Prednisolone is a synthetic glucocorticoid, a potent anti-inflammatory and immunosuppressant agent. It is the active metabolite of prednisone, formed in the liver. It is a mainstay of therapy for a wide range of inflammatory, allergic, autoimmune, and neoplastic conditions in the Indian healthcare setting. Its efficacy must be balanced against a significant risk of dose and duration-dependent adverse effects.
Adult: Highly variable based on condition. Anti-inflammatory/Immunosuppressive: 5-60 mg/day orally in single or divided doses. Severe conditions: Initial dose up to 60 mg/day, tapered. Adrenal insufficiency replacement: 4-5 mg/m²/day.
Note: Administer with or immediately after food to reduce GI irritation. Single daily doses should be taken in the morning (around 8 AM) to mimic the body's natural cortisol rhythm and minimize HPA axis suppression. Do not crush or chew enteric-coated tablets. For tapering, reduce dose gradually (e.g., 2.5-5 mg every 3-7 days) based on response and duration of therapy.
Prednisolone binds to the cytosolic glucocorticoid receptor (GR), forming a complex that translocates to the nucleus. This complex binds to Glucocorticoid Response Elements (GREs) in DNA, modulating gene transcription. It increases transcription of anti-inflammatory proteins (e.g., lipocortin-1, IL-10) and decreases transcription of pro-inflammatory proteins (e.g., cytokines, chemokines, adhesion molecules, inflammatory enzymes like COX-2). It also has post-transcriptional effects.
Pregnancy: FDA Category C. Crosses placenta. Use only if potential benefit justifies potential fetal risk. Chronic use associated with low birth weight. Monitor neonates for adrenal insufficiency. Avoid high doses in first trimester.
Driving: May cause dizziness, vertigo, or visual disturbances. Patients should not drive or operate machinery if they experience these effects.
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Increased risk of GI ulceration and bleeding | Major |
| Warfarin | Altered INR response (may increase or decrease); monitor INR closely | Moderate |
| Antidiabetics (Insulin, Metformin) | Prednisolone causes hyperglycemia; may require dose adjustment of antidiabetics | Major |
| Diuretics (Furosemide, Hydrochlorothiazide) | Enhanced potassium loss, severe hypokalemia | Major |
| Phenytoin, Phenobarbital, Rifampicin | Increased hepatic metabolism of prednisolone, reducing its efficacy | Major |
| Ketoconazole, Itraconazole, Clarithromycin | Inhibit CYP3A4, increasing prednisolone levels and toxicity | Major |
| Live Vaccines (MMR, Varicella, OPV) | Reduced immune response, risk of vaccine-induced infection | Contraindicated |
Same composition (Prednisolone (NA)), different brands: