Prednisolone

What Does Prednisolone Do?

Prednisolone is a corticosteroid medication effective in treating various inflammatory conditions, including arthritis, severe allergic reactions, multiple sclerosis, lupus, respiratory disorders, skin issues, kidney ailments, thyroid conditions, and cancer symptoms. It may also be used off-label for other conditions that involve significant inflammation.

Prednisolone is a highly effective and incredibly good drug in the short-term, but it can cause significant issues with long-term use. 

One of the most common usages of prednisolone is for a condition called polymyalgia rheumatica (meaning multiple muscle and joint pains). 

How Does Prednisolone Work? (the complicated stuff!)

Prednisolone operates by binding to the glucocorticoid receptor (GR), leading to the inhibition of pro-inflammatory signals and promotion of anti-inflammatory signals. This process involves translocating to the nucleus, where it inhibits the transcription of pro-inflammatory genes, reducing the production of cytokines that mediate inflammation. Simultaneously, prednisolone promotes the transcription of anti-inflammatory genes, resulting in increased production of mediators that alleviate inflammation. By decreasing inflammation and modulating immune system activity, prednisolone effectively slows down or halts the progression of various inflammatory diseases, thereby improving patient symptoms and quality of life.

Drug Type and Category of Prednisolone

Prednisolone is a corticosteroid medication. It falls under the category of anti-inflammatory drugs.

What dosage of Prednisolone should you be taking?

NICE Guidelines

According to the British National Formulary (BNF), the initial adult dosage typically ranges from 10 to 20 mg taken once daily, preferably in the morning after breakfast. This dose can often be reduced within a few days but may need to be continued for longer periods, depending on the clinical response. ¹

For certain conditions, higher initial doses may be required. For example, in the management of acute exacerbations of multiple sclerosis, a common regimen involves administering 500 mg of methylprednisolone (a related corticosteroid) daily for 5 days.

What are the side-effects of Prednisolone?

Common Side Effects:

• Increased Appetite and Weight Gain: Prednisolone can stimulate appetite, leading to weight gain.
• Mood and Behavioral Changes: Patients may experience mood swings, anxiety, irritability, or even more severe psychiatric effects such as depression or euphoria.
• Insomnia: Difficulty falling or staying asleep is a reported side effect.
• Elevated Blood Sugar Levels: Prednisolone can increase blood glucose levels, which is particularly concerning for individuals with diabetes.
• Fluid Retention and oedema: Some individuals may notice swelling in the lower legs due to fluid retention.
• Increased Susceptibility to Infections: The immune-suppressing effects of prednisolone can make patients more prone to infections.

Less Common but Serious Side Effects:

• Osteoporosis: Long-term use can lead to bone thinning, increasing the risk of fractures.
• Hypertension: Elevated blood pressure may occur with prolonged use.
• Eye Problems: Issues such as cataracts or glaucoma can develop.
• Gastrointestinal Issues: There's an increased risk of peptic ulcers and pancreatitis.
• Adrenal Suppression: Extended use can suppress the body's natural steroid production, leading to adrenal insufficiency.

Withdrawal Considerations:

Abrupt discontinuation after prolonged use can result in withdrawal symptoms, including fatigue, body aches, and lightheadedness. It's essential to taper off the medication under medical supervision to allow the adrenal glands to resume normal function.

Interactions

Common Drug Interactions:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
• Examples: Ibuprofen, naproxen.
• Interaction: Concurrent use can increase the risk of gastrointestinal bleeding and ulcers.
• Recommendation: Use with caution; consider gastroprotective measures if long-term combined use is necessary.
2. Anticoagulants:
• Examples: Warfarin.
• Interaction: Prednisolone may enhance or diminish the effects of anticoagulants, affecting blood clotting parameters.
• Recommendation: Monitor blood coagulation levels (e.g., INR) closely and adjust anticoagulant dosage as needed.
3. Diabetes Medications:
• Examples: Insulin, metformin, sulfonylureas.
• Interaction: Prednisolone can elevate blood glucose levels, potentially reducing the effectiveness of antidiabetic drugs.
• Recommendation: Monitor blood sugar levels regularly; dosage adjustments of diabetes medications may be required.
4. Diuretics:
• Examples: Furosemide, hydrochlorothiazide.
• Interaction: Combined use may lead to increased potassium loss, raising the risk of hypokalemia.
• Recommendation: Monitor electrolyte levels, particularly potassium, and consider supplementation if necessary.
5. Vaccines:
• Interaction: Prednisolone's immunosuppressive effects can reduce the efficacy of live vaccines and increase the risk of infection.
• Recommendation: Avoid live vaccines during prednisolone therapy; consult with a healthcare provider regarding vaccination schedules.
6. CYP3A4 Inhibitors:
• Examples: Ketoconazole, erythromycin.
• Interaction: These drugs can increase prednisolone levels by inhibiting its metabolism, potentially leading to enhanced side effects.
• Recommendation: Monitor for increased corticosteroid effects and consider dosage adjustments.

Disease Interactions:

Prednisolone may exacerbate certain medical conditions, including:

• Infections: May mask signs of infection and decrease resistance.
• Hypertension: Can elevate blood pressure.
• Osteoporosis: Long-term use can decrease bone density.
• Diabetes: May increase blood glucose levels.

Natural Alternatives to Prednisolone

1. Curcumin (Turmeric Extract)

Curcumin, the active compound in turmeric, has potent anti-inflammatory and antioxidant properties. Studies suggest it may help reduce symptoms of rheumatoid arthritis, inflammatory bowel disease, and asthma by modulating inflammatory pathways².

2. Omega-3 Fatty Acids

Found in fish oil, flaxseeds, and chia seeds, omega-3 fatty acids help reduce systemic inflammation by inhibiting pro-inflammatory cytokines and eicosanoids³. They have been studied for their potential benefits in autoimmune diseases, arthritis, and cardiovascular health.

3. Boswellia Serrata (Indian Frankincense)

Boswellia contains active compounds that can inhibit pro-inflammatory enzymes, similar to corticosteroids but with fewer side effects⁴. Research indicates that it may benefit individuals with osteoarthritis, asthma, and inflammatory bowel diseases.

4. Ginger (Zingiber officinale)

Ginger has natural anti-inflammatory effects that can help with conditions like osteoarthritis and digestive inflammation. Its bioactive compounds, such as gingerol, act on the same pathways as NSAIDs and corticosteroids⁵.

5. Quercetin

A flavonoid found in apples, onions, and berries, quercetin has antihistamine and anti-inflammatory effects. It helps stabilise mast cells, making it useful for allergies and inflammatory conditions such as asthma and autoimmune disorders⁶.

6. Vitamin D

Vitamin D plays a crucial role in immune regulation and inflammation control. Deficiency is linked to autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and lupus⁷. Maintaining optimal vitamin D levels may help reduce inflammation and disease severity.

7. Magnesium

Magnesium is essential for muscle relaxation, nerve function, and reducing inflammation. Low magnesium levels are associated with increased inflammation and immune dysregulation, making supplementation beneficial for individuals with chronic inflammatory conditions⁸.

8. Adaptogenic Herbs (Ashwagandha and Rhodiola Rosea)

Adaptogens help the body adapt to stress, which is critical for individuals with inflammatory or autoimmune conditions. Ashwagandha has been shown to lower cortisol levels and reduce inflammation, potentially offering benefits similar to low-dose corticosteroids⁹.

9. Dietary and Lifestyle Modifications

• Anti-Inflammatory Diet – A Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats can help reduce chronic inflammation¹⁰.
• Exercise and Stress Management – Regular physical activity and stress reduction techniques such as meditation and yoga support immune balance and reduce inflammation¹¹.

Interesting facts about Prednisolone

Prednisolone is 4 to 5 times more potent than cortisol, making it highly effective in reducing inflammation with smaller doses compared to the body’s natural steroid production.

While prednisolone is effective in reducing inflammation, it also suppresses the immune system, making individuals more prone to infections and slower wound healing.

Prednisolone may also be used in organ transplant recipients, helping to prevent organ rejection by suppressing the immune system.

Disclaimer

This article is generated for informational purposes only. It was created in March 2025. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://bnf.nice.org.uk/drugs/prednisolone
2. Curcumin as an Anti-Inflammatory Agent: A Review. Journal of Medicinal Food, 2021.
3. Effects of Omega-3 Fatty Acids on Inflammatory Diseases. Nutrients, 2020.
4. Boswellia and Its Role in Inflammatory Conditions. Phytotherapy Research, 2019.
5. Ginger in Pain and Inflammation Management. International Journal of Rheumatic Diseases, 2022.
6. Quercetin and Mast Cell Stabilization: Implications for Inflammatory Diseases. Allergy Journal, 2021.
7. Vitamin D and Autoimmune Diseases: A Systematic Review. Endocrinology Reviews, 2022.
8. The Role of Magnesium in Inflammatory and Autoimmune Conditions. Journal of Clinical Nutrition, 2020.
9. Adaptogenic Herbs in Stress and Inflammation Regulation. Alternative Medicine Review, 2021.
10. The Mediterranean Diet and Chronic Inflammation. American Journal of Clinical Nutrition, 2021.
11. Physical Activity and Immune System Modulation. Sports Medicine Journal, 2023.