Prednisolone: uses, side effects and steroid safety

Prednisolone is a corticosteroid, not the muscle-building kind. The NHS explains that steroids mimic stress hormones the body makes naturally and dampen inflammation. It is used for allergies, blood disorders, skin diseases, inflammation, infections, certain cancers and to prevent organ rejection after transplants, and it calms the immune system when the body mistakenly attacks its own tissues, as in rheumatoid arthritis. The emc entry names asthma, inflammatory bowel disease and many other uses.

It comes as tablets, gastro-resistant (enteric-coated) tablets, soluble tablets and liquid; injections are mostly hospital use. NHS brands for this class include Deltacortril, Deltastab, Dilacort and Pevanti, and emc lists others such as Prednesol.

The NHS recommends a single dose once a day, with breakfast. Morning dosing means levels are lowest at bedtime, which helps sleep. Enteric-coated tablets must be swallowed whole and can be taken with or without food. Some people are prescribed it on alternate days only. The NHS notes typical adult daily doses fall in a wide range and children receive doses based on height and weight; your prescriber sets yours. The emc entry says the lowest effective dose should be used for the shortest period.

Courses range from about a week to many years, depending on the condition. If you miss a dose, take it when you remember; if you do not remember until the next day, skip it. Never double up. An occasional extra tablet is unlikely to harm, but speak to a pharmacist if worried.

Long or high-dose use makes the adrenal glands reduce their own steroid output. The NHS says it is dangerous to stop suddenly, with a risk of flare-up and withdrawal symptoms such as severe tiredness, weakness, body aches and joint pain, and that dose reduction takes place over several weeks. The emc adds that abrupt withdrawal after prolonged use can cause serious adrenal insufficiency. Carry your steroid card and tell any clinician treating you that you take steroids, especially if you are ill or having surgery.

The NHS lists common effects as weight gain (more appetite and water retention), indigestion, trouble sleeping, sweating and mood changes. Taking it in the morning and with food helps. For indigestion, extra stomach protection may be added.

Call 111 or 999 as directed for infection signs (high temperature, sore throat, cough, painful urination), high blood sugar (thirst, hunger, frequent urination, fruity breath), Cushing-type changes (rounded face, weight gain on the upper back or belly), adrenal problems, low potassium, severe abdominal or back pain, breathlessness, limb swelling, vision change or unusual bruising. The NHS says call 999 for vomiting blood or thoughts of self-harm. The emc warns of psychiatric effects, including severe mood changes.

• Call 999: vomiting blood, thoughts of harming yourself.

• Call NHS 111: infection signs, very high thirst, vision change.

Months or years of use can thin bones (osteoporosis), worsen diabetes control, cause eye problems and high blood pressure, and slow growth in children. The NHS suggests regular exercise, enough calcium, and occasional bone scans where appropriate. Eye pressure and eyesight checks may be arranged.

The NHS says most adults and children can take it. Tell your doctor about current infections, unhealed wounds, recent contact with shingles, chickenpox or measles, recent or planned vaccines, previous allergy, and conditions including liver problems, mental health history, heart failure, recent heart attack, high blood pressure, diabetes, epilepsy, glaucoma, underactive thyroid, osteoporosis or stomach ulcer. Live vaccines are unsuitable because of reduced immunity; the NHS says non-live flu, shingles and polio vaccines are options.

Anyone trying to conceive, pregnant or breastfeeding should get medical guidance first. The emc says most prednisolone is inactivated crossing the placenta, but prolonged exposure may increase the risk of poor fetal growth. The NHS says you can drink alcohol on prednisolone, and driving is safe unless eyesight is affected.

Prednisolone is prescription only. Suspected side effects can be reported through the Yellow Card scheme.