Corticosteroids – general use

Prednisolone 25mg tablets are for use by oncology only where doses exceed 75mg.

Dose dependent on indication - see BNF for further details.

Orally, usual range 0.5-10mg daily.

By intramuscular injection or slow intravenous injection or infusion, initially 0.5-20mg.

Dose dependent on indication - see BNF for further details.

Usual range, 2-40mg daily.

By slow intravenous injection or infusion, initially 10-500mg.

Deep intramuscular injection into gluteal muscle, 40-120mg, repeated after 2-3 weeks if required.

Prescribing Notes:

For use of corticosteroids in the treatment of asthma, see Acute Asthma treatment pathway in the Respiratory chapter of the formulary.
For use of corticosteroids in the treatment of musculoskeletal and joint disorders see Musculoskeletal chapter of the formulary.
For use of corticosteroids in dermatology, see dermatology pathways in the Skin chapter of the formulary.
Patients should be given a steroid card to carry and a steroid emergency card (if appropriate), giving details of therapy including drug, dose and possible complications.
Patients receiving 7.5mg or more of prednisolone daily (or equivalent; see BNF section Endocrine System > Glucocorticoid Therapy) for longer than 3 months should be considered for osteoporosis prophylaxis. No osteoporosis prophylaxis is indicated when corticosteroids are used as replacement therapy.
Prednisolone enteric coated (e/c) is non-formulary. There is no evidence it reduces the risk of peptic ulceration. Prednisolone e/c is more expensive than standard tablets and may cause erratic absorption from the GI tract.
For patients with swallowing difficulties prednisolone oral solution or soluble tablets may be considered. Prednisolone tablets may be dispersed in water as an alternative to soluble tablets or oral solution preparations. This is an off-label use but more cost-effective option. Refer to local board policies on the use of unlicensed (and off-label) medicines for further guidance.
Care should be taken in reducing pharmacological doses of glucocorticoids if the patient has been treated for longer than 3 weeks to avoid cortisol insufficiency due to prolonged suppression of the hypothalamic-pituitary-adrenal (HPA) axis (see BNF section Endocrine System > Glucocorticoid Therapy).
Patients who are on long-term pharmacological therapy with corticosteroids (i.e. not for replacement therapy) on a daily dose of oral prednisolone less than 10mg (or equivalent, see BNF section Endocrine System > Glucocorticoid Therapy) should be advised to increase their dose to 10mg prednisolone during intercurrent illness and to seek medical attention if vomiting and unable to take their tablets.
In terms of their anti-inflammatory properties, approximately 20mg hydrocortisone is equivalent to 5mg prednisolone or 750micrograms dexamethasone. See BNF Glucocorticoid therapy treatment summary.

History Notes

28/11/2024

Removal of 'Prednisolone 5mg soluble tablets' and updates to associated prescribing notes - ERFC Dec 2024.

16/02/2022

East Region Formulary content agreed.

Prednisolone 25mg tablets are for use by oncology only where doses exceed 75mg.
Standard Prednisolone 5mg tablets can be dispersed in water.

For dose, follow specialist advice.

Prescribing Notes:

For use of corticosteroids in the treatment of inflammatory bowel disease, see Ulcerative colitis / Inflammatory bowel disease pathways.
For use of corticosteroids in the treatment of asthma, see Acute Asthma treatment pathway.
For use of corticosteroids in the treatment of musculoskeletal and joint disorders see the MSK pathways.
For use of corticosteroids in dermatology, see dermatology pathways.
Patients should be given a steroid card to carry and a steroid emergency card (if appropriate), giving details of therapy including drug, dose and possible complications.
Prednisolone enteric coated (e/c) is non-formulary. There is no evidence it reduces the risk of peptic ulceration. Prednisolone e/c is more expensive than standard tablets and may cause erratic absorption from the GI tract.
Care should be taken in reducing pharmacological doses of glucocorticoids if the patient has been treated for longer than 3 weeks to avoid cortisol insufficiency due to prolonged suppression of the hypothalamic-pituitary-adrenal (HPA) axis (see BNFc Glucocorticoid therapy).
Patients who are on long-term pharmacological therapy with corticosteroids (i.e. not for replacement therapy) on a daily dose of oral prednisolone less than 2-2.5mg/m² (or equivalent, BNFc Glucocorticoid therapy) should have the dose doubled during periods of intercurrent illness and to seek medical attention if vomiting and unable to take their tablets.
In terms of their anti-inflammatory properties, approximately 20mg hydrocortisone is equivalent to 5mg prednisolone or 750micrograms dexamethasone. See BNFc Glucocorticoid therapy treatment summary.

History Notes

29/02/2024

East Region Formulary content agreed.