Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Prednisolone

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USE IF: Inflammatory exacerbation (e.g., asthma/COPD), autoimmune flare, selected allergic/derm/IBD/nephrotic/oncology protocols β€” with infection vigilance, glucose plan when needed, and explicit taper plan if exposure is prolonged.

AVOID IF: Abrupt stop after prolonged therapy (without taper plan); live vaccines during high-dose immunosuppression; systemic infection without source control / coverage when risk/benefit is unfavorable (relative).

Prednisolone

Systemic glucocorticoid

AdultPediatricSteroidImmunosuppressionERWardClinic

Indication

Airway exacerbation β€’ Allergy adjunct β€’ Autoimmune flare β€’ Derm β€’ IBD / nephrotic / oncology (protocol) β€’ AI replacement (specialist)

At a glance

INDICATIONS (CORE USE)

- Asthma / COPD exacerbation - Allergic reactions (non-anaphylaxis adjunct) - Autoimmune flares (e.g., SLE, RA) - Dermatologic inflammatory conditions

ADULT DOSE (STANDARD)

Short course (e.g., asthma/COPD): 30–50 mg PO daily Γ— 5–10 d (often no taper) Moderate inflammatory disease: ~10–40 mg PO daily (severity-dependent) Severe disease: higher PO or IV steroids (hydrocortisone / methylpred) per protocol

MAX DOSE

Indication-dependent β€” duration drives adrenal risk as much as dose

Route

PO (main); IV equivalent = hydrocortisone (per protocol)

PEDIATRIC DOSE

Weight-based; specialist / protocol-driven

Do not miss

Must-not-miss safety points

Major warning

- Immunosuppression β†’ infection risk (can mask sepsis) - Hyperglycemia (especially diabetics) - Adrenal suppression β†’ DO NOT stop abruptly if prolonged use - Psychiatric effects (mood, agitation, psychosis) - GI risk (ulcer, bleeding esp. with NSAIDs) - Long-term: osteoporosis, weight gain, Cushingoid features

Indications

Primary

  • Asthma / COPD exacerbation
  • Allergic reactions (non-anaphylaxis adjunct)
  • Autoimmune flares (e.g., SLE, RA)
  • Dermatologic inflammatory conditions

Secondary

  • Inflammatory bowel disease flares
  • Nephrotic syndrome (selected protocols)
  • Hematologic / oncologic protocols (context-specific)

Other

  • Adrenal insufficiency replacement (specialist-guided)

Dosing

STANDARD (ADULT PO)

Short course (e.g., asthma/COPD): 30–50 mg PO daily Γ— 5–10 d (no taper usually needed) Moderate inflammatory disease: 10–40 mg PO daily (severity-dependent)

ADULT DOSE

Severe disease: higher doses or IV steroids (hydrocortisone / methylprednisolone) per protocol Use lowest effective dose Duration matters as much as dose for adrenal suppression risk

PEDIATRIC DOSE

Weight-based; specialist / protocol-driven

MAX DOSE

Indication-dependent β€” escalate via protocol, not reflexively without monitoring bundle

Practical Note

TAPERING (critical) - Short course (<10 d): usually NO taper - β‰₯2–3 wk use: taper to avoid adrenal crisis - Long-term: gradual reduction; monitor for adrenal insufficiency (fatigue, hypotension) - Biggest harm prevention: do not stop abruptly after prolonged exposure

Warnings

Clinical warnings

  • Infection masking (fever / sepsis signs may be blunted)
  • Hyperglycemia β€” monitor closely in diabetes
  • Fluid retention / hypertension
  • Psychiatric effects (insomnia, mood lability, psychosis)
  • Myopathy (long-term)
  • Osteoporosis (chronic use)

Contraindications

  • Systemic untreated infection (relative β€” weigh risk/benefit, source control, coverage)
  • Known hypersensitivity

Drug interactions

  • NSAIDs β†’ ↑ GI bleed risk
  • Antidiabetics β†’ ↓ glucose control
  • CYP3A4 inducers / inhibitors β†’ altered steroid exposure
  • Live vaccines β†’ avoid in high-dose immunosuppression

Special populations

Pediatrics

Weight-based; specialist / protocol-driven

Pregnancy

Pregnancy: use lowest dose / shortest duration when benefit outweighs risk; follow current labeling and maternal–fetal medicine input.

Lactation

excreted in milk in small amounts; risk/benefit with pediatric exposure.

Renal impairment

Diabetes: expect hyperglycemia β€” tighten glucose monitoring and adjust antidiabetic therapy. Renal: no major dose adjustment; fluid status and electrolytes still matter.

Hepatic impairment

Altered metabolism possible β€” monitor clinical response and cumulative toxicity.

Elderly

Higher risk of delirium, osteoporosis, glucose intolerance β€” monitor cognition, bone context, glucose.

Administration

- Give in morning (circadian mimic) - With food to reduce GI irritation

Monitoring

  • Monitor: - Symptoms (therapeutic response) - Glucose - BP - Weight / fluid retention - Infection signs
  • Recheck: - Within days on short courses - Regular review if prolonged therapy - Reassess early if deterioration (think infection)
  • Hold / reassess: - Severe infection - Severe hyperglycemia - Psychiatric instability

Overdose / toxicity

Clinical Picture

Hyperglycemia Psychiatric symptoms Fluid retention

Immediate Actions

Supportive care Manage glucose / electrolytes Taper thoughtfully if chronic supraphysiologic exposure (specialist input)

Antidote

None β†’ supportive care

Decontamination

Acute massive ingestion: poison center; supportive care is mainstay.

Escalation

Severe psychiatric crisis, DKA-level hyperglycemia, or hemodynamic collapse β†’ ICU / endocrine / psychiatry pathways per protocol.

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield

  • Short course β‰  long-term risk profile
  • Do not taper short courses unnecessarily

Clinical

  • If patient deteriorates on steroids β†’ think infection
  • Always consider glucose impact

Safety

  • Biggest error = abrupt stop after prolonged use

Pharmacy Tool

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Prednisolone 1 mg/mL oral suspension

suspension Β· oral

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Pharmacokinetics

- Oral absorption good - Hepatic metabolism - Biological effect longer than plasma half-life

Mechanism of action

- Glucocorticoid receptor agonist β†’ suppresses inflammatory gene transcription

Common brand names

Saudi Arabia

Prednisolone, Solupred, Deltacortril

Global

Prelone, Orapred, Pediapred, (placeholder β€” verify local formulation)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

Global data (no country-specific data available)

  • Follow local antimicrobial stewardship policy, hospital formulary, and national resistance guidance.
  • Confirm dosing, stock, and restrictions with institutional pharmacy and current product labeling.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • GINA / asthma exacerbation management references
  • GOLD / COPD exacerbation management references
  • ACR / EULAR disease-specific steroid use (where applicable)
  • BNF / local formulary
  • FDA / SFDA product labeling