Glucocorticoid·Endocrinology - Systemic Corticosteroids

Prednisolone

Acute asthma/COPD, rheumatoid arthritis, IBD flares, severe allergic reactions, giant cell arteritis

PBSSTEROIDPanafcortelone, Solone, Redipred (liquid)1 mg tabletS4+1

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At a glance

Max Dose

75 mg/day

Half-life

2-4 h

Caution: Hyperglycemia

HIGH RISK

Caution: Tapering

REQUIRED

Cautions

Avoid / Cautions

Systemic fungal infections, live vaccines (if on high doses). Pregnancy Category A, but chronic use risks fetal adrenal suppression and cleft palate.

Where it stands

Rapid Summary

Overview

The quintessential oral systemic glucocorticoid. Provides profound, rapid suppression of the immune system and inflammatory cascades.

Clinical Focus

Use > 2 weeks suppresses the HPA axis. Abrupt cessation will cause fatal Addisonian crisis. Must be tapered.

Bottom Line

Prednisolone is the most commonly used oral corticosteroid for inflammatory, autoimmune, and allergic conditions, but long-term use causes devastating metabolic, bone, and adrenal suppression effects requiring slow taper.

Formulation & Access

Brand Names

Panafcortelone, Solone, Redipred (liquid)

Oral Routes

Take with food

Tablets (1 mg, 5 mg, 25 mg). Oral liquid (5 mg/mL). Take with food.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Acute asthma/COPD, rheumatoid arthritis, IBD flares, severe allergic reactions, giant cell arteritis.

Clinical Place

The most commonly prescribed oral steroid on the ward. Five times more potent anti-inflammatory action than hydrocortisone.

Quick reference

Class & Role

Glucocorticoid — The quintessential oral systemic glucocorticoid.

Route / Formulation

Tablets (1 mg, 5 mg, 25 mg). Oral liquid (5 mg/mL). Take with food. (Panafcortelone, Solone, Redipred (liquid))

Usual Dose & Max

PO 37.5 - 50 mg OD in the morning for 5 days. (No taper required for < 5 day courses). Max 75 mg/day (Doses > 50 mg/day are generally considered massive and reserved for extreme rheumatologic/pulmonary flares).

Key Indication Doses

Asthma / COPD Flare: PO 37.5 - 50 mg OD in the morning for 5 days. (No taper required for < 5 day courses). Rheumatoid Arthritis Flare: PO 10-25 mg OD, tapering rapidly to lowest effective dose. Gout Flare: PO 35 mg OD for 3-5 days (if NSAIDs/colchicine contraindicated).

Best Uses

Key Risks

Endocrine: HPA axis suppression. HIGH — Severe hyperglycemia (especially post-prandial), Cushing's syndrome (moon face, buffalo hump, central obesity). Neurological: Steroid psychosis, delirium, severe insomnia, mania. Musculoskeletal: Osteoporosis (with chronic use), avascular necrosis of the femoral head, steroid myopathy. Gastrointestinal: Peptic ulceration (especially combined with NSAIDs).

Key Interactions

NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI. Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture.

Monitoring

BSL checks. Even non-diabetic patients can hit sugars of 20+ on 50mg of prednisolone. Baseline DEXA scan for bone density if anticipating > 3 months of use.

Clinical Pearl

Always prescribe the entire daily dose in the morning (with breakfast). Giving it at night destroys the patient's sleep architecture and causes severe insomnia and mood disturbance.

Access

Panafcortelone, Solone, Redipred (liquid)1 mg tablet

Brand: Panafcortelone, Solone, Redipred (liquid)
Formulation: Tablets (1 mg, 5 mg, 25 mg). Oral liquid (5 mg/mL). Take with food.

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