Systemic glucocorticoid
Prednisolone
Binds cytosolic glucocorticoid receptors to alter gene transcription, suppressing cytokine production, eosinophil survival and vascular permeability.
Brands
Deltacortril · Omnacortil · Wysolone
Adult dosing
Maximum Indication dependent; 40-50 mg/day for airway exacerbations| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Acute asthma or COPD exacerbation | 40-50 mg | Oral | Once daily in the morning for 5 days |
| Inflammatory disease, high dose | 0.5-1 mg/kg/day | Oral | Once daily, then tapered |
Older adults: Consider bone protection and glucose monitoring from the outset.
Paediatric dosing
Always confirm the weight and the local paediatric formulary| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Acute asthma, 1-5 years | 20 mg | Oral | Once daily for 3 days |
| Acute asthma, over 5 years | 30-40 mg | Oral | Once daily for 3-5 days |
| Weight-based alternative | 1-2 mg/kg/dayMax 40 mg/day | Oral | Once daily |
Renal adjustment
Move the slider to the patient's eGFRNo adjustment
- Any eGFRNo adjustment
Hepatic adjustment
- Severe impairmentPrefer prednisolone over prednisone — no hepatic activation needed
Practical notes
The things that go wrong at the bedside- Courses of up to 3 weeks need no taper; longer or repeated courses do.
- Anyone on long-term steroid needs a steroid emergency card and sick-day dose rules.
DrZep structured dosing table (demo dataset, formulary-aligned) · DrZep. Confirm every dose against your local formulary and the patient's weight, renal function and comorbidities.
Indications
- Acute asthma exacerbation
- COPD exacerbation
- Inflammatory and autoimmune disease flares
- Allergic reactions and angio-oedema (adjunct)
- Croup and other paediatric indications
Dosing summary
- Acute asthma (adult)
- 40-50 mg once daily for 5-7 days; no taper needed for short courses
- COPD exacerbation
- 30-40 mg once daily for 5 days
- Children (asthma)
- 1-2 mg/kg once daily (maximum 40 mg) for 3-5 days
- Long-term therapy
- Lowest effective dose; taper if used for more than 3 weeks
Organ adjustment
Renal
- All stages
- No adjustment; monitor blood pressure and fluid retention
Hepatic
- Severe impairment
- Prednisolone is preferred over prednisone (no hepatic activation needed)
Monitoring
- 1Glucose during and after the course, especially in diabetes
- 2Blood pressure and weight
- 3Bone protection assessment for courses beyond 3 months or frequent repeats
- 4Cumulative annual steroid exposure
Contraindications & cautions
Do not use / use with care
- Systemic fungal infection without antifungal cover
- Live vaccine administration during high-dose therapy
- Untreated serious infection (relative)
Pregnancy & lactation
- Pregnancy
- Used when indicated; prednisolone is largely inactivated by the placenta. Monitor maternal glucose and blood pressure.
- Lactation
- Compatible; consider a 4-hour gap after high doses.
Interactions
- NSAIDsMarked increase in GI ulceration and bleedingmajor
- Live vaccinesRisk of disseminated infection at immunosuppressive dosesmajor
- CYP3A4 inhibitors (ritonavir, itraconazole)Raised steroid exposure and Cushingoid effectsmoderate
- Rifampicin, phenytoin, carbamazepineReduced steroid efficacymoderate
- Insulin and oral hypoglycaemicsHyperglycaemia requiring dose increasemoderate
Adverse effects
Common
- Hyperglycaemia
- Insomnia and mood change
- Increased appetite and weight gain
- Dyspepsia
- Fluid retention
Serious
- Adrenal suppression
- Osteoporosis and fragility fracture
- Serious infection and reactivation of tuberculosis or strongyloides
- Psychosis
- Avascular necrosis
- Peptic ulcer perforation
Toxicity & overdose
Recognise and treat
- Abrupt withdrawal after prolonged therapy causes adrenal crisis — hypotension, hyponatraemia, hypoglycaemia; treat with IV hydrocortisone and fluids and issue a steroid emergency card
Alternatives
- Dexamethasone (longer acting, single dose in croup or paediatric asthma)
- Inhaled corticosteroid escalation for maintenance
- Biologics in severe eosinophilic asthma to spare oral steroids
Linked diseases & guidelines
GINA Global Strategy for Asthma Management and Prevention
Track 1 ICS-formoterol reliever strategy, stepwise control and exacerbation management.
Global Initiative for AsthmaGlobal2025
GOLD Global Strategy for Diagnosis, Management and Prevention of COPD
ABE assessment groups, initial inhaler choice by symptoms and exacerbations, eosinophil-guided ICS use.
GOLDGlobal2025
Demo monograph for educational use. Always confirm dose, route and interactions against your national formulary and the product label before prescribing.
Demo content. Educational decision support only. Verify every dose, citation and recommendation against your national formulary and the primary source before clinical use.