Prednisolone

How it works

     * Prednisolone is corticosteroid that is used to reduce inflammation
       and calm down an overactive immune system. It has predominant
       glucocorticoid and low mineralocorticoid activity, which means it
       affects the immune response and inflammation rather than
       electrolytes and water.
     * Prednisolone mimics the effect of cortisol, a hormone released by
       the adrenal glands (located on top of the kidneys) that
       controls metabolism and stress.
     * Prednisolone belongs to the class of medicines known as
       corticosteroids. Specifically, it is a glucocorticoid.

Upsides

     * Prednisolone can help dampen down an over-reactive immune system
       and reduce inflammation.
     * Used in the treatment of allergies, arthritis, certain blood
       disorders, cancer, endocrine disorders, inflammatory bowel
       diseases, swelling and skin conditions.
     * Typically only taken as a short-course.
     * Prednisolone also helps to control moderate-to-severe asthma
       attacks by controlling inflammation.
     * Prednisolone is the active form of prednisone (prednisone is
       metabolized in the liver first to become prednisolone).
     * Available as an oral tablet, orally disintegrating tablet, oral
       suspension, and ophthalmic solution.
     * Generic prednisolone is available.

Downsides

   If you are between the ages of 18 and 60, take no other medication or
   have no other medical conditions, side effects you are more likely to
   experience include:
     * Acne, dizziness, facial flushing, general aches and pains,
       headache, an increased appetite which may result in weight gain,
       increased sweating, indigestion, insomnia, are the most common side
       effects reported.
     * May also cause facial hair growth (especially in women), high blood
       pressure, slow skin healing and skin thinning, osteoporosis
       (brittle bones), the onset of diabetes, sodium and water retention,
       and stomach ulcers with long-term use.
     * Side effects are more likely to be experienced at higher dosages.
     * Limit or avoid alcohol use while taking prednisolone to help
       prevent stomach ulcers.
     * With high doses of corticosteroids, ‘live vaccines’ should be
       delayed until several months after corticosteroid treatment has
       stopped.
     * Children may be especially sensitive to the effects of
       prednisolone. Prolonged prednisolone use may affect growth and
       development in children.
     * All corticosteroids, including prednisolone, can cause salt and
       fluid retention, which may lead to blood pressure elevation and
       increased potassium excretion. Calcium excretion is also increased.
     * Cataracts, glaucoma, eye infections, an increase in new episodes of
       optic neuritis and corneal perforation associated with herpes
       simplex of the eye, have all been reported with prednisolone use.
     * Prednisolone may cause low potassium levels (hypokalemia), which
       may be potentiated by other drugs that also cause hypokalemia (such
       as diuretics, amphotericin B).
     * Prednisolone is considerably more expensive than prednisone, but
       their effectiveness is similar.
     * May cause withdrawal symptoms if stopped suddenly after long-term
       or high-dose therapy. Symptoms include fever, vomiting, loss of
       appetite, diarrhea, weight loss, general aches, and pains.
     * May not be suitable for some people including those with fungal
       infections, thyroid disorders, herpes infection of the eyes, mental
       health issues, stomach ulcers, liver disease, high blood pressure,
       osteoporosis, myasthenia gravis, or multiple sclerosis.
     * Prednisolone may interact with a number of other medications
       including anticholinesterase agents, antidiabetic agents,
       anticoagulants, digoxin, estrogens, NSAIDs, and vaccinations
       (including both live and inactivated vaccines). It may also
       suppress the reaction to some skin tests.

   Notes: In general, seniors or children, people with certain medical
   conditions (such as liver or kidney problems, heart disease, diabetes,
   seizures) or people who take other medications are more at risk of
   developing a wider range of side effects. For a complete list of all
   side effects, [84]click here.

Bottom Line

     * Prednisolone effectively controls inflammation and an overactive
       immune system but may not be suitable for everybody. Long-term use
       is limited by potentially severe side effects such as adrenal
       suppression and an increased risk of infection. Prednisolone should
       always be used at the lowest effective dose for the shortest
       possible time.

Tips

     * Take with food and a full glass of water.
     * Single doses are preferred over split doses.
     * Take exactly as directed by your doctor. Sometimes dosing for
       prednisolone may seem complicated. Follow the prescription label
       and your doctor's instructions exactly. If you have any concerns,
       ask your doctor. Do not take more or less prednisolone than
       prescribed.
     * Take prednisolone in the morning, before 9 AM to more closely mimic
       your body's natural secretion of cortisol.
     * If you are taking prednisolone suspension or giving a dose to a
       child, shake the suspension well and ensure you use a properly
       calibrated dosing syringe, rather than a kitchen teaspoon, to
       accurately measure the dose.
     * Keep prednisolone disintegrating tablets unopened in their packet
       until it is time to take them. Use dry hands to open the packet,
       and peel back the foil from the tablet, rather than trying to push
       the tablet through. Place the tablet in your mouth and allow to
       disintegrate, do not crush or chew.
     * Prednisolone ophthalmic solution is not compatible with contact
       lenses. Ask your doctor or health care professional when you can
       use your lenses again.
     * Stopping prednisolone suddenly can be dangerous. Do not stop taking
       without a doctor's advice. People who have taken prednisolone
       long-term must slowly wean themselves off it over a period of days
       or weeks, following their doctor's instructions.
     * Avoid alcohol while you are taking prednisolone.
     * Prednisolone may affect blood sugar readings in people with
       diabetes. Talk to your doctor about how you should manage this.
     * Talk to your doctor if you become unwell or stressed while taking
       prednisolone. Your dosage may need to be adjusted temporarily.
     * Avoid contact with anybody known to have, or recently exposed to,
       viral illnesses such as chickenpox or measles. If you inadvertently
       come into contact with somebody, contact your doctor immediately as
       immune globulin or antiviral treatment may be required.
     * Tell other health care professionals, including your dentist, that
       you are taking prednisolone. Talk to your doctor or pharmacist
       before taking any other medications with prednisolone, including
       those bought over-the-counter, because some may not be compatible
       with prednisolone.

Response and Effectiveness

     * Effects can last from 18-36 hours, meaning that alternate day
       dosing is possible.
     * Temporary dosage increases may be necessary during disease
       flare-ups or during times of stress or infection.
     * Prednisolone is five times more potent at relieving inflammation
       than naturally occurring cortisol.

References