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Prednisolone oral

Updated 2 Feb 2023 | Glucocorticoid therapy


Oral formulations of prednisolone.

Drugs List

  • DILACORT 2.5mg gastro-resistant tablets
  • DILACORT 5mg gastro-resistant tablets
  • prednisolone 10mg tablets
  • prednisolone 1mg gastro-resistant tablets
  • prednisolone 1mg tablets
  • prednisolone 2.5mg gastro-resistant tablets
  • prednisolone 2.5mg tablets
  • prednisolone 20mg tablets
  • prednisolone 25mg tablets
  • prednisolone 30mg tablets
  • prednisolone 5mg gastro-resistant tablets
  • prednisolone 5mg tablets
  • Therapeutic Indications


    Inflammatory or allergic conditions
    Myasthenia gravis
    Nephrotic syndrome
    Nephrotic syndrome - prevention of relapse

    Treatment of allergic or inflammatory conditions including the following.

    Allergy and anaphylaxis
    Bronchial asthma, drug hypersensitivity reactions, serum sickness, angioneurotic oedema, anaphylaxis.

    Giant cell arteritis/polymyalgia rheumatica, mixed connective tissue disease (excluding systemic sclerosis), polyarteritis nodosa, polymyositis.

    Blood disorders
    Haemolytic anaemia (autoimmune), leukaemia (acute monocytic, acute granulocytic, acute lymphoblastic and chronic lymphocytic), malignant lymphoma, multiple myeloma, idiopathic thrombocytopenic purpura.

    Cardiovascular disorders
    Post myocardial infarction syndrome, rheumatic fever with severe carditis.

    Endocrine disorders
    Primary and secondary adrenal insufficiency, congenital adrenal hyperplasia.

    Gastrointestinal disorders
    Crohn's disease, ulcerative colitis, persistent coeliac syndrome (coeliac disease unresponsive to gluten withdrawal), autoimmune chronic active hepatitis, multisystem disease affecting liver, biliary peritonitis.

    Sarcoidosis, vitamin D excess.

    Infections (with appropriate chemotherapy)
    Helminthic infestations, Herxheimer reaction, infectious mononucleosis, miliary tuberculosis, mumps orchitis (adult), tuberculous meningitis, rickettsial disease.

    Muscular disorders
    Polymyositis, dermatomyositis.

    Neurological disorders
    Infantile spasms, Shy-Drager syndrome, subacute demyelinating polyneuropathy.

    Ocular disease
    Scleritis, posterior uveitis, retinal vasculitis, pseudo tumours of the orbit, giant cell arteritis, malignant ophthalmic Graves disease.

    Renal disorders
    Lupus nephritis, acute interstitial nephritis, minimal change glomerulonephritis, nephrosis.

    Respiratory disease
    Allergic pneumonitis, asthma, occupational asthma, pulmonary aspergillosis, pulmonary fibrosis, pulmonary alveolitis, aspiration of foreign body, aspiration of stomach contents, pulmonary sarcoid, drug induced lung disease, adult respiratory distress syndrome, spasmodic croup.

    Rheumatic disorders
    Rheumatoid arthritis, polymyalgia rheumatica, juvenile chronic arthritis, psoriatic arthritis, systemic lupus erythematosus, dermatomyositis, mixed connective tissue disease, rheumatic carditis, acute rheumatic fever.

    Skin disorders
    Pemphigus vulgaris, exfoliative dermatitis, bullous pemphigoid, systemic lupus erythematosus, pyoderma gangrenosum, inflammatory skin disorders.

    Sarcoidosis, hyperpyrexia, Behcet's disease, immunosuppression in organ transplantation.


    The lowest effective dose should be used for the minimum period. The dose depends on the disease, disease severity and clinical response.

    An intermittent dosage regimen may be used in some patients, taking a single dose on alternate days or at longer intervals.


    Initial dosage varies between 5mg to 60mg daily depending on the condition, severity and clinical response.

    Maintenance dose varies between 2.5mg to 15mg daily, higher doses may be required.

    Short term therapy

    20mg to 30mg daily. Dose may be reduced gradually by 2.5mg to 5mg every 2 to 5 days depending on response.

    Daily doses of 75mg or higher may be required initially in acute conditions.

    Allergic and Skin disorders
    5mg to 15mg daily.

    20mg to 30mg daily.
    Higher doses may be required in severe cases.

    Rheumatoid arthritis
    Initial dose of 10mg to 15mg daily. For maintenance therapy, the lowest effective dosage should be used.

    Blood disorders and lymphoma
    15mg to 60mg daily reducing once an adequate clinical or haematological response is achieved. Higher doses may be required in order to induce remission in leukaemia.

    Suppression of inflammatory response and allergic disorders
    Initial dose of 10mg to 20mg daily.

    In severe disease state an initial dose maximum 60mg daily, can be continued for several weeks or months.

    Maintenance dose of 2.5mg to 15mg daily, higher doses may be required.

    Ulcerative colitis or Crohn's disease
    Initial dose of 20mg to 40mg a day (up to 60mg daily in some cases).

    Severe acute asthma
    Give 40mg to 50mg for at least 5 days.


    The manufacturers state that fractions of the adult dosage may be used (e.g. 75% at 12 years, 50% at 7 years and 25% at 1 year), but clinical factors must be given due weight. Soluble prednisolone tablets and oral liquid are licensed for use in children; see product literature.

    Acute asthma attacks

    Children aged 12 to 18 years
    40mg to 50mg daily for at least 5 days.
    Patients already receiving maintenance steroid therapy should receive 2mg/kg (up to a maximum of 60mg).

    Children aged 1 month to 12 years
    1mg/kg to 2mg/kg once a day for up to 3 days. Maximum of 40mg once a day. Duration of treatment may be longer, if considered necessary.
    If the child has been given oral corticosteroid for more than a few days, then give prednisolone 2mg/kg once a day. Maximum of 60mg once a day.

    1mg/kg to 2mg/kg.

    Autoimmune inflammatory disorders
    Initial dose of 1mg/kg to 2mg/kg once a day, up to a maximum of 60mg. If appropriate, dose should be reduced after a few days.

    Autoimmune hepatitis
    Initial dose of 2mg/kg once a day, up to a maximum of 40mg.

    Corticosteroid replacement therapy
    Children aged 12 to 18 years
    2mg to 2.5mg per square metre daily, either as a single dose or in two divided doses.

    Idiopathic thrombocytopenic purpura
    Children aged 1 to 10 years
    1mg/kg to 2mg/kg daily for a maximum of 14 days.
    Alternatively, 4mg/kg daily for a maximum of 4 days may be used.

    Nephrotic syndrome
    Initial dose of 60mg per square metre once a day, up to a maximum of 80mg daily, for 4 to 6 weeks until proteinuria ceases. Reduce dose to 40mg per square metre on alternate days for 4 to 6 weeks, withdraw dose gradually.

    To prevent a relapse, it is recommended 0.5mg/kg to 1mg/kg once a day or on alternate days for 3 to 6 months.

    Infantile spasms
    Children aged 1 month to 1 year
    Initial dose of 10mg four times daily for 2 weeks then reduce dose gradually over 15 days until stopped.
    If seizures are not controlled after 7 days of therapy, increase dose to 20mg three times daily for 7 days.

    For patients taking 40mg a day, reduce dose in steps of 10mg every 5 days, until treatment is stopped.

    For patients taking 60 mg a day, reduce dose in stages down to 40mg a day for 5 days, then 20mg a day for 5 days, then 10mg a day for 5 days, then stop treatment.

    Moderate to severe pneumocystis infections associated with HIV infection (adjunctive therapy)
    2mg/kg once a day for 5 days, up to a maximum of 80mg a day. Reduce dose gradually over 16 days until stopped.
    Corticosteroid treatment should be started at the same time as the anti-pneumocystis therapy or no later than 24 to 72 hours after initial dose. Corticosteroid treatment should be withdrawn before anti-pneumocystis treatment is completed.

    Ulcerative colitis and Crohn's disease
    Children aged 2 to 18 years
    2m/kg once daily until remission occurs then reduce dose. Maximum dose of 60mg.

    Additional Dosage Information

    If patients have been receiving a dose higher than the physiological dose (7.5mg) for longer than 3 weeks, withdrawal should not be abrupt. A dose reduction regime should be carried out depending on the likelihood of disease relapse and the level of risk of hypothalamic-pituitary-adrenal (HPA) suppression.

    In patients using doses up to 40mg for up to 3 weeks for a disease unlikely to relapse, abrupt withdrawal should be appropriate due to low risk of HPA suppression. However, if there is uncertainty about HPA suppression these patients should have the dose reduced to 7.5mg and then gradually reduce to allow HPA axis recovery.

    In the following patient groups, gradual reduction of prednisolone therapy should be considered (even after courses lasting less than 3 weeks):
    Repeated courses of systemic corticosteroids, particularly if taken for longer than 3 weeks.
    Within one year of a long-term corticosteroid therapy course.
    Adrenocortical insufficiency (other than exogenous corticosteroid therapy).
    Systemic corticosteroid doses greater than 40mg daily of prednisolone (or equivalent).
    Patient taking repeated doses in the evening.

    If there is a lack of satisfactory clinical response to prednisolone, gradually discontinue treatment and transfer patient to alternative therapy.


    Uncontrolled systemic infection
    Ocular herpes simplex infection

    Precautions and Warnings

    Children under 18 years
    Family history of diabetes mellitus
    Family history of glaucoma
    Congestive cardiac failure
    Cushing's disease
    Diabetes mellitus
    Disorder of lipid metabolism
    Duchenne muscular dystrophy
    Epileptic disorder
    Glucose-galactose malabsorption syndrome
    Hepatic cirrhosis
    Hepatic impairment
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    History of tuberculosis
    Lactose intolerance
    Myasthenia gravis
    Peptic ulcer
    Recent myocardial infarction
    Renal impairment
    Severe affective disorders
    Thromboembolic disorder
    Ulcerative colitis

    Consider reintroducing steroids temporarily during illness/trauma/surgery
    Disease reactivation may occur in patients with latent TB
    Exposure to measles may require prophylaxis with normal immunoglobulin
    Live virus vaccine should not be given for 3 months after treatment
    May mask peritonitis or other signs or symptoms of GI disorders
    May mask symptoms or signs of infections
    Patients with diabetes may experience fluctuations in blood glucose
    Systemic sclerosis: Scleroderma renal crisis risk in doses above 15mg daily
    Temporary increase in dose may be needed during illness, trauma or surgery
    Use enteric coated tablets with caution in Crohn's disease or IBS patients
    Consider prophylactic anti-tuberculosis therapy if appropriate
    Passive immunisation of chicken pox / herpes zoster may be required
    Contains lactose
    Some products may contain soya or soya derivative
    Frequent review needed to titrate dose to disease activity
    Monitor blood pressure regularly
    Monitor regularly the height of children receiving prolonged treatment
    Possible mineralocorticoid secretion suppression & need for supplementation
    Post menopausal women at increased risk of osteoporosis
    Pregnancy: Monitor closely patients with pre-eclampsia or fluid retention
    Prolonged or high dose may lead to adrenal suppression
    Psychological changes may occur during initiation & withdrawal of treatment
    Supervise patient closely during drug withdrawal
    Adrenal cortical atrophy may persist for years after stopping drug
    Advise patient to report new visual problems and symptoms
    Antibody response to vaccines may be reduced
    Breastfeeding: Risk of adrenal suppression in breastfed infant
    Corticosteroids may cause growth retardation in children under 18 years
    Immunosuppressive drugs may increase risk of malignancy
    May cause activation of latent psychosis
    Oversuppression of immune system may increase susceptibility to infection
    Patient should report worrying psychological changes esp. suicidal thoughts
    Refer immediately visual disturbances to a specialist
    Sudden withdrawal may be inadvisable -see product information/SPC
    Advise patient not to take St John's wort concurrently
    Advise patient to avoid exposure to measles
    Advise patient to seek urgent medical attention if exposed to measles
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    Consider issuing Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention

    Patients (or parents of children) without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and seek urgent medical attention if exposed as chickenpox can prove fatal in immunocompromised patients. If exposed while on prednisolone or within three months of previous use, passive immunisation with varicella/zoster immunoglobulin (VZIG) should be administered within 10 days of the exposure. If chickenpox occurs, treat urgently under specialist care. Do not stop prednisolone therapy, an upward dosage adjustment may be required.

    Treatment of elderly patients, particularly if long term, should be planned bearing in mind the more serious consequences of the common side effects of corticosteroids in old age, especially osteoporosis, diabetes, hypertension, hypokalaemia, susceptibility to infection and thinning of the skin. Close clinical supervision is required especially during long term therapy.

    Pregnancy and Lactation


    Use prednisolone with caution in pregnancy.

    The manufacturer advises caution if prednisolone is used during pregnancy.

    Animal studies have shown teratogenic effects (palate gap and skeletal malformations). Human data is limited and as such a potential risk cannot be ruled out.

    Corticosteroids are able to cross the placenta but 88% of prednisolone is inactivated as it crosses the placenta. Prolonged treatment may increase the risk of intra-uterine growth retardation and imposes a risk of adrenal insufficiency in the newborn. Stillbirth could be a result of use. Reduced placental and birth weight have been reported in human after long term treatment.

    Hypoadrenalism may occur in the neonate following pre-natal exposure to corticosteroids but this usually resolves spontaneously after birth.

    Cataracts have been observed in infants born to mothers treated with long term prednisolone during pregnancy.


    Use prednisolone with caution during breastfeeding.

    The manufacturer advises caution if prednisolone is used when breastfeeding.

    Corticosteroids are secreted in breast milk in small amounts. Doses of up to 40 mg daily of prednisolone are unlikely to cause systemic effects in the infant.

    Infants of mothers taking higher doses than this may have a degree of adrenal suppression but the benefits of breastfeeding are likely to outweigh any theoretical risk.

    In patients with high maternal doses, breastfeeding should be avoided for 4 hours as this should be markedly decrease the dose recieved by the infant. This is not necessary in short term treatments.

    Side Effects

    Abdominal distension
    Acute pancreatitis
    Aggravation of schizophrenia
    Avascular osteonecrosis
    Behavioural disturbances
    Blurred vision
    Central serous chorioretinopathy
    Cognitive impairment
    Congestive cardiac failure
    Corneal thinning
    Cushing's syndrome
    Cushingoid facies
    Cutaneous atrophy
    Emotional lability
    Epidural lipomatosis
    Exacerbation of diabetes
    Exacerbation of epilepsy
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Growth suppression in infancy, childhood and adolescence
    Hypersensitivity reactions including anaphylaxis
    Hypokalaemic alkalosis
    Impaired carbohydrate tolerance, increased need for anti-diabetic therapy
    Impaired healing
    Increased intra-ocular pressure
    Increased susceptibility and severity of infections
    Increased sweating
    Irregular menstruation
    Kaposi's Sarcoma
    Negative calcium balance
    Negative nitrogen balance
    Oesophageal candidiasis
    Oesophageal ulceration
    Opportunistic infections
    Peptic ulceration with perforation and haemorrhage
    Posterior subcapsular cataracts
    Potassium loss
    Proximal myopathy
    Pseudotumour cerebri syndrome (mainly in children)
    Psychological dependence
    Psychotic reactions
    Raised intracranial pressure
    Recurrence of dormant tuberculosis
    Retinal detachment
    Scleral thinning
    Scleroderma renal crisis
    Sleep disturbances
    Sodium/water retention
    Stevens-Johnson syndrome
    Suicidal tendencies
    Suppression of reactions to skin tests
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Toxic epidermal necrolysis
    Tumour lysis syndrome
    Vertebral and long bone fractures
    Weight gain

    Withdrawal Symptoms and Signs

    Withdrawal symptoms may involve or resemble a clinical relapse of the disease for which the patient has been undergoing treatment. Other effects that may occur during withdrawal or change of corticosteroid therapy include benign intracranial hypertension with headache and vomiting and papilloedema caused by cerebral oedema. Latent rhinitis or eczema may be unmasked.

    Withdrawal symptoms due to a rapid reduction of corticosteroid doses may lead to adrenal insufficiency, hypotension and death.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2018

    Reference Sources

    Summary of Product Characteristics: Deltacortril 1mg Gastro-resistant Tablets. Alliance Pharmaceuticals. Revised September 2017.
    Summary of Product Characteristics: Deltacortril 2.5 mg Gastro-resistant Tablets. Alliance Pharmaceuticals. Revised September 2017.
    Summary of Product Characteristics: Deltacortril 5 mg Gastro-resistant Tablets. Alliance Pharmaceuticals. Revised June 2014.
    Summary of Product Characteristics: Dilacort 2.5 mg Gastro-Resistant Tablets. Crescent Pharma Ltd. Revised December 2017.
    Summary of Product Characteristics: Dilacort 5 mg Gastro-Resistant Tablets. Crescent Pharma Ltd. Revised December 2017..
    Summary of Product Characteristics: Pevanti 2.5 mg Tablets. AMCo. Revised October 2017.
    Summary of Product Characteristics: Pevanti 20 mg Tablets. AMCo. Revised October 2017.
    Summary of Product Characteristics: Pevanti 25 mg Tablets. AMCo. Revised October 2017.
    Summary of Product Characteristics: Prednisolone 1 mg Tablets. Actavis UK Ltd. Revised October 2014.
    Summary of Product Characteristics: Prednisolone 5 mg Tablets. Actavis UK Ltd. Revised October 2014.
    Summary of Product Characteristics: Prednisolone 2.5 mg Tablets. Accord UK Ltd. Revised April 2021.
    Summary of Product Characteristics: Prednisolone 10 mg Tablets. Accord UK Ltd. Revised April 2021.
    Summary of Product Characteristics: Prednisolone 20 mg Tablets. Accord UK Ltd. Revised April 2021.
    Summary of Product Characteristics: Prednisolone 30 mg Tablets (Caduceus). Accord UK Ltd. Revised February 2018.
    Summary of Product Characteristics: Prednisolone 2.5mg Gastro-resistant Tablets. Accord UK Ltd. Revised July 2017.
    Summary of Product Characteristics: Prednisolone 5 mg Gastro-resistant Tablets. Accord UK Ltd. Revised July 2017.
    Summary of Product Characteristics: Prednisolone 1 mg Tablets. Teva UK Ltd. Revised December 2011.
    Summary of Product Characteristics: Prednisolone 5 mg Tablets. Teva UK Ltd. Revised November 2011.
    Summary of Product Characteristics: Prednisolone 2.5mg Gastro-resistant Tablets. Teva UK Ltd. Revised February 2012.
    Summary of Product Characteristics: Prednisolone 5 mg Gastro-resistant Tablets. Teva UK Ltd. Revised February 2012.
    Summary of Product Characteristics: Prednisolone Tablet. Wockhardt UK Ltd. Revised October 2017.
    Summary of Product Characteristics: Prednisolone 25 mg Tablets. Zentiva. Revised December 2017.

    NICE Evidence Services Available at: Last accessed: 9th April 2018

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Prednisolone. Last revised: 15 February 2021
    Last accessed: 29 November 2021

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