Prednisolone is indicated in the following conditions:

Rheumatic Disorders: Psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, acute and subacute bursitis, acute non-specific tenosynovitis, acute gouty arthritis, post-traumatic osteoarthritis.

Endocrine Disorders: Primary or secondary adrenocortical insufficiency, congenital adrenal hyperplasia, nonsuppurative thyroiditis, hypercalcemia associated with malignancy.

Dermatologic Diseases: Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme, exfoliative dermatitis, mycosis fungoides, severe psoriasis.

Allergic Conditions: Seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions.

Respiratory Diseases: Symptomatic sarcoidosis, berylliosis, fulminating aspiration pneumonitis.

Hematologic Disorders: Idiopathic thrombocytopenic purpura, secondary thrombocytopenia, autoimmune hemolytic anemia, erythroblastopenia (RBC aplasia).

Edematous States: To induce diuresis or remission of proteinuria in nephrotic syndrome without uremia, either idiopathic or due to systemic lupus erythematosus.

Gastrointestinal Diseases: Ulcerative colitis, regional enteritis.

Prednisolone is a synthetic adrenocortical steroid with predominantly glucocorticoid activity. It inhibits phospholipase A2, thereby reducing the formation of inflammatory mediators such as leukotrienes, SRS-A, and prostaglandins. After oral administration, prednisolone is rapidly and well absorbed from the gastrointestinal tract. It is approximately 70–90% plasma protein bound. The plasma half-life is about 2–4 hours. It is primarily metabolized in the liver and excreted in urine.

Adult

Nephrotic Syndrome:

• Initial: 2 mg/kg/day (maximum 80 mg/day) in divided doses 3 to 4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1 to 1.5 mg/kg/dose given every other day for 4 weeks.
• Maintenance dose: 0.5 to 1 mg/kg/dose given every other day for 3 to 6 months.

Anti-inflammatory: 5 to 60 mg per day in divided doses 1 to 4 times/day.

Acute Asthma: 40–60 mg/day PO in single daily dose or divided q12 hr for 3–10 days.

Allergic Conditions:

• Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime.
• Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime.
• Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime.
• Day 4: 5 mg PO before breakfast, after lunch, and at bedtime.
• Day 5: 5 mg PO before breakfast and at bedtime.
• Day 6: 5 mg PO before breakfast.

Pediatric

Asthma:

• 1 year: Acute: 10 mg orally every 12 hours. Maintenance: 10 mg orally every other day.
• 1 to 4 years: Acute: 20 mg orally every 12 hours. Maintenance: 20 mg orally every other day.
• 5 to 12 years: Acute: 30 mg orally every 12 hours. Maintenance: 30 mg orally every other day.
• 12 years: Acute: 40 mg orally every 12 hours. Maintenance: 40 mg orally every other day.

Anti-inflammatory: 0.05 to 2 mg/kg/day divided 1 to 4 times/day.

Immunosuppression: 0.05 to 2 mg/kg/day divided 1 to 4 times/day.

The effectiveness of prednisolone may be reduced by aminoglutethimide, antacids, barbiturates, carbamazepine, griseofulvin, mitotane, phenylbutazone, phenytoin, primidone, and rifampin. Prednisolone may decrease serum potassium levels. If hypokalemia occurs, concurrent use with digitalis may increase the risk of cardiac arrhythmias. Immunization should be performed with caution during therapy.

Systemic fungal or bacterial infections unless appropriate anti-infective therapy is given. Hypersensitivity to any component of the formulation. Ocular herpes simplex due to risk of corneal perforation.

Fluid and Electrolyte Disturbances: Sodium and fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension.

Musculoskeletal: Muscle weakness, steroid-induced myopathy, muscle wasting, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathological fractures of long bones.

Gastrointestinal: Peptic ulcer with risk of perforation and hemorrhage, pancreatitis, abdominal distension, ulcerative esophagitis.

Dermatologic: Delayed wound healing, thin fragile skin, petechiae and ecchymoses, facial redness, increased sweating, suppression of skin test reactions.

Neurological: Convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri), vertigo, headache.

Endocrine: Menstrual irregularities, Cushingoid features, growth suppression in children, secondary adrenal and pituitary suppression (especially during stress such as surgery, trauma, or illness), decreased glucose tolerance, manifestation of latent diabetes, increased insulin or oral hypoglycemic requirement.

Ophthalmic: Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos.

Metabolic: Negative nitrogen balance due to protein breakdown.

This medicine should be used during pregnancy only if clearly necessary and when the expected benefit outweighs the potential risk to the fetus. Corticosteroids are excreted in breast milk and may suppress infant growth, affect endogenous steroid production, or cause other adverse effects.

Patients receiving immunosuppressive doses of corticosteroids should be advised to avoid exposure to chickenpox and measles. If exposure occurs, immediate medical advice should be sought.

In patients under corticosteroid therapy who are exposed to unusual physical or psychological stress, an increased dose of rapidly acting corticosteroids may be required before, during, and after the stressful period.

Corticosteroids may mask signs of infection, and new infections may develop during therapy. Reduced resistance and impaired ability to localize infection may also occur with corticosteroid use.

Prolonged corticosteroid therapy may lead to posterior subcapsular cataracts, glaucoma with possible optic nerve damage, and increased risk of secondary ocular infections caused by fungi or viruses.

Moderate to high doses of hydrocortisone or cortisone may cause hypertension, sodium and water retention, and increased potassium excretion.

Patients on corticosteroid therapy should not receive smallpox vaccination. Other immunizations should also be avoided, especially in patients receiving high doses, due to risk of neurological complications and reduced antibody response.

Children receiving immunosuppressive therapy are more prone to infections compared to healthy children. Chickenpox and measles may have a severe or even fatal course in non-immune children or adults on corticosteroids.

Pediatric Use: In infants treated for endocrine disorders such as primary or secondary adrenocortical insufficiency, mineralocorticoid supplementation is particularly important. Infants born to mothers who received high doses of corticosteroids during pregnancy should be closely monitored for signs of adrenal suppression. Immunization should be avoided in pediatric patients receiving corticosteroids. Immunocompromised children are at higher risk of infections, which may be severe or fatal in cases such as chickenpox and measles. Long-term corticosteroid therapy in children should be carefully monitored for growth and developmental effects.

Adverse effects of prednisone usually occur only after prolonged use of doses exceeding normal physiological requirements. Treatment is mainly symptomatic, and the dose should be gradually reduced when possible.

Glucocorticoids

Store in a cool, dry place, protected from light. Keep out of reach of children.