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.

• Take prednisolone once a day in the morning so it doesn't keep you awake. The most common side effects of prednisolone are insomnia, weight gain, indigestion and sweating a lot.
• Taking prednisolone can make you more likely to get infections. Tell your doctor if you're exposed to infectious illnesses like chickenpox or shingles.
• If you take prednisolone for more than 3 weeks, or you're on a high dose, you'll get a blue steroid card. Show this card to your doctor or dentist before any treatment, so they know you're taking prednisolone.
• Prednisolone can cause extra side effects if you stop taking it suddenly. Do not stop taking prednisolone 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.

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
• 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

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 usually equal to 10mg.

Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, straight after breakfast. For example, if your dose is 40mg daily, your doctor may tell you 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 your prednisolone tablets are labelled as "enteric coated" or "gastro resistant", 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 or gastro resistant tablets.

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

How much will I take?

The dose you'll take 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. This is to reduce the risk of withdrawal symptoms.

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.

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
• sleep problems
• 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.

Call 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" (a puffy, rounded face), very bad headaches and slow wound healing - these can be signs of Cushing's syndrome
• a very upset stomach or you're being sick (vomiting), very bad dizziness or passing out, muscle weakness, 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 you're being sick - these can be signs of pancreas problems

You should also call 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 you're vomiting blood

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to prednisolone.

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

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.

What to do about:

• weight gain - try to eat well 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.
• sleep problems - take prednisolone in the morning so the levels are the lowest at bedtime
• restlessness - if you're restless when you're trying to sleep, take prednisolone in the morning so the levels are the lowest at bedtime
• sweating a lot - try wearing loose clothing, use a strong anti-perspirant and keep cool with a fan. If this doesn't help, talk to your doctor as you may be able to try a different medicine.

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.

For more information about how prednisolone can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

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.

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.

Mixing prednisolone with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with prednisolone.