Indications & Dose:
Acute exacerbation of chronic obstructive pulmonary disease (if increased breathlessness interferes with daily activities)
Adult: 30 mg daily for 7–14 days
Severe croup (before transfer to hospital) | Mild croup that might cause complications (before transfer to hospital)
Child: 1–2 mg/kg
Mild to moderate acute asthma (when oral corticosteroid taken for more than a few days) | Severe or lifethreatening acute asthma (when oral corticosteroid taken for more than a few days)
Child 1 month–11 years: 2 mg/kg once daily (max. per dose 60 mg) for up to 3 days, longer if necessary
Mild to moderate acute asthma | Severe or lifethreatening acute asthma
Child 1 month–11 years: 1–2 mg/kg once daily (max. per dose 40 mg) for up to 3 days, longer if necessary
Child 12–17 years: 40–50 mg daily for at least 5 days
Adult: 40–50 mg daily for at least 5 days
Suppression of inflammatory and allergic disorders
Adult: Initially 10–20 mg daily, dose preferably taken in the morning after breakfast, can often be reduced within a few days but may need to be continued for several weeks or months; maintenance 2.5–15 mg daily, higher doses may be needed; cushingoid sideeffects increasingly likely with doses above 7.5mg daily
Suppression of inflammatory and allergic disorders (initial dose in severe disease)
Adult: Initially up to 60 mg daily, dose preferably taken in the morning after breakfast, can often be reduced within a few days but may need to be continued for several weeks or months
Idiopathic thrombocytopenic purpura
Adult: 1 mg/kg daily, gradually reduce dose over several weeks
Ulcerative colitis | Crohn’s disease
Adult: Initially 20–40 mg daily until remission occurs, followed by reducing doses, up to 60 mg daily, may be used in some cases, doses preferably taken in the morning after breakfast
Neuritic pain or weakness heralding rapid onset of permanent nerve damage (during reversal reactions multibacillary leprosy)
Adult: Initially 40–60 mg daily, dose to be instituted at once
Generalised myasthenia gravis (when given on alternate days)
Adult: Initially 10 mg once daily on alternate days, then increased in steps of 10 mg once daily on alternate days, increased to 1–1.5 mg/kg once daily on alternate days (max. per dose 100 mg)
Generalised myasthenia gravis in ventilated patients (when given on alternate days)
Adult: Initially 1.5 mg/kg once daily on alternate days (max. per dose 100 mg)
Generalised myasthenia gravis (when giving daily)
Adult: Initially 5 mg daily, increased in steps of 5 mg daily. maintenance 60–80 mg daily, alternatively maintenance 0.75–1 mg/kg daily, ventilated patients may be started on 1.5 mg/kg (max. 100 mg) on alternate days
Ocular myasthenia
Adult: Usual dose 10–40 mg once daily on alternate days, reduce to minimum effective dose
Reduction in rate of joint destruction in moderate to severe rheumatoid arthritis of less than 2 years’ duration
Adult: 7.5 mg daily
Polymyalgia rheumatica
Adult: 10–15 mg daily until remission of disease activity; maintenance 7.5–10 mg daily, reduce gradually to maintenance dose. Many patients require treatment for at least 2 years and in some patients it may be necessary to continue long term low-dose corticosteroid treatment
Giant cell (temporal) arteritis
Adult: 40–60 mg daily until remission of disease activity, the higher dose being used if visual symptoms occur; maintenance 7.5–10 mg daily, reduce gradually to maintenance dose. Many patients require treatment for at least 2 years and in some patients it may be necessary to continue long term low-dose corticosteroid treatment
Polyarteritis nodosa | Polymyositis | Systemic lupus erythematosus
Adult: Initially 60 mg daily, to be reduced gradually; maintenance 10–15 mg daily
Anorexia (symptom control in palliative care)
Adult: 15–30 mg daily
Pneumocystis pneumonia in moderate to severe infections associated with HIV infection
Adult: 50–80 mg daily for 5 days, the dose is then reduced to complete 21 days of treatment, corticosteroid treatment should ideally be started at the same time as the anti-pneumocystis therapy and certainly no later than 24–72 hours afterwards. The corticosteroid should be withdrawn before antipneumocystis treatment is complete
Short-term prophylaxis of episodic cluster headache as monotherapy or in combination with verapamil during verapamil titration
Adult: 60–100 mg once daily for 2–5 days, then reduced in steps of 10 mg every 2–3 days until prednisolone is discontinued Proctitis
Contraindications:
Peptic ulcer, live virus immunisation, systemic infection, hypersensitivity.
Side Effects:
CNS: Depression, headache, mood changes, seizures, vertigo
CV: CHF, hypertension, tachycardia, thromboemblism, thrombophlebitis
EENT: Systemic: Cataracts, glaucoma, increased intraocular pressure, optic nerve damage; papiliedema;
ophthalmic: Blurred vision, burning with administration, cataracts, corneal infection, decreased visual acuity and visual fields, glaucoma exacerbation, increased intraocular pressure, optic nerve damage, poor corneal wound healing, stinging with administration
G1: Abdominal distension, diarrhea, GI hemorrhage,increased appetite, nausea, pancreatitis
METAB: Cushingoid state, decreased glucose tolerance, growth suppression in children, HPA axis suppression, hypercalciuria, hypokalemia
MS: Aseptic necrosis of femoral and humeral heads, fractures, muscle mass loss, osteoporosis, weakness
SKIN: Acne, ecchymosis, petechiae, ,sttiae, poor wound healing, suppression of skin test reactions, thin ,fragile skin
Cautions:
Precautions:
System fungal infections; (ophth): acute superficial herpes simplex keratitis and viral diseases of the cornea and conjunctiva; fungal diseases of ocular structures; ocular TB; following uncomplicated removal of a superficial corneal foreign body.
PREGNANCY: Use only if clearly indicated.
BREAST-FEEDING: Use with caution.
OLD AGE: Use with caution.
Interaction:
Drugs
Aminoglutethamide: Increased clearance of prednisolone; doubling of dose may be required
Antidiabetics: Increased blood glucose
Barbiturates: Increased clearance of prednisolone
Cholestyramine, colestipol: Reduced absorption of prednisolone
Clarithromycin, erythromycin, trvleandomycin, ketoconazole: Possible enhanced steroid effect
Estrogens, oral contraceptives: Eahanced effects of corticosteroid
Intrauterine devices: Decreased contraceptive effect (possibly secondary inhibition of inflammatory reaction)
lsoniazid:Reduced plasma concentrations of isoniazid; (rapid isoniazid acetylators at increased risk,)
NSAIDs: Increased risk GI ulceration
Rifampin: May reduce hepatic clearance of prednisolone Salicylates: Increased salicylate clearance
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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