Prednisolone

About prednisolone

Prednisolone is a type of medicine known as a corticosteroid or steroid. Corticosteroids are not the same as anabolic steroids.

Prednisolone is used to treat a wide range of health problems including allergies, blood disorders, skin diseases, infections, certain cancers and to prevent organ rejection after a transplant.

It helps by reducing inflammation. It also damps down your immune system, which can help in autoimmune illnesses, like rheumatoid arthritis, where your immune system mistakenly attacks its own tissues.

Prednisolone is available only on prescription as tablets and as a liquid to drink. It can also be given by injection but this is usually only done in hospital.

Key facts

Take prednisolone once a day in the morning so it doesn't keep you awake.
Taking prednisolone can make you more likely to get infections. Tell your doctor if you're exposed to infectious illnesses like chickenpox or shingles.
The most common side effects of prednisolone are weight gain, indigestion, insomnia and sweating a lot.
Prednisolone can cause withdrawal problems if you stop taking it suddenly. Do not stop the medicine suddenly if you've been on it for more than 3 weeks or have taken high doses (more than 40mg) for more than 1 week.
It's also called by the brand names Deltacortril, Deltastab, Dilacort and Pevanti.

Who can and can't take prednisolone

Prednisolone can be taken by adults and children.

Prednisolone isn't suitable for some people.

Tell your doctor before starting the medicine if you:

have had an allergic reaction to prednisolone or any other medicine
have an infection (including eye infections)
are trying to get pregnant, are already pregnant or you are breastfeeding
have recently been in contact with someone with shingles, chickenpox or measles (unless you are sure you are immune to these infections)
have recently had, or are about to have, any vaccinations

Make sure your doctor is aware if you have:

had liver problems
had mental health problems (either you or close family members)
any unhealed wounds
heart failure or have had a recent heart attack
high blood pressure
diabetes
epilepsy
glaucoma
underactive thyroid
osteoporosis (thinning bones)
a stomach ulcer

How and when to take it

It's important to take prednisolone as your doctor has advised.

The usual dose varies between 5mg and 60mg daily - 1ml of liquid prednisolone is roughly equal to 10mg.

It's best to take prednisolone as a single dose once a day straight after breakfast. For example, if your dose is 40mg daily, it's usual to take 8 tablets (8 x 5mg) all at the same time.

Take prednisolone with breakfast so it doesn't upset your stomach. Taking prednisolone in the morning also means it's less likely to affect your sleep.

If you have enteric coated (red or brown) tablets, you can take these with or without food but make sure to swallow them whole. Do not take indigestion medicines 2 hours before or after taking enteric coated tablets.

Sometimes, you may be advised to take prednisolone on alternate days only.

How much will I take?

The dose depends on your illness and whether you are taking prednisolone as a short course or for longer.

In children, the dose may be lower than for an adult with the same illness because it is calculated according to their height and weight.

Will my dose go up or down?

Your dose may go up or down.

Once your illness starts to get better, it's likely that your dose will go down.

Your doctor will probably reduce your dose before you stop treatment completely.

Your dose may go up if your illness gets worse.

What if I forget to take it?

If you miss a dose of prednisolone, take it as soon as you remember. If you don't remember until the following day, skip the missed dose.

Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too many prednisolone tablets by accident is unlikely to harm you.

If you're worried, talk to your doctor or pharmacist.

Side effects

The higher the dose of prednisolone that you take, the greater the chance of side effects. You are less likely to get side effects if you take a relatively low dose of less than 20mg prednisolone daily.

Some side effects, such as stomach upset or mood changes, can happen straight away. Others, such as getting a rounder face, happen after weeks or months.

Common side effects

Common side effects happen in more than 1 in 100 people. Keep taking the medicine, but tell your doctor if they bother you or don't go away:

weight gain
indigestion
not able to sleep
restlessness
sweating a lot

Serious side effects

You are more likely to have a serious side effect if you take a higher dose (more than 20mg daily) of prednisolone or if you have been taking it for more than a few weeks.

Tell a doctor straight away if you get:

fever, chills, a very sore throat, ear or sinus pain, a cough, more saliva or a change in colour of saliva, pain with passing urine, mouth sores or a wound that will not heal - these can be signs of an infection
sleepy or confused, feeling very thirsty or hungry, passing urine more often, flushing, breathing quickly or breath that smells like fruit - these can be signs of high blood sugar
weight gain in the upper back or belly, moon face, very bad headaches and slow wound healing - these can be signs of Cushing's syndrome
a very upset stomach or vomiting, very bad dizziness or passing out, muscle weakness, feeling very tired, mood changes, loss of appetite and weight loss - these can be signs of adrenal gland problems
muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal - these can be signs of low potassium levels
severe stomach pain, severe back pain, severe upset stomach or vomiting - these can be signs of pancreas problems

You should also tell a doctor straight away if you get:

breathless
swelling in your arms or legs
changes in your eyesight
any bruising or bleeding that isn't normal
black poo
black or dark brown vomit or vomiting blood

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to prednisolone.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

These are not all the side effects of prednisolone. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

Stunted growth in children

Long periods of prednisolone treatment can slow down the normal growth of children and teenagers.

Your child's doctor will watch their growth carefully while they are taking steroids. That way any slowing of growth can be picked up promptly and treatment changed if necessary.

Talk to your doctor about the risks of giving prednisolone to your child if you are concerned.

How to cope with side effects

What to do about:

weight gain - try to eat a healthy balanced diet without increasing your portion sizes so you don't gain too much weight. Regular exercise will also help to keep your weight stable.
indigestion - take prednisolone with food to reduce the chances of stomach problems. It may also help if you avoid rich or spicy food while you're taking this medicine. If symptoms carry on, ask your doctor if you may benefit from taking an additional medicine to protect your stomach.

Pregnancy and breastfeeding

Prednisolone isn't usually recommended in pregnancy unless the potential benefits outweigh the risks.

Prednisolone has occasionally been linked to problems in the first 12 weeks of pregnancy. High doses or long term use can also affect the unborn baby's growth.

If you take prednisolone in pregnancy, the baby's growth will be checked often.

Prednisolone and breastfeeding

You can usually take prednisolone while you're breastfeeding. However, prednisolone can get into breast milk. If you're taking a high dose of prednisolone the baby may need to be monitored for side effects.

For safety, it's usually recommended that you wait 3 to 4 hours after taking your dose of prednisolone before feeding your baby or expressing milk.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Cautions with other medicines

There are many medicines that interfere with the way prednisolone works, or that increase the risk of side effects. It's very important you check a medicine is safe to take with prednisolone before you start taking it.

This includes some medicines that you buy over the counter like aspirin and anti-inflammatory painkillers such as ibuprofen.

Tell your doctor or pharmacist if you take any other medicines, including herbal remedies, vitamins or supplements.

Common questions

How does prednisolone work?

Steroids mimic the effects of hormones your body naturally produces in your adrenal glands. The adrenal glands sit on top of your kidneys.

When prescribed in doses higher than your body's usual levels, steroids like prednisolone dampen inflammation. This can reduce the symptoms of inflammatory conditions, such as arthritis and asthma.

Steroids also damp down your immune system, which can help in autoimmune illnesses, like rheumatoid arthritis, where your immune system mistakenly attacks its own tissues.

When will I feel better?

This can vary.

For some illnesses, you will feel better after a couple of days.

For other illnesses, you may not feel any better even though the medicine is helping you. This may be the case if you're taking prednisolone to stop your symptoms getting worse or to prevent a problem happening (for example after an organ transplant).

Ask your doctor what to expect for your illness.

How long will I take prednisolone for?

This depends on your health problem.

You may only need a short course of prednisolone for up to a week.

You may need to take it for longer – even for many years or the rest of your life.

Will I put on weight?

If you have to take prednisolone for more than a few weeks, the chances are that you will put on weight. Prednisolone can make you hungrier and retain water so it can be quite challenging to avoid weight gain. Try to eat a healthy balanced diet without increasing your portion sizes. Regular exercise will also help to keep your weight stable.

What will happen if I come off prednisolone?

It can be dangerous to stop taking prednisolone suddenly, especially if you have been on a high dose for a long time.

Your health condition may flare up again. You may also get withdrawal symptoms including:

severe tiredness
weakness
body aches
joint pain

Withdrawal problems are most likely to happen if you have taken prednisolone for more than a few weeks or you take more than 40mg daily.

Your doctor will probably want to reduce your dose gradually over several weeks to prevent these side effects.

Don't stop taking prednisolone without talking to your doctor – you will need to reduce the dose gradually.

Can I take prednisolone for a long time?

Taking prednisolone for many months or years can have several harmful effects on your body. It can lead to:

thinner bones (osteoporosis)
poorly controlled diabetes
eyesight problems
slower growth in children and teenagers

If you have to take prednisolone for a long time, there are steps you can take to stay as healthy as possible:

Take regular exercise and make sure you get enough calcium in your diet to help strengthen your bones. Calcium-rich foods include milk, cheese and leafy greens. To check your bones, your doctor may arrange for you to have an occasional bone scan.
If you have diabetes, you may need to check your blood glucose more often. Your doctor can advise you more about this.
To reduce the chances of eyesight problems, visit an optometrist every 12 months to check for high pressure in your eye (glaucoma) and cataracts.
Make sure that children and teenagers have their height monitored regularly by a doctor so that any stunting of growth can be picked up promptly.

Do I need to be careful of infections?

Taking prednisolone makes you more likely to catch infections such as flu, the common cold and chest infections.

Keep away from people with an infectious disease, especially chickenpox or shingles. If you have never had these illnesses they could make you very ill.

Tell your doctor straight away if you come into contact with someone who has an infectious disease such as chickenpox or shingles. Your doctor may be able to prescribe a medicine to protect you.

Can I have vaccinations?

Some vaccines are not suitable for you while you are taking prednisolone.

Taking prednisolone lowers your immune system. If you have a 'live' vaccine, like the shingles vaccine, while you are taking prednisolone your immune system might not be able to handle it. This may lead to an infection. Inactive vaccinations, like the flu vaccine, are safe.

If you need any vaccinations, mention that you are taking a steroid.

Do I need a blue steroid card?

If you are taking prednisolone for longer than 3 weeks or you have been prescribed a high dose of more than 40mg daily, your doctor or pharmacist will give you a blue steroid treatment card.

The card is the size of a credit card and fits in your wallet or purse. It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much prednisolone you take and how long the treatment will last for.

If you need any medical or dental treatment show your blue steroid card to the doctor or dentist so they know that you are taking prednisolone.

Are there other steroids?

There are other steroids available, including:

deflazacort
dexamethasone
methylprednisolone
prednisone

For most health problems, these steroids are very similar to prednisolone in terms of how well they work and how safe they are.

Will it affect my mood?

You may notice mood changes and mental health problems while taking prednisolone, including:

feeling depressed (including thinking about suicide)
feeling high or moods that go up and down
feeling anxious, having problems sleeping, difficulty in thinking or being confused and losing your memory
feeling, seeing or hearing things which do not exist
having strange and frightening thoughts, changing how you act or having feelings of being alone

The higher the dose, the more intense the mood changes can be.

If this happens to you, talk to your doctor.

Will it affect my fertility?

No, prednisolone does not reduce the fertility of men or women.

Will it affect my contraception?

For women, prednisolone will not affect contraceptive pills or the morning after pill.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking prednisolone.

Is there any food or drink I need to avoid?

Do not eat liquorice while taking prednisolone.

It's thought that real liquorice increases the amount of prednisolone in the body and also increases the risk of low potassium.