BMA Concise Guide to Medicine & Drugs

Prednisolone

Brand names Deltacortril, Deltastab, Minims prednisolone, Pred Forte, Predenema, Predfoam, Predsol, and others

Used in the following combined preparations Predsol-N, Scheriproct

QUICK REFERENCE

Drug group Corticosteroid

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Prednisolone, a powerful corticosteroid, is used for a wide range of conditions, including some skin diseases, rheumatic disorders, allergic states, and certain blood disorders. It is used as eye drops to reduce inflammation in conjunctivitis or iritis and may be given as an enema to treat inflammatory bowel disease. It is also prescribed with fludrocortisone for pituitary or adrenal gland disorders.

Prednisolone taken short term either by mouth or topically rarely causes serious side effects. However, long-term treatment with high doses can cause systemic effects, such as osteoporosis, fluid retention, indigestion, diabetes, hypertension, and acne. Enteric-coated tablets reduce the local effects of the drug on the stomach but not these systemic effects.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, injection, suppositories, enema, foam, eye and ear drops.

Frequency and timing of doses Usually once daily or on alternate days with food (tablets); 2–4 x daily, more frequently initially (eye/ear drops).

Adult dosage range Considerable variation. Follow your doctor’s instructions.

Onset of effect 2–4 days.

Duration of action 12–72 hours.

Diet advice A low-sodium diet may be recommended when the oral form of the drug is prescribed for extended periods. Follow the advice of your doctor.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 6 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor. Abrupt cessation of long-term treatment by mouth may be dangerous.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

The more serious adverse effects occur only when high doses are taken by mouth for long periods; their frequency then increases with both dose and duration of treatment. Common adverse effects are indigestion and acne; rarer ones include weight gain, muscle weakness, mood changes, and depression. Discuss with your doctor if weight gain is substantial or if any of the other symptoms occur. If you have black or bloodstained faeces, you should stop taking the drug and contact your doctor immediately. If you are taking prenisolone tablets regularly, you should avoid close contact with chickenpox and herpes zoster and seek urgent medical attention if exposed. Long-term use of prednisolone may also cause various disorders (see Prolonged use).

INTERACTIONS

Anticonvulsant drugs Carbamazepine, phenytoin, and phenobarbital can reduce the effects of prednisolone.

Vaccines Serious reactions can occur if live vaccines are given with this drug. Discuss with your doctor.

Anticoagulant drugs Prednisolone may affect the response to these drugs.

Antihypertensive and antidiabetic drugs and insulin Larger doses may be needed when taken with prednisolone.

Ciclosporin and tacrolimus may reduce the dose of prednisolone required.

NSAIDs There is an increased risk of peptic ulcers when these drugs are taken with prednisolone.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had a peptic ulcer.

· You have glaucoma.

· You have had tuberculosis.

· You suffer from depression or psychiatric illness.

· You have any infection.

· You have diabetes.

· You have osteoporosis.

· You are taking other medicines.

Pregnancy No evidence of risk with eye or ear drops. Taken as tablets in low doses, harm to the fetus is unlikely. Discuss with your doctor.

Breast-feeding No evidence of risk with eye or ear drops. Taken by mouth, it passes into the breast milk, but at low doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Only given when essential. Alternate-day dosing preferred to prevent growth retardation.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work No known problems.

Alcohol Keep consumption low. Alcohol may increase the risk of peptic ulcers with prednisolone taken by mouth or injection.

Infection Avoid exposure to chickenpox, shingles, or measles if you are on systemic treatment.

PROLONGED USE

Prolonged use by mouth can lead to diabetes, peptic ulcers, glaucoma, muscle weakness, osteoporosis, and growth retardation in children. Prolonged topical use may also lead to skin thinning. People on long-term treatment should carry a steroid card.