1. About prednisolone
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.
2. Key facts
- 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.
3. Who can and can't take prednisolone
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:
4. How and when to take it
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.
5. Side effects
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
- sleep problems
- 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:
- 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.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of prednisolone. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
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.
6. How to cope with side effects
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.
7. Pregnancy and breastfeeding
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.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
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.
For safety, tell your doctor or pharmacist if you take any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does prednisolone work?
Steroids mimic the effects of hormones your body naturally produces in your adrenal glands. The adrenal glands sit on top of your kidneys.
When prescribed in doses higher than your body's usual levels, steroids like prednisolone dampen inflammation. This can reduce the symptoms of inflammatory conditions, such as arthritis and asthma.
Steroids also damp down your immune system, which can help in autoimmune illnesses like rheumatoid arthritis, where your immune system mistakenly attacks its own tissues.
When will I feel better?
This can vary.
For some illnesses, you will feel better after a couple of days.
For other illnesses, you may not feel any better even though the medicine is helping you. This may be the case if you're taking prednisolone to stop your symptoms getting worse or to prevent a problem happening (for example after an organ transplant).
Ask your doctor what to expect for your illness.
How long will I take prednisolone for?
This depends on your health problem.
You may only need a short course of prednisolone for up to a week.
You may need to take it for longer - even for many years or the rest of your life.
Will I put on weight?
If you have to take prednisolone for more than a few weeks, the chances are that you will put on weight. Prednisolone can make you hungrier and retain water, so it can be quite challenging to avoid weight gain.
Once you stop taking prednisolone, any issues around increased appetite or water retention should return to normal.
How do I come off prednisolone and will I get withdrawal symptoms?
It can be dangerous to stop taking prednisolone suddenly, especially if you have been on a high dose for a long time.
Your health condition may flare up again. You may also get extra side effects including:
- severe tiredness
- body aches
- joint pain
These side effects are most likely to happen if you have taken prednisolone for more than a few weeks or you take more than 40mg daily.
Your doctor will probably want to reduce your dose gradually over several weeks to prevent these side effects.
Do not stop taking prednisolone without talking to your doctor - you will need to reduce the dose gradually.
Can I take prednisolone for a long time?
Taking prednisolone for many months or years can have several harmful effects on your body. It can lead to:
- thinner bones (osteoporosis)
- poorly controlled diabetes
- eyesight problems
- slower growth in children and teenagers
If you have to take prednisolone for a long time, there are steps you can take to stay as healthy as possible:
- Take regular exercise and make sure you get enough calcium in your diet to help strengthen your bones. Calcium-rich foods include milk, cheese and leafy greens. To check your bones, your doctor may arrange for you to have an occasional bone scan.
- If you have diabetes, you may need to check your blood glucose more often. Your doctor can advise you more about this.
- To reduce the chances of eyesight problems, visit an optometrist every 12 months to check for high pressure in your eye (glaucoma) and cataracts.
- Make sure that children and teenagers have their height monitored regularly by a doctor so that any stunting of growth can be picked up promptly.
Do I need to be careful of infections?
Tell your doctor straight away if you come into contact with someone who has an infectious disease such as chickenpox or shingles. Your doctor may be able to prescribe a medicine to protect you.
Can I have vaccinations?
Some vaccines are not suitable for you while you are taking prednisolone.
Taking prednisolone lowers your immune system. If you have a "live" vaccine, like the shingles vaccine, while you are taking prednisolone your immune system might not be able to handle it. This may lead to an infection. Inactive vaccinations, like the flu vaccine, are safe.
If you need any vaccinations, mention that you are taking a steroid.
Do I need a blue steroid card?
If you are taking prednisolone for longer than 3 weeks, or you have been prescribed a high dose of more than 40mg daily, your doctor or pharmacist will give you a blue steroid treatment card.
The card is the size of a credit card and fits in your wallet or purse. It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much prednisolone you take and how long the treatment will last for.
If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist so they know that you are taking prednisolone.
Are there other steroids?
There are other steroids available, including:
For most health problems, these steroids are very similar to prednisolone in terms of how well they work and how safe they are.
Will it affect my mood?
You may notice mood changes and mental health problems while taking prednisolone, including:
- feeling depressed (including thinking about suicide)
- feeling high, or moods that go up and down
- feeling anxious, having problems sleeping, difficulty in thinking, or being confused and losing your memory
- feeling, seeing or hearing things that do not exist
- having strange and frightening thoughts, changing how you act, or having feelings of being alone
The higher the dose, the more intense the mood changes can be.
If this happens to you, talk to your doctor.
Will it affect my fertility?
There's no firm evidence to suggest that taking prednisolone will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking prednisolone.
Is there any food or drink I need to avoid?
Do not eat liquorice while taking prednisolone.
It's thought that real liquorice increases the amount of prednisolone in the body and also increases the risk of low potassium.