ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Corticosteroid Pregnancy: C — short courses acceptable. Long-term use: neonatal adrenal suppression risk, oral cleft in first trimester (small risk).

Prednisolone (Systemic)

Brand names: Deltacortril, Pred Forte

Adult dose

Dose: Asthma/COPD exacerbation: 40mg OD × 5 days. Acute allergic reaction: 40–60mg OD. Autoimmune: 0.5–1mg/kg OD
Route: Oral
Frequency: Once daily (morning to mimic diurnal cortisol)
Max: 60mg/day (most indications). Autoimmune: up to 1mg/kg/day
Asthma: 40mg OD × 5 days — no taper needed for short courses <3 weeks. COPD exacerbation: 30–40mg OD × 5 days (NICE). PMR/GCA: start 15–60mg/day and taper slowly over months–years.

Paediatric dose

Dose: 1 mg/kg
Route: Oral
Frequency: Once daily for 3–5 days
Max: 40mg
Concentration: 1 mg/ml

Dose adjustments

Renal

No dose adjustment, but monitor fluid retention and BP.

Paediatric weight-based calculator

Clinical pearls

  • Short courses (<3 weeks) at standard doses: no need to taper and no adrenal suppression concern.
  • Long-term steroids (>3 months): prescribe bone protection (alendronate + calcium/vitamin D per NICE NG187 GIOP guidelines).
  • Sick day rules: patients on long-term steroids should double their dose for 48h during intercurrent illness — adrenal crisis prevention.
  • Steroid emergency card: all patients on >5mg/day prednisolone for >4 weeks should carry one.
  • REDUCE trial: 5-day prednisolone non-inferior to 14-day course in COPD exacerbations.

Contraindications

  • Systemic infection without appropriate antimicrobial cover
  • Live vaccines (within 3 months of high-dose steroids)
  • Peptic ulcer disease (prescribe PPI prophylaxis)

Side effects

  • Hyperglycaemia — check BM in diabetics
  • Fluid retention, hypertension
  • Osteoporosis (long-term use — prescribe calcium/vitamin D if >3 months)
  • Immunosuppression — increased infection risk, may mask sepsis
  • Adrenal suppression (courses >3 weeks — do not stop abruptly)
  • Weight gain, cushing's syndrome
  • Psychiatric effects (euphoria, psychosis, depression)

Interactions

  • NSAIDs: increased GI bleeding risk — add PPI
  • Warfarin: unpredictable INR changes — monitor closely
  • Rifampicin: reduces prednisolone levels significantly
  • Hypoglycaemic agents: steroids antagonise effect

Monitoring

  • Blood glucose (at every clinic visit if diabetic)
  • BP
  • weight
  • bone density (if >3 months)
  • adrenal function if stopping long-term course

Reference: BNFc; BTS/SIGN Asthma 2023; NICE NG115 COPD; NICE NG187 GIOP; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways