptic ulceration with perforation and haemorrhage. Dyspepsia, nausea, vomiting, abdominal distension, abdominal pain, diarrhoea.'
  • Skin (§4.8): 'Skin Atrophy, skin striae, acne, telangiectasia, hyperhidrosis, rash, pruritus, urticaria, hirsutism.' General: 'Impaired healing, malaise.'
  • Cardiovascular (§4.8): 'Myocardial rupture following recent myocardial infarction. Congestive cardiac failure (in susceptible patients). Bradycardia.' Vascular: 'Embolism, hypertension.'
  • Immune (§4.8): 'Hypersensitivity including anaphylaxis.' Blood: 'Leukocytosis.' Neoplasms: 'Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy.'
  • §4.8 frequency caveat, verbatim: 'The incidence of predictable undesirable effects, including hypothalamo-pituitary-adrenal (HPA) suppression, correlates with the relative potency of the drug, dosage, timing of administration and the duration of treatment.' All the above are listed at frequency 'Not known'.
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • Steroid treatment card — §4.4 verbatim: '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.'
  • Disease activity during withdrawal — §4.4 verbatim: 'Clinical assessment of disease activity may be needed during withdrawal.'
  • Cover for physiological stress — §4.2 verbatim: 'During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage; if corticosteroids have been stopped following prolonged therapy they may need to be temporarily re-introduced.'
  • Identify children needing a gradual taper even after a short course — §4.4 lists: patients who have had repeated courses, particularly if taken for greater than 3 weeks; a short course prescribed within one year of cessation of long-term therapy; other reasons for adrenocortical insufficiency; doses greater than 40 mg daily of prednisolone or equivalent; and 'Patients repeatedly taking doses in the evening.'
  • Frequent review of dose — §4.4 verbatim (truncated at the source-fetch limit): 'Frequent patient review is required to appropriately titrate the […]'.
  • ⚠️ The fetched SPC sections give no laboratory monitoring schedule.
  • This list may be incomplete — check the full SPC.

Clinical monograph

How it works

It binds intracellular glucocorticoid receptors to modulate gene transcription, suppressing inflammatory mediators and immune cell activity.

Prescribing in practice

  • Prolonged or repeated courses suppress the hypothalamic-pituitary-adrenal axis and impair linear growth in children, so the lowest effective dose for the shortest duration should be used and longer courses tapered rather than stopped abruptly.
  • It increases susceptibility to infection and can mask its signs; varicella and measles exposure in a non-immune child on systemic steroids needs prompt assessment.
  • Soluble and standard tablets and liquids exist; confirm the correct strength and formulation against a children's formulary.

Monitoring

For longer courses monitor growth, blood pressure, blood glucose and signs of infection, and provide steroid-sickness advice for those at risk of adrenal suppression.

Counselling the patient

  • Give with or after food to reduce stomach upset.
  • Do not stop a longer course suddenly; follow the reducing plan.
  • Carry a steroid alert card if on prolonged treatment and seek advice if the child is exposed to chickenpox or measles.

Evidence & guidelines

Oral corticosteroids such as prednisolone are recommended in national asthma and croup guidance, and short courses are standard relapse treatment in childhood nephrotic syndrome.

Reference: NICE NG80 (Asthma); RCPCH Nephrotic Syndrome Guidelines; BTS/SIGN Asthma Guideline; 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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