Overview
Prednisolone is a synthetic glucocorticoid with potent anti-inflammatory and immunosuppressive properties. It is used to treat a wide range of inflammatory, allergic, autoimmune, and neoplastic conditions by suppressing immune responses and reducing inflammation. Treatment requires careful dosing and monitoring due to significant side effects and the need for gradual tapering.
Mechanism of Action
Prednisolone binds to glucocorticoid receptors, modulating gene expression to inhibit pro-inflammatory cytokines, reduce leukocyte migration, and suppress immune cell function. It also affects carbohydrate, protein, and fat metabolism while influencing electrolyte and water balance.
Indications
- Allergic conditions (severe rhinitis, asthma, dermatitis, drug hypersensitivity)
- Dermatologic diseases (pemphigus, bullous dermatitis, erythema multiforme)
- Edematous states (nephrotic syndrome)
- Endocrine disorders (adrenal insufficiency, congenital adrenal hyperplasia)
- Gastrointestinal diseases (ulcerative colitis, Crohn's disease)
- Hematologic disorders (idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia)
- Neoplastic diseases (acute leukemia, aggressive lymphomas)
- Nervous system (multiple sclerosis exacerbations)
- Ophthalmic diseases (uveitis, ocular inflammation)
- Respiratory diseases (sarcoidosis, COPD exacerbations, asthma, pulmonary fibrosis)
- Rheumatic disorders (rheumatoid arthritis, lupus, gout, bursitis)
- Miscellaneous (tuberculosis complications, organ rejection, trichinosis)
Common Doses
- 5 mg/5 mL oral solution
- 15 mg/5 mL oral solution
Dosage
Initial dosage ranges from 5-60 mg daily based on disease severity and patient response, with maintenance doses titrated to the lowest effective level. Pediatric dosing is typically 0.14-2 mg/kg/day. Tapering is required after long-term use to avoid adrenal insufficiency.
Contraindications
- Systemic fungal infections
- Hypersensitivity to prednisolone or formulation components
Side Effects
- Fluid retention, hypertension, hypokalemia
- Peptic ulcers, gastrointestinal bleeding, pancreatitis
- Osteoporosis, avascular necrosis, muscle weakness
- Hyperglycemia, Cushingoid appearance, adrenal suppression
- Increased infection risk, impaired wound healing
- Cataracts, glaucoma, increased intraocular pressure
- Psychiatric disturbances, headache, vertigo
- Skin thinning, bruising, acne, hirsutism
Interactions
- Barbiturates, phenytoin, rifampin: Decreased prednisolone efficacy via increased metabolism
- Ketoconazole: Increased prednisolone levels and toxicity risk
- Warfarin: Altered anticoagulant effect requiring monitoring
- NSAIDs/aspirin: Increased gastrointestinal ulcer risk
- Diuretics: Enhanced hypokalemia risk
- Antidiabetic agents: May require dosage adjustment due to hyperglycemia
- Vaccines: Diminished immune response to live vaccines
Counseling Points
- Take exactly as prescribed; do not stop abruptly without medical guidance
- Report signs of infection, unusual weight gain, swelling, or mood changes
- Monitor blood glucose if diabetic; medication may increase levels
- Take with food to minimize gastrointestinal upset
- Carry medical identification indicating steroid use
- Inform all healthcare providers about prednisolone use before procedures or vaccinations
- Maintain adequate calcium and vitamin D intake for bone health