Prednisolone

Overview

Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers, electrolyte imbalances, and skin conditions. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, multiple sclerosis, and phimosis. It can be taken by mouth, injected into a vein, used topically as a skin cream, or as eye drops.[1–4] WP

Common side effects with short-term use include nausea, difficulty concentrating, insomnia, increased appetite, and fatigue. More severe side effects include psychiatric problems, which may occur in about 5% of people. Common side effects with long-term use include bone loss, weakness, yeast infections, and easy bruising. While short-term use in the later part of pregnancy is safe, long-term use or use in early pregnancy is occasionally associated with harm to the baby. It is a glucocorticoid made from hydrocortisone (cortisol).[1][2][5][6][7] WP

Prednisolone was discovered and approved for medical use in 1955. It is on the World Health Organization's List of Essential Medicines. It is available as a generic drug. In 2023, it was the 146th most commonly prescribed medication in the United States, with more than 3 million prescriptions.[2][7–10] WP

Uses, dosage and effects

Medical uses

When used in low doses, corticosteroids serve as an anti-inflammatory agent. At higher doses, they are considered as immunosuppressants. Corticosteroids inhibit the inflammatory response to a variety of inciting agents and, it is presumed, delay or slow healing. They inhibit edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation associated with inflammation.[11][12][13] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

Systemic use

Prednisolone is a corticosteroid drug with predominant glucocorticoid and low mineralocorticoid activity, making it useful for the treatment of a wide range of inflammatory and autoimmune conditions such as asthma, uveitis, pyoderma gangrenosum, rheumatoid arthritis, urticaria, angioedema, ulcerative colitis, pericarditis, temporal arteritis, Crohn's disease, Bell's palsy, multiple sclerosis, cluster headaches, vasculitis, acute lymphoblastic leukemia, autoimmune hepatitis, lupus, Kawasaki disease, dermatomyositis, post-myocardial infarction syndrome, and sarcoidosis.[3][14–21] WP

Prednisolone can also be used for allergic reactions ranging from seasonal allergies to drug allergic reactions.[22] WP

Prednisolone can also be used as an immunosuppressant for organ transplants.[3][23] WP

Prednisolone in lower doses can be used in cases of adrenal insufficiency due to Addison's disease.[24][25] WP

Topical use

Ophthalmology Topical prednisolone is mainly used in the ophthalmic pathway as eye drops in numerous eye conditions, including corneal injuries caused by chemicals, burns, and alien objects, inflammation of the eyes, mild to moderate non-infectious allergies, disorders of the eyelid, conjunctiva or sclera, ocular inflammation caused by operation and optic neuritis. Some side effects include glaucoma, blurred vision, eye discomfort, impaired recovery of injured site, scarring of the optic nerve, cataracts, and urticaria. However, their prevalence is not known.[26][27][28] WP

Prednisolone eye drops are contraindicated in individuals who develop hypersensitivity reactions against prednisolone, or individuals with the current conditions, such as tuberculosis of the eye, shingles affecting the eye, raised intraocular pressure, and eye infection caused by fungus.[26][29] WP

Prednisolone acetate ophthalmic suspension (eye drops) is prepared as a sterile ophthalmic suspension and used to reduce swelling, redness, itching, and allergic reactions affecting the eye. It has been explored as a treatment option for bacterial keratitis.[4][30][31][32] WP

Prednisolone eye drops are used in conjunctivitis caused by allergies and bacteria, marginal keratitis, uveitis, endophthalmitis, which is an infection of the eye involving the aqueous humor, Graves' ophthalmopathy, herpes zoster ocular infection, inflammation of the eye after surgery, and corneal injuries caused by chemicals, radiation, thermal burns, or penetration of foreign objects. It is also used in the prevention of myringosclerosis, herpes simplex stromal keratitis. Topical prednisolone can also be used after procedures such as Laser Peripheral Iridotomy for patients with primary angle-closure suspects (PACS) to control inflammations.[27][33][34][35] WP

Ear drops WP

In addition, topical prednisolone can also be administered as ear drops.[36] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.⚠ A table follows this text in the source and is not copied here. Open the source to see it.

Dosage forms

Prednisolone is supplied as oral liquid, oral suspension, oral syrup, oral tablet, and oral disintegrating tablet. It may be a generic medication or supplied as brands Flo-Pred (prednisolone acetate oral suspension), Millipred (oral tablets), Orapred (prednisolone sodium phosphate oral dissolving tablets), Pediapred (prednisolone sodium phosphate oral solution), Veripred 20, Prelone, Hydeltra-T.B.A., Hydeltrasol, Key-Pred, Cotolone, Predicort, Medicort, Predcor, Bubbli-Pred, Omnipred, P-Pred (prednisolone acetate ophthalmic suspension), Pred Mild, Pred Forte, and others.[3][4][22][30][31][37][38][39] WP

Veterinary uses

Prednisolone is used in the treatment of inflammatory and allergic conditions in cats, dogs, horses, small mammals such as ferrets, birds, and reptiles. Its usage in treating inflammation, immune-mediated disease, Addison's disease, and neoplasia is often considered off-label use. Many drugs are commonly prescribed for off-label use in veterinary medicine." Studies in ruminating species, such as alpacas, have shown that oral administration of the drug is associated with a reduced bioavailability compared to intravenous administration; however, levels that are therapeutic in other species can be achieved with oral administration in alpacas.[40–43] WP

It is used in a broad spectrum of diseases, for example, inflammation of scleral tissues, cornea, and conjunctiva in dogs. In horses, prednisolone acetate suspensions are priorly used to treat inflammation in the middle layer of the eye, also known as anterior uveitis and equine recurrent uveitis (ERU), which is the leading cause of visual impairment in horses. Prednisolone acetate eye drops are not to be used in other animals such as birds.[40][41] WP

Prednisolone acetate eye drops are also prescribed to dogs and cats to lessen swelling, redness, burning, and pain sensations after surgeries of the eye.[40] WP

Cats with conjunctivitis usually are required to avoid using ophthalmic preparations of corticosteroids and its derivatives. The most typical infections are caused by herpes virus.[41] WP

Risks and side effects

Adverse effects

Adverse reactions from the use of prednisolone include:[3][37] WP

• Increased appetite, weight gain,[44][45] WP
• nausea,[3][37] WP
• malaise,[3][37] WP
• Increased risk of infection[3][37] WP
• Cardiovascular events[3][37] WP
• Dermatological effects including reddening of the face, bruising/skin discoloration, impaired wound healing, skin atrophy, skin rash, edema, and abnormal hair growth[3][37] WP
• Hyperglycemia; patients with diabetes may need increased insulin or diabetic therapies[3][37] WP
• Menstrual abnormalities[3][37] WP
• Lower response to hormones, especially during stressful instances such as surgery or illness[3][37] WP
• Change in electrolytes: rise in blood pressure, increased sodium and low potassium, leading to alkalosis[3][37] WP
• Gastrointestinal system effects: swelling of the stomach lining, reversible increase in liver enzymes, and risk of stomach ulcers[3][37] WP
• Muscular and skeletal abnormalities, such as muscle weakness/muscle loss, osteoporosis (see steroid-induced osteoporosis), long bone fractures, tendon rupture, and back fractures[3][37] WP
• Neurological effects, including involuntary movements (convulsions), headaches, and vertigo[3][37] WP
• Psychosocial behavioral and emotional disturbances with aggression being one of the most common cognitive symptoms, especially with oral use.[38][46] WP
• Nasal septum perforation and bowel perforation (in some pathologic conditions).[47][48] WP

Discontinuing prednisolone after long-term or high-dose use can lead to adrenal insufficiency.[38] WP

Mania and hypomania are known possible side effects of prednisolone.[49] WP

Pregnancy and breastfeeding

Although there are no major human studies of prednisolone use in pregnant women, studies in several animals show that it may cause birth defects including increased likelihood of cleft palate. WP

Prednisolone is found in the breast milk of mothers taking prednisolone.[38] WP

Local adverse effects in the eye

When used topically on the eye, the following are potential side effects: WP

• Cataracts: Extended usage of corticosteroids may cause clouding at the back of the lens, also known as posterior subcapsular cataract. This type of cataract reduces the path of light reaching the eye, which interferes with a person's reading vision. Consumption of prednisolone eye drops post-surgery may also retard the healing process.[26] WP
• Corneal thinning: When corticosteroids are used in the long term, corneal and scleral thinning is also one of the consequences. When not ceased, thinning may ultimately lead to perforation of the cornea.[26] WP
• Glaucoma: Prolonged use of corticosteroids has a chance of causing a raised intraocular pressure (IOP), injuring the optic nerve and weakening visual awareness. Corticosteroids should be used cautiously in patients with concomitant conditions of glaucoma. Doctors track patients' IOP if they are using corticosteroid eye drops for more than 103 days.[26] WP

Interactions

Interactions

Co-administration of prednisolone eye drops with ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) may perhaps exacerbate its effects, causing unwanted side effects such as toxicity. The wound healing process may also be hindered.[28] WP⚠ Wikipedia itself has flagged this text: clarification needed.

Drug interactions of prednisolone include other immunosuppressants like azathioprine or ciclosporin, antiplatelet drugs like clopidogrel, anticoagulants like dabigatran or warfarin, or NSAIDs such as aspirin, celecoxib, or ibuprofen.[50] WP

Pharmacology

Pharmacodynamics

As a glucocorticoid, the lipophilic structure of prednisolone allows for easy passage through the cell membrane where it then binds to its respective glucocorticoid receptor (GCR) located in the cytoplasm. Upon binding, the formation of the GC/GCR complex causes dissociation of chaperone proteins from the glucocorticoid receptor enabling the GC/GCR complex to translocate inside the nucleus. This process occurs within 20 minutes of binding. Once inside the nucleus, the homodimer GC/GCR complex binds to specific DNA binding sites known as glucocorticoid response elements (GREs) resulting in gene expression or inhibition. Complex binding to positive GREs leads to the synthesis of anti-inflammatory proteins while binding to negative GREs blocks the transcription of inflammatory genes. They inhibit the release of signals that promote inflammation such as nuclear factor-Kappa B (NF-κB), Activator protein 1 (AP-1), nuclear factor of activated T-cells (NFAT), and stimulate anti-inflammatory signals such as the interleukin-10 gene. All of them will collectively cause a sequence of events, including the inhibition of prostaglandin synthesis and additional inflammatory mediators. Glucocorticoids also inhibit neutrophil cell death and demargination. As well as phospholipase A2, which in turn lessens arachidonic acid derivative genesis.[11][51–54] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

Pharmacokinetics

Prednisolone has a relatively short half-life, ranging 2–4 hours. It also has a large therapeutic window, considering the dosage required to produce a therapeutic effect is a few times higher than what the body naturally produces.[11] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

Prednisolone is 70–90% plasma protein bound, it binds to proteins such as albumin.[11] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

Both prednisolone phosphate and prednisolone acetate go through ester hydrolysis in the body to form prednisolone. It subsequently undergoes the usual metabolism of prednisolone. Concomitant use of prednisolone and strong CYP3A4 inhibitors such as ketoconazole is shown to cause a rise in plasma prednisolone concentrations by about 50% owing to a diminished clearance.[53] WP

Prednisolone predominantly undergoes kidney elimination and is excreted in the urine as sulphate and metabolites of glucuronide conjugate.[11] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

Prednisone

Prednisone is a prodrug that is activated in the liver. When it enters the body, prednisone is triggered by the liver and body chemicals to turn into its active form, prednisolone.[55] WP

Legal status

Athletics

As a glucocorticosteroid, unauthorized or ad hoc use of prednisolone during competition via oral, intravenous, intramuscular, or rectal routes is banned under World Anti-Doping Agency (WADA) anti-doping rules.[56] WP

Chemistry

Formula

C21H28O5 PC

CAS number

50-24-8 PC

Molar mass (g/mol)

360.4 PC

IUPAC name (computed by PubChem)

(8S,9S,10R,11S,13S,14S,17R)-11,17-dihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-7,8,9,11,12,14,15,16-octahydro-6H-cyclopenta[a]phenanthren-3-one PC

SMILES

C[C@]12C[C@@H]([C@H]3[C@H]([C@@H]1CC[C@@]2(C(=O)CO)O)CCC4=CC(=O)C=C[C@]34C)O PC

InChIKey

OIGNJSKKLXVSLS-VWUMJDOOSA-N PC

PubChem CID

5755

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

1. Other WHO Model Formulary 2008. 2009
2. Other Prednisolone
3. Journal / agency Orapred ODT- prednisolone sodium phosphate tablet, orally disintegrating. 11 September 2019
4. Journal / agency Omnipred- prednisolone acetate suspension. 9 September 2019
5. Other Pevanti 10mg Tablets – Summary of Product Characteristics (SPC) – (eMC). 1 December 2014
6. Other Prednisolone Use During Pregnancy. 16 January 2000
7. Other Kim KW, Roh JK, Wee HJ, Kim C. Cancer Drug Discovery: Science and History. 2016
8. Journal / agency World Health Organization. The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list. 2025. doi:10.2471/B09474
9. Other Top 300 of 2023
10. Other Prednisolone Drug Usage Statistics, United States, 2014 - 2023
11. Harm reduction site Prednisolone phosphate
12. Journal / agency Schwiebert LM, Beck LA, Stellato C, Bickel CA, Bochner BS, Schleimer RP, Schwiebert LA. Glucocorticosteroid inhibition of cytokine production: relevance to antiallergic actions. The Journal of Allergy and Clinical Immunology. January 1996. doi:10.1016/s0091-6749(96)80214-4 · PMID 8568145
13. Journal / agency Lee SH. Mechanisms of Glucocorticoid Action in Chronic Rhinosinusitis. Allergy, Asthma & Immunology Research. November 2015. doi:10.4168/aair.2015.7.6.534 · PMID 26333699 · PMC4605925
14. Journal / agency Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clinical Pharmacokinetics. 2005. doi:10.2165/00003088-200544010-00003 · PMID 15634032
15. Journal / agency Fiel SB, Vincken W. Systemic corticosteroid therapy for acute asthma exacerbations. The Journal of Asthma. Jun 2006. doi:10.1080/02770900600567163 · PMID 16801135
16. Journal / agency Spickett G. Urticaria and angioedema. The Journal of the Royal College of Physicians of Edinburgh. 2014. doi:10.4997/JRCPE.2014.112 · PMID 24995449
17. Journal / agency Thrower BW. Relapse management in multiple sclerosis. The Neurologist. January 2009. doi:10.1097/NRL.0b013e31817acf1a · PMID 19131851
18. Journal / agency Lambrou GI, Vlahopoulos S, Papathanasiou C, Papanikolaou M, Karpusas M, Zoumakis E, Tzortzatou-Stathopoulou F. Prednisolone exerts late mitogenic and biphasic effects on resistant acute lymphoblastic leukemia cells: Relation to early gene expression. Leukemia Research. December 2009. doi:10.1016/j.leukres.2009.04.018 · PMID 19450877
19. Journal / agency Miura M, Tamame T, Naganuma T, Chinen S, Matsuoka M, Ohki H. Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy. Paediatrics & Child Health. October 2011. doi:10.1093/pch/16.8.479 · PMID 23024586 · PMC3202387
20. Other Prednisolone 5mg Tablets - Summary of Product Characteristics (SmPC) - (emc)
21. Journal / agency Gera K, Gupta N, Ahuja A, Shah A. Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure. BMJ Case Reports. April 2014. doi:10.1136/bcr-2013-202247 · PMID 24789154 · PMC4024548
22. Journal / agency Millipred- prednisolone tablet. 8 April 2019
23. Journal / agency Vethe NT, Midtvedt K, Asberg A, Amundsen R, Bergan S. Drug interactions and immunosuppression in organ transplant recipients. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, NY Raekke. October 2011. doi:10.4045/tidsskr.11.0138 · PMID 22016125
24. Journal / agency Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Falorni A, Gan EH, Hulting AL, Kasperlik-Zaluska A, Kämpe O, Løvås K, Meyer G, Pearce SH. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. Journal of Internal Medicine. February 2014. doi:10.1111/joim.12162 · PMID 24330030
25. Other AMA Department of Drugs: AMA Drug Evaluations. 1986
26. Other Prednisone Drug Information
27. Other Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 2017
28. Other Prednisolone (Ophthalmic Route) Side Effects
29. Other Common and Rare Side Effects for prednisolone acetate ophthalmic (eye)
30. Journal / agency Pred Forte- prednisolone acetate suspension/ drops. 19 July 2019
31. Journal / agency Pred Mild- prednisolone acetate suspension/ drops. 19 July 2019
32. Journal / agency Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. The Cochrane Database of Systematic Reviews. October 2014. doi:10.1002/14651858.CD005430.pub3 · PMID 25321340 · PMC4269217
33. Journal / agency Arslan N, Tepe D, Taştan E, Demirci M, Caydere M, Ustun H, Oguz H. Evaluation of the effectiveness of topical ciprofloxacin and prednisolone in the prevention of myringosclerosis. European Archives of Oto-rhino-laryngology. November 2012. doi:10.1007/s00405-011-1889-z · PMID 22197890
34. Journal / agency Wilhelmus KR, Gee L, Hauck WW, Kurinij N, Dawson CR, Jones DB, Barron BA, Kaufman HE, Sugar J, Hyndiuk RA, Laibson PR, Stulting RD, Asbell PA. Herpetic Eye Disease Study: A Controlled Trial of Topical Corticosteroids for Herpes Simplex Stromal Keratitis. Ophthalmology. April 2020. doi:10.1016/j.ophtha.2020.01.037 · PMID 32200827
35. Journal / agency Gayam K, Ramulu PY, Rengaraj V, Srinivasan K. Safety and Efficacy of 0.1% Nepafenac versus 1% Prednisolone Acetate Eye Drops after Laser Peripheral Iridotomy: A Prospective, Randomized Trial. Ophthalmology. Glaucoma. 29 February 2020. doi:10.1016/j.ogla.2020.02.006 · PMID 32672612
36. Other BNF: Prednisolone, Medicine Forms
37. Journal / agency Flo-Pred- prednisolone acetate suspension. 28 February 2019
38. Journal / agency Pediapred- prednisolone sodium phosphate solution. 29 January 2020
39. Other Prednisolone: Uses, Dosage, Side Effects, Warnings. 6 July 2022
40. Other PrednisoLONE Acetate Ophthalmic Suspension
41. Other Prednisolone Acetate Ophthalmic for Veterinary Use
42. Other Gollakner R. Prednisolone/Prednisone
43. Journal / agency Videla R, Sommardahl C, Smith J, Schaefer DM, Cox S. Pharmacokinetics of Orally Administered Prednisolone in Alpacas. Frontiers in Veterinary Science. 2021. doi:10.3389/fvets.2021.745890 · PMID 34746285 · PMC8569471
44. Journal / agency Fardet L, Nazareth I, Petersen I. Long-term systemic glucocorticoid therapy and weight gain: a population-based cohort study. Rheumatology. March 2021. doi:10.1093/rheumatology/keaa289 · PMID 32864693
45. Journal / agency Da Silva JA, Jacobs JW, Kirwan JR, Boers M, Saag KG, Inês LB, de Koning EJ, Buttgereit F, Cutolo M, Capell H, Rau R, Bijlsma JW. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Annals of the Rheumatic Diseases. March 2006. doi:10.1136/ard.2005.038638 · PMID 16107513 · PMC1798053
46. Other Prednisolone (Oral Route)
47. Journal / agency ReMine SG, McIlrath DC. Bowel perforation in steroid-treated patients. Annals of Surgery. 1980. doi:10.1097/00000658-198010000-00016 · PMID 7425698 · PMC1347010
48. Journal / agency Cervin A, Andersson M. Intranasal steroids and septum perforation--an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology. September 1998. PMID 9830677
49. Journal / agency De Bock M, Sienaert P. Corticosteroids and mania: A systematic review. World J Biol Psychiatry. March 2024. doi:10.1080/15622975.2024.2312572 · PMID 38363330
50. Other Prednisolone Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD
51. Other Goldstein BG, Goldstein AO. Topical corticosteroids: Use and adverse effects. 13 September 2022
52. Journal / agency Stahn C, Löwenberg M, Hommes DW, Buttgereit F. Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists. Molecular and Cellular Endocrinology. September 2007. doi:10.1016/j.mce.2007.05.019 · PMID 17630118
53. Journal / agency Schijvens AM, Ter Heine R, de Wildt SN, Schreuder MF. Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome. Pediatric Nephrology. March 2019. doi:10.1007/s00467-018-3929-z · PMID 29549463 · PMC6349812
54. Harm reduction site Prednisolone acetate
55. Other What's the Difference Between Prednisolone and Prednisone?
56. Other Prohibited List. January 2020

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