What is prednisolone?
Prednisolone falls under a class of drugs called corticosteroids, which also includes methylprednisolone, fluticasone, and budesonide, among others. It is sold under several brand names, including Orapred, Pediapred, and Flo-Pred, and is also available as a generic medication.
Corticosteroids are steroid hormones that occur naturally in your body, while synthetic versions (such as prednisolone) are used medicinally. Corticosteroids are involved in several processes, including your immune response, inflammation, and metabolism. Corticosteroids can be further categorized, with the main classes being glucocorticoids and mineralocorticoids. Glucocorticoids are the type of corticosteroids that influence your immune response and inflammation.
Prednisolone is a glucocorticoid and therefore has anti-inflammatory effects. This is why you may see it referred to as both a corticosteroid and glucocorticoid.
Prednisolone is, therefore, usually used to treat conditions that are characterized by inflammation, including different forms of arthritis, allergic conditions (including asthma), and chronic skin conditions (such as psoriasis). A more comprehensive list of conditions prednisolone is used to treat can be found in question 2: What is prednisolone used for?
Prednisolone can be taken orally (as a tablet, solution, or soluble granules, among other forms) by injection, as eye drops, as a nasal spray, as a topical treatment (forms applied directly to the skin, such as ointment), and as a suppository.
The possibility to inject prednisolone may make it preferable to other drugs under certain circumstances; for example, if taking oral medications is not feasible.
What is prednisolone used for?
The anti-inflammatory characteristics of prednisolone make it a potential treatment option for a wide range of diseases that are characterized by inflammation.
The use of corticosteroids in treating allergic conditions, including asthma, allergic rhinitis (hay fever), and allergic reactions to other drugs, is usually reserved for severe cases and when conventional treatment has been ineffective.
Prednisolone can be used, in addition to long-term therapy, as a short-term treatment for acute episodes or ‘flare-ups’ of several rheumatic disorders. These include rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, among others.
Prednisolone may be used to treat endocrine disorders such as Addison’s disease, which is characterized by the adrenal glands not producing enough steroid hormones (primarily cortisol). Prednisolone can be used as a treatment, as it mimics cortisol (see question 3: How does prednisolone work).
Prednisolone can be used to treat autoimmune diseases related to collagen (the main protein in connective tissue), either during an exacerbation or as maintenance therapy. These include lupus, dermatomyositis, and acute rheumatic carditis.
Prednisolone can be used to treat several skin conditions, including psoriasis, seborrheic dermatitis, exfoliative dermatitis, bullous dermatitis herpetiformis, mycosis fungoides, pemphigus, and Stevens-Johnson syndrome. As prednisolone is one of the more potent corticosteroids, it may be used in particularly severe cases.
Prednisolone may be used to help prevent organ rejection following a transplant.
Prednisolone may be used to treat certain cancers, often alongside chemotherapy. The use of steroids in cancer treatment can be to help treat cancer itself, to reduce inflammation, to mitigate the risk of rejection following a transplant, or to treat the side effects of other drugs (such as nausea caused by chemotherapy).
Other uses for prednisolone include a range of respiratory disorders, hematological disorders, edematous states, gastrointestinal diseases, and diseases of the nervous system (such as acute exacerbations of multiple sclerosis). It may also be used ‘off-label’ (in a manner not approved by the FDA or other health agencies) at your doctor’s discretion.
For more details about which conditions prednisolone is used to treat and whether it may be a suitable option for you, you can read the FDA label (available in the sources at the bottom of this page) or speak to your doctor.
How does prednisolone work?
Corticosteroid drugs, such as prednisolone, work by mimicking the effects natural corticosteroid hormones have on your body. In particular, they mimic cortisol, which is the most important glucocorticoid (see question 1: What is prednisolone? for a brief explanation of what glucocorticoids are).
One of the primary actions of prednisolone is to limit your immune system’s activity, particularly regarding inflammation. Inflammation is an important part of your immune system’s normal response; however, many diseases are characterized by the immune system being overactive or mistakenly attacking healthy parts of the body (such as the joints in people living with rheumatoid arthritis).
By limiting this response, prednisolone can reduce inflammation and ease symptoms.
The downside to this mechanism of action is that prednisolone can weaken your immune system and make you more susceptible to infections. Cortisol, the hormone prednisolone replicates, also plays a role in a variety of other functions within your body. Prednisolone can, therefore, cause several side effects related to these other functions, particularly when taken at high doses. You can read more about the side effects of prednisolone in question 5: What are the side effects of prednisolone?
The mechanisms of corticosteroids are markedly different from non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and meloxicam. NSAIDs block enzymes that promote pain and inflammation, rather than limiting the response of your immune system.
What is the difference between prednisolone, prednisone, and methylprednisolone?
Prednisolone, prednisone, and methylprednisolone all work in very similar ways and are generally used to treat the same conditions. However, there are some differences:
- Prednisone is a ‘prodrug’. This means it is biologically inactive until it is metabolized. Prednisone is metabolized in the liver, releasing prednisolone, which then acts on the body. Prednisone is taken orally
- Prednisolone is, therefore, the active metabolite of prednisone. Unlike prednisone, it does not need to be metabolized before it starts having a biological effect. It can be taken orally, with injections, or topically (creams/ointments applied on the skin). Prednisolone and prednisone have been found to have similar potency
- Methylprednisolone is the most potent of the three; 4mg of methylprednisolone is equivalent to 5mg of prednisone or prednisolone. It can be taken orally, with injections, or topically.
Your doctor will consider the differences between methylprednisolone, prednisone, prednisolone, another corticosteroid, and other treatment options (such as NSAIDs) when deciding the most suitable option.
What are the side effects of prednisolone?
Prednisolone can cause a wide range of symptoms, some of which are specific to the specific form of prednisolone you are taking and in which form (tablets, injections, topical).
Side effects of prednisolone that require medical attention
Some side effects can occur when prednisolone is taken orally or by injections and require medical attention. They include:
- Blurred vision
- Decreased amount of urine
- Mood changes, aggression, or irritability
- Slow, fast, or irregular heartbeat
- Difficulty swallowing
- Trouble breathing
- Numbness or tingling in your arms or legs
- Itching or skin rashes
- Eye pain or tearing
- Loss of appetite
- Yellow eyes or skin
- Unexplained weight gain or loss
- Pain in your stomach or abdomen
Should you experience any of these side effects, you should contact your doctor immediately.
Side effects of prednisolone that do not usually require medical attention
Other side effects of prednisolone are not considered as serious and may go away once your body adapts to the drug. Some side effects can occur when prednisolone is taken orally or by injections include:
- Dry scalp
- Thinning of hair
- Swelling of the stomach area
- Lightening skin color
- Red face
- Red or purple lines on your arm, face, legs, or groin
Side effects that are more likely to occur when prednisolone is taken orally include:
- Increased sweating
- Thin or fragile skin
- Menstrual changes
Side effects that can occur when prednisolone is taken by injection include:
- Pain, redness, or hard skin at the injection site
- Pitting or depression at the injection site
These side effects will often ease or go away as your body gets used to prednisolone. However, if they are severe, persistent, or worsen, you should speak to your doctor.
Side effects of topical prednisolone
Topical prednisolone, most commonly sold under the brand name Advantan, can produce different side effects to oral and injectable forms of prednisolone. Common side effects include:
Less common side effects include:
- Skin infection at the site of application
- Swelling at the site of application
- Irritation at the site of application
- Bacterial skin infection
- Cracks on the skin
- Thinning of the skin
- Skin discoloration
Although serious side effects to topical prednisolone are rare, you should speak to your doctor if you are concerned about any side effects that you (or your child) experience.
Allergic reactions to prednisolone
Allergic reactions to prednisolone are rare but can occur. Signs of a serious allergic reaction should be treated as a medical emergency. They include:
- Skin rash – for example itchy, red, or swollen skin
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
Effects of prednisolone on the immune system
The way that prednisolone works means that it may reduce your immune system’s ability to fight infections. You should, therefore, be aware of any signs of infection and speak to your doctor if you experience symptoms such as fever, chills, a bad cough, or persistent sore throat. You should also speak to your doctor immediately if you are exposed to chickenpox or measles.
Speak to your doctor & read the label
This is not a comprehensive list of side effects that can occur when you take prednisolone. Because prednisolone comes in different forms and is prescribed at different strengths and for different lengths of time, it is important to both speak to your doctor about which side effects that you should be aware of. You should also read the leaflet that comes with your medication.
How long do the side effects of prednisolone last?
Given the wide-ranging use of prednisolone, the different forms and strengths, and the varied side effects that can occur, there is no single length of time you can expect side effects to last. As discussed in the previous question, What are the side effects of prednisolone, you should speak to your doctor immediately if serious side effects occur.
Less serious side effects should begin easing off as your body adapts to prednisolone. This will often happen within a week but can take longer. If your side effects do not ease off (or if they worsen), you should speak to your doctor.
How long does it take for prednisolone to work?
Although prednisolone begins working immediately, the length of time it takes before you notice an improvement in symptoms varies drastically depending on your condition, the severity of your condition, and the form of prednisolone.
It is possible you will notice an improvement within a few days, but it can take several weeks for prednisolone to have its full effects.
You should speak to your doctor about your specific treatment and how long it should take to start working. If you have not noticed any improvement within a timeframe specified by your doctor (often a few weeks), an alternative treatment may be considered.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.