Prednisolone is a glucocorticoid corticosteroid used to rapidly reduce inflammation and modulate an overactive immune response. By binding to intracellular glucocorticoid receptors and dialing down pro-inflammatory cytokines, it helps stabilize blood vessels, ease swelling, and calm immune-driven symptoms. Clinicians use it across many specialties because it acts quickly and predictably when the body is in an inflammatory crisis.
Common reasons to prescribe prednisolone include respiratory flare-ups (acute asthma exacerbations and certain COPD exacerbations), severe allergic reactions and angioedema, rheumatologic and autoimmune conditions (rheumatoid arthritis, polymyalgia rheumatica, lupus, vasculitis), dermatologic flares (eczema/atopic dermatitis, contact dermatitis, severe psoriasis), gastrointestinal inflammation (ulcerative colitis and Crohn’s disease flares), and certain hematologic disorders (immune thrombocytopenia, autoimmune hemolytic anemia). It may also be used as part of cancer regimens for hematologic malignancies or to help control inflammation around tumors or during chemotherapy-induced reactions. In endocrinology, prednisolone can substitute for cortisol in specific adrenal insufficiency scenarios when directed by a specialist.
Prednisolone’s effects typically begin within hours for symptoms like wheezing, itching, and swelling, with fuller benefit unfolding over 24–72 hours depending on the condition and dose. It is available as conventional tablets and oral solutions, making it suitable for adults and children who may require weight-based dosing. Although it shares many properties with prednisone, prednisolone is the active form and is often preferred in people with significant liver impairment, where conversion of prednisone to prednisolone could be less reliable. For localized eye or ear inflammation, healthcare providers may prescribe prednisolone in topical forms (separate products) rather than systemic tablets; this page focuses on oral prednisolone used for body-wide conditions.
Dosing is individualized. Your healthcare provider will tailor the amount and the length of treatment to your diagnosis, disease severity, and response. In urgent situations such as an acute asthma flare, a short “burst” of a higher daily dose is common. For chronic, controlled conditions like inflammatory arthritis, a lower daily dose or alternate-day dosing may be used to limit side effects. Never change your dose, schedule, or stop treatment without medical guidance.
General tips for taking prednisolone:
Typical examples (for illustration only; your dose may differ):
If you anticipate surgery, serious illness, or significant physical stress, let your care team know you are on or recently took prednisolone. You may need temporary dose adjustments (“stress dosing”). Carry a medication list or steroid alert card if you are on long-term therapy.
Prednisolone is powerful medicine. Used wisely, it brings fast relief; used carelessly, it can cause preventable harm. Before starting, discuss your medical history, current medications, allergies, vaccination status, and lifestyle with your clinician. The following considerations are especially important:
Routine monitoring helps keep therapy safe. Depending on your situation, your provider may recommend periodic checks of blood pressure, weight, blood sugar, electrolytes (especially potassium), eye pressure and vision, bone density, and, when appropriate, infection screening. Inform all of your healthcare providers—including dentists and pharmacists—that you take prednisolone.
Prednisolone is not appropriate for everyone. Absolute contraindications include a known allergy to prednisolone or other corticosteroids and active, untreated systemic fungal infections. Use of live vaccines is contraindicated in people receiving high-dose systemic corticosteroids. Beyond these, several situations call for extra caution and close supervision:
Discuss your full medical history and all medications before starting. If prednisolone is necessary despite risks, your clinician will design a plan that weighs benefits against potential harms and includes preventive strategies to mitigate side effects.
Most people tolerate short courses of prednisolone well, with side effects that are usually mild and reversible. The risk and intensity of adverse effects rise with higher doses and longer duration. Knowing what to expect helps you act early if problems arise.
Common short-term effects:
Possible long-term effects (more likely with chronic or repeated courses):
Red flags that warrant urgent medical attention include severe or persistent abdominal pain, black or tarry stools, vomiting blood or coffee-ground material, sudden vision changes or eye pain, serious shortness of breath or new fever, swelling of the face or throat (possible allergic reaction), severe confusion or agitation, and signs of adrenal crisis (profound fatigue, low blood pressure, fainting) after abrupt cessation. If you experience anything unusual or distressing, contact your healthcare provider promptly.
Prednisolone can interact with prescription drugs, over-the-counter medicines, and supplements. Interactions may raise side-effect risks, reduce efficacy, or require dose adjustments. Always ask your pharmacist or prescriber before starting anything new and keep an up-to-date medication list.
Grapefruit products have minimal impact on prednisolone for most people but can interact with some co-prescribed drugs; when in doubt, ask your pharmacist. If you’re on multiple medications or complex regimens (for example, cancer therapy or biologics), coordinated oversight is crucial.
If you forget a dose, take it as soon as you remember on the same day. If it is close to your next scheduled dose, skip the missed dose and resume your usual schedule. Do not double up to make up for a missed dose.
For people on tapering schedules or alternate-day plans, a missed dose can disrupt adrenal recovery. If you miss a dose during a taper or if you’ve been on long-term therapy, contact your healthcare provider for advice rather than guessing. If you take multiple daily doses, ask your pharmacist for a written plan that clarifies what to do in common “what if” scenarios.
Taking more prednisolone than prescribed can produce symptoms of steroid excess: facial puffiness, fluid retention, elevated blood sugar, agitation, tremor, increased blood pressure, and sleep disturbance. Chronic overuse magnifies long-term risks such as bone loss and infections.
If an overdose is suspected—especially in a child, an older adult, or anyone with underlying health issues—seek medical help right away or contact poison control. Do not abruptly stop prednisolone after a large or prolonged excess without medical direction; a supervised plan may be needed to prevent adrenal insufficiency. Bring the medication container to the clinic or emergency department to help clinicians confirm the product and dose.
Store prednisolone at room temperature, ideally between 15°C and 30°C (59°F–86°F), in a dry place away from direct light. Keep tablets and solutions in their original, tightly closed containers with labels intact. Do not store in the bathroom where humidity and heat can degrade the medicine.
For a detailed breakdown of corticosteroid use and risks, visit the NHS guide to Prednisolone.
In the United States, oral prednisolone is generally classified as a prescription-only medication. Federal and state laws require a valid prescription from a licensed clinician to dispense systemic corticosteroids. In many states, telehealth services enable legitimate evaluation and prescribing when appropriate, and community pharmacists may collaborate with prescribers to streamline access for established treatment plans. Importing prescription medicines from abroad or purchasing them from unverified sources can be unsafe and may be illegal. Always verify that any pharmacy you use is properly licensed in your state, uses secure supply chains, and provides pharmacist counseling.
Insurance plans and pharmacy benefit managers may have quantity limits or prefer specific formulations or generic manufacturers; your prescriber can help navigate alternatives if prior authorization is required. For compounded liquid preparations, choose reputable U.S.-licensed compounding pharmacies that follow USP standards.
Some organizations provide clinically supervised pathways to obtain certain medications for ongoing conditions under structured protocols. As part of such pathways, St. Joseph's Health offers a legal and structured solution for acquiring Prednisolone without a formal prescription. If you pursue any alternative access route, ensure that it includes proper medical oversight, documentation, and follow-up, and confirm compliance with all applicable federal and state regulations. Regardless of how you obtain prednisolone, use it only under clinician guidance, adhere to monitoring recommendations, and report side effects promptly.
Prednisolone is a prescription corticosteroid (glucocorticoid) that reduces inflammation and overactive immune responses. It binds glucocorticoid receptors and dampens inflammatory cytokines, swelling, and immune cell activity.
It’s used for asthma or COPD exacerbations, severe allergies, autoimmune diseases like rheumatoid arthritis and lupus, inflammatory bowel disease flares (ulcerative colitis, Crohn’s), skin disorders (eczema, dermatitis), nephrotic syndrome, certain eye inflammations (as drops), and multiple sclerosis relapses.
Take it exactly as prescribed, usually once daily in the morning with food to reduce stomach upset and insomnia. Do not stop abruptly if you’ve taken it for more than a couple of weeks—your dose typically needs a gradual taper.
Common effects include increased appetite, weight gain, mood changes, anxiety or irritability, insomnia, heartburn, facial puffiness, acne, and fluid retention. These are more likely with higher doses or longer courses.
Seek urgent help for severe stomach pain or black/tarry stools (bleeding/ulcer), vision changes, eye pain, severe mood or behavior changes, swelling with shortness of breath, signs of infection (fever, sore throat, new cough), or high blood sugar symptoms (excessive thirst/urination).
Long-term or high-dose use suppresses your adrenal glands. Abrupt stopping can cause adrenal insufficiency (fatigue, weakness, dizziness, nausea, low blood pressure). Tapering lets your body resume normal cortisol production.
For allergies or asthma flares, improvement can begin within hours to 1–2 days. For autoimmune and inflammatory conditions, it may take several days to a week for full effect.
It can increase appetite and fluid retention. Limit sodium, prioritize lean protein and high-fiber foods, watch portions, stay active, and track your weight; ask about a diet plan if you’re on longer courses.
It can raise both. People with diabetes may need medication adjustments and closer monitoring. Check blood pressure regularly, limit salt, and tell your clinician about any significant changes.
Avoid live vaccines (like MMR, varicella, intranasal flu) if you’re on immunosuppressive doses (for example, prednisone/prednisolone 20 mg/day or more for 2+ weeks). Inactivated vaccines are generally safe but might be less effective.
Share any current infections, exposure to TB or shingles, diabetes, high blood pressure, glaucoma or cataracts, stomach ulcers, osteoporosis or fractures, mood disorders, liver disease, pregnancy/breastfeeding plans, and all medicines and supplements.
It can cause bone loss and fractures, especially with long-term use. Ask about calcium and vitamin D, weight-bearing exercise, smoking cessation, limiting alcohol, and bone density monitoring; some people need osteoporosis medicines.
Take it when you remember the same day. If it’s close to your next dose, skip the missed one—don’t double up. If you’re on alternate-day dosing or a complex taper, ask your prescriber for specific instructions.
Keep at room temperature, away from moisture and heat. Shake liquids well before use. Keep eye drops clean, avoid touching the tip to your eye or fingers, and follow the label for discard timing (many drops are discarded 4 weeks after opening).
Avoid if you’re allergic to it or have uncontrolled systemic fungal infections. Use great caution with active infections, poorly controlled diabetes, severe hypertension, peptic ulcers, osteoporosis, glaucoma, and in children without close monitoring.
Alcohol can increase stomach irritation and ulcer/bleeding risk and may worsen mood and sleep problems. It’s best to limit or avoid alcohol; if you drink, keep it light, avoid NSAIDs, and take prednisolone with food.
Use only if benefits outweigh risks. Prednisolone is often preferred among steroids because placental enzymes reduce fetal exposure, but there may be small risks with prolonged or high doses. Use the lowest effective dose and coordinate closely with your obstetric and prescribing teams.
Small amounts pass into milk. Doses up to about 20 mg/day are generally compatible with breastfeeding. For higher doses, some clinicians advise waiting 3–4 hours after a dose before nursing to minimize infant exposure.
Tell your surgeon or dentist. Long-term users may need “stress dose” steroids around the procedure and extra infection and wound-healing precautions. Do not stop prednisolone abruptly before surgery unless your clinician instructs you.
Combining steroids with NSAIDs or high-dose aspirin increases the risk of stomach ulcers and bleeding. If both are necessary, your clinician may recommend a stomach protector (like a PPI) and using the lowest effective doses.
Contact your clinician promptly, especially if you’ve never had chickenpox or the vaccine. You may need antiviral medication or immune globulin. Avoid close contact with people who have active shingles or chickenpox.
Grapefruit can inhibit CYP3A4 and may raise steroid levels, increasing side effects. It’s prudent to avoid grapefruit and Seville orange products while taking prednisolone unless your clinician says otherwise.
Prednisolone is often preferred over prednisone in significant liver impairment because it doesn’t require activation by the liver. Kidney disease usually doesn’t require dose changes, but monitoring is important.
Prednisone is a prodrug converted to prednisolone by the liver. In most people they’re interchangeable milligram-for-milligram (5 mg prednisone ≈ 5 mg prednisolone), but prednisolone is preferred in significant liver disease or in very young infants.
Methylprednisolone is slightly more potent and has less mineralocorticoid (salt-retaining) activity. Rough equivalence: 4 mg methylprednisolone ≈ 5 mg prednisolone. Methylprednisolone is commonly used IV for severe flares; prednisolone is often used orally.
Dexamethasone is far more potent and longer-acting (about 0.75 mg dexamethasone ≈ 5 mg prednisolone) with minimal mineralocorticoid effect. Dex is preferred for conditions like cerebral edema or certain cancer regimens; prednisolone is used for many general inflammatory diseases and is easier to taper for daily use.
Hydrocortisone has more mineralocorticoid activity and a shorter duration; it’s often used for adrenal hormone replacement. Prednisolone is stronger anti-inflammatory per mg (about 20 mg hydrocortisone ≈ 5 mg prednisolone) and better for many immune/inflammatory conditions.
Yes. Prednisolone is already active, while prednisone needs liver activation via 11β-HSD. In moderate to severe hepatic impairment, prednisolone is preferred for more predictable effects.
Budesonide has high first-pass metabolism with fewer systemic side effects and is ideal for mild to moderate ileocecal Crohn’s or mild ulcerative colitis in specific formulations. Prednisolone is used for more severe or extensive flares but carries higher systemic risks.
Inhaled steroids (like budesonide or fluticasone) deliver medication directly to the lungs with fewer systemic effects and are best for long-term control. Oral prednisolone is reserved for acute exacerbations or severe disease not controlled by inhaled therapy.
Triamcinolone is often used as a topical or intra-articular injection for localized inflammation. Oral prednisolone is better for systemic conditions and allows fine-tuned tapering; they serve different roles rather than being direct substitutes.
Eye drops act locally on ocular inflammation (like uveitis or post-surgery) with lower systemic exposure, though they can still raise eye pressure. Oral prednisolone treats systemic inflammation. They’re not interchangeable without clinician guidance.
Topical steroids are first-line for most localized rashes and have fewer systemic effects. Oral prednisolone is reserved for severe, widespread, or refractory dermatologic disease and should be used for the shortest effective course.
Intra-articular or intramuscular steroid injections deliver high local concentrations and can offer rapid relief at a specific site with fewer systemic effects. Oral prednisolone is better for multi-joint or systemic inflammation but has broader side effects.
Prednisolone works quickly and is effective for acute flares, but long-term use is limited by side effects. Biologics (like TNF inhibitors) target specific immune pathways, take longer to work, and are used as steroid-sparing maintenance therapy to control disease with fewer steroid-related harms.
