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Corticosteroid (oral) — bridge/anti-inflammatory Pregnancy: Oral prednisolone used in pregnancy for autoimmune conditions — lowest effective dose; avoid in first trimester if possible.

Prednisolone (Rheumatology)

Brand names: Deltacortril, Precortisyl Forte

Adult dose

Dose: RA bridge: 7.5–15 mg/day; PMR: 15–20 mg/day; GCA: 40–60 mg/day; Severe flares: 0.5–1 mg/kg/day
Route: Oral
Frequency: Once daily (morning)
Max: 60 mg/day (standard rheumatological); higher specialist doses for vasculitis
RA bridging therapy: 7.5–15 mg/day while awaiting DMARD effect, taper over 3 months. PMR: 15–20 mg/day, taper by 1 mg every 4 weeks. GCA: 40–60 mg/day (IV methylprednisolone if visual loss imminent). All patients on >3 months steroids: bone protection (calcium, Vit D ± bisphosphonate) + PPI.

Paediatric dose

Dose: 1 mg/kg
Route: Oral
Frequency: Once daily
Max: 40 mg/day
JIA flare: 0.5–1 mg/kg/day (max 40 mg). Taper as quickly as clinically possible. Growth suppression risk — use alternate-day dosing where possible.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required; hepatic conversion of prednisolone to active form may be impaired in severe disease.

Paediatric weight-based calculator

JIA flare: 0.5–1 mg/kg/day (max 40 mg). Taper as quickly as clinically possible. Growth suppression risk — use alternate-day dosing where possible.

Clinical pearls

  • GCA visual loss: immediate IV methylprednisolone 500–1000 mg/day for 3 days then oral prednisolone
  • Sick day rule: double dose during intercurrent illness (adrenal insufficiency prevention)
  • Bone protection: all patients >7.5 mg/day for >3 months should receive bisphosphonate + calcium/Vit D
  • Carry steroid emergency card/MedicAlert bracelet if on long-term doses
  • PMR target: CRP normalisation; taper to minimum effective dose to avoid osteoporosis

Contraindications

  • Systemic fungal infections (unless with antifungal cover)
  • Live vaccines (during high doses)

Side effects

  • Weight gain and fluid retention
  • Hyperglycaemia (steroid-induced diabetes)
  • Hypertension
  • Osteoporosis (fracture risk with long-term use)
  • Adrenal suppression and HPA axis suppression
  • Cataracts and glaucoma
  • Cushingoid features
  • Increased infection susceptibility
  • Mood changes (euphoria, depression, psychosis)

Interactions

  • NSAIDs — increased GI bleeding risk (use PPI)
  • Antidiabetics — reduced efficacy
  • Warfarin — variable effect on INR
  • Live vaccines — contraindicated
  • CYP3A4 inducers — reduce prednisolone levels

Monitoring

  • Blood glucose (SMBG)
  • Blood pressure
  • Bone density (DEXA at baseline and annually)
  • Weight
  • Serum potassium

Reference: BNFc; BNF; BSR PMR/GCA Guidelines; NOGG osteoporosis guidelines; NICE CG169. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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