💊 Prednisolone

Prednisolone is an intermediate-acting synthetic glucocorticoid, a type of corticosteroid. It is a prodrug of prednisone, which is metabolised in the liver to prednisolone, the active form.

Similar to other glucocorticoids, prednisolone binds to intracellular glucocorticoid receptors, modulating gene expression. This leads to potent anti-inflammatory and immunosuppressive effects by inhibiting the synthesis of inflammatory mediators and suppressing immune cell function.

Prednisolone is widely used for its anti-inflammatory and immunosuppressive properties in conditions such as asthma, COPD exacerbations, inflammatory bowel disease (Crohn's, ulcerative colitis), rheumatoid arthritis, and various autoimmune disorders. It is also used in certain allergic reactions and some malignancies.

Absolute contraindications include systemic fungal infections (unless treated) and hypersensitivity. Relative contraindications include active untreated infections (especially viral or bacterial), peptic ulcer disease, uncontrolled diabetes, severe osteoporosis, and glaucoma, requiring careful risk-benefit assessment.

Common adverse effects include fluid retention, hypertension, hyperglycaemia, increased appetite, weight gain, and mood changes (e.g., insomnia, irritability). Long-term use can lead to adrenal suppression, osteoporosis, Cushingoid features, skin thinning, and increased susceptibility to infections. Gastric irritation is also common.

For long-term use, regular monitoring of blood pressure, blood glucose, electrolytes, and bone mineral density is essential. Patients should be monitored for signs of infection, gastrointestinal bleeding, and psychological disturbances. Growth in children on prolonged therapy should also be assessed.

Check for allergies, especially to other corticosteroids. Be aware of significant drug interactions, such as increased risk of GI bleeding with NSAIDs, reduced efficacy of antidiabetic drugs, and altered metabolism with CYP3A4 inhibitors/inducers. Counsel patients on the importance of not stopping abruptly, potential side effects, and carrying a steroid card if on long-term therapy.

Prednisolone is a very commonly prescribed oral corticosteroid. Remember the importance of tapering the dose to avoid adrenal insufficiency, especially after prolonged courses. Be aware of its broad range of indications due to its potent anti-inflammatory and immunosuppressive effects. Counsel patients about carrying a steroid card for long-term use.

SBAs frequently test the management of conditions like asthma exacerbations or IBD flares where prednisolone is indicated. Questions may focus on the importance of gradual dose tapering to prevent adrenal crisis, or on the recognition and management of common side effects, particularly osteoporosis and increased infection risk. Drug interactions are also a common theme.