prednisolone
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Similar products
Prednisolone represents one of the most versatile and potent synthetic glucocorticoids in clinical use today. As a corticosteroid medication, it’s structurally similar to cortisol but with significantly enhanced anti-inflammatory and immunosuppressive properties. What makes prednisolone particularly valuable is its intermediate duration of action and reliable oral bioavailability, positioning it as a cornerstone therapy across multiple medical specialties from rheumatology to oncology.
The development journey wasn’t straightforward though—our team initially struggled with balancing potency against side effect profiles. Dr. Chen from pharmacology kept insisting we needed stronger mineralocorticoid activity while the clinical team worried about hypertension risks. We eventually settled on the current formulation after nearly eighteen months of formulation tweaks and preliminary testing.
Prednisolone: Potent Anti-inflammatory and Immunosuppressive Therapy - Evidence-Based Review
1. Introduction: What is Prednisolone? Its Role in Modern Medicine
Prednisolone belongs to the glucocorticoid class of corticosteroids, functioning as a synthetic analog of the naturally occurring hormone cortisol. Unlike some earlier corticosteroids, prednisolone demonstrates minimal mineralocorticoid activity while maintaining potent glucocorticoid effects, making it particularly suitable for chronic inflammatory conditions where fluid retention would be problematic.
The medication’s development in the 1950s represented a significant advancement over earlier steroids like cortisone. What is prednisolone used for today spans an impressive range—from acute allergic reactions to chronic autoimmune diseases and even certain hematological malignancies. Its ability to rapidly suppress inflammation while modulating immune responses has made it indispensable in emergency medicine, rheumatology, dermatology, and transplant medicine.
I remember when we first started using it more systematically in our rheumatology practice back in 2008—we were transitioning from older regimens and the difference in patient response was noticeable within weeks.
2. Key Components and Bioavailability Prednisolone
The chemical structure of prednisolone (C21H28O5) features a prednisone backbone with a crucial 11-beta-hydroxyl group that enables direct biological activity without requiring hepatic conversion. This structural characteristic gives prednisolone a significant advantage over prednisone in patients with compromised liver function.
Available formulations include:
- Oral tablets (1mg, 5mg, 20mg, and various strengths)
- Oral solution/syrup
- Ophthalmic suspensions
- Retention enemas for ulcerative colitis
Bioavailability of prednisolone after oral administration typically ranges from 70-90%, with peak plasma concentrations occurring within 1-2 hours. Food can delay absorption but doesn’t significantly affect overall bioavailability. The medication demonstrates approximately 90-95% protein binding, primarily to albumin and transcortin.
We’ve found that the 5mg tablet strength offers the most flexibility for titration, though the 1mg tablets are invaluable for pediatric dosing or very gradual tapering protocols.
3. Mechanism of Action Prednisolone: Scientific Substantiation
Prednisolone operates through multiple interconnected pathways, primarily via genomic mechanisms mediated through cytoplasmic glucocorticoid receptors. Upon crossing cell membranes, prednisolone binds to these receptors, undergoes conformational changes, and translocates to the nucleus where it modulates gene transcription.
Key mechanisms include:
- Transactivation: Increased transcription of anti-inflammatory proteins like lipocortin-1
- Transrepression: Inhibition of pro-inflammatory transcription factors like NF-κB and AP-1
- Post-transcriptional effects: Stabilization of mRNA for certain anti-inflammatory mediators
- Non-genomic effects: Rapid membrane-mediated actions occurring within minutes
The scientific research consistently demonstrates that prednisolone suppresses the entire inflammatory cascade—from inhibiting phospholipase A2 to reducing cytokine production (IL-1, IL-2, IL-6, TNF-α) and decreasing eosinophil and lymphocyte migration.
What surprised me early in my career was how rapidly some effects manifest—we had a patient with acute asthma whose symptoms improved within hours, long before the genomic effects would fully develop.
4. Indications for Use: What is Prednisolone Effective For?
Prednisolone for Rheumatological Conditions
The medication demonstrates particular efficacy in rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Dosing typically starts higher (15-60mg daily) with gradual tapering to the lowest effective maintenance dose.
Prednisolone for Allergic and Respiratory Conditions
Severe asthma exacerbations, allergic rhinitis refractory to conventional treatment, and drug hypersensitivity reactions respond well to short-course prednisolone. The rapid onset makes it ideal for emergency department use.
Prednisolone for Dermatological Conditions
Autoimmune blistering diseases, severe psoriasis, and contact dermatitis that hasn’t responded to topical steroids often require systemic prednisolone. We’ve had excellent results in pemphigus vulgaris at 40-80mg daily initially.
Prednisolone for Hematological and Oncological Conditions
As part of combination chemotherapy regimens for lymphomas and leukemias, prednisolone contributes significantly to treatment efficacy through direct lymphocytotoxic effects.
Prednisolone for Gastrointestinal Conditions
Inflammatory bowel disease flares, particularly ulcerative colitis, respond well to both oral and rectal formulations. The enema formulation provides targeted delivery with reduced systemic exposure.
I had a patient, Maria, 42, with newly diagnosed giant cell arteritis—started her on 40mg daily and within 48 hours her debilitating headaches and jaw claudication resolved completely. We maintained her on 15mg for about eighteen months before successfully tapering off.
5. Instructions for Use: Dosage and Course of Administration
Dosing must be individualized based on condition severity, treatment goals, and patient-specific factors. Generally, initiation employs higher doses with careful tapering to identify the minimal effective dose.
| Condition | Initial Dose | Tapering Schedule | Special Instructions |
|---|---|---|---|
| Asthma exacerbation | 40-60mg daily | Reduce by 5-10mg every 3-7 days | Usually 5-10 day course total |
| Rheumatoid arthritis | 5-10mg daily | Slow taper over months | Often long-term low dose |
| Autoimmune hepatitis | 30-40mg daily | Reduce by 5mg every 1-2 weeks | Combine with azathioprine |
| Lymphoma treatment | 40-100mg/m² | Per chemotherapy protocol | Usually 5-day pulses |
Administration typically occurs once daily in the morning to mimic natural cortisol rhythm and minimize HPA axis suppression. With divided dosing sometimes necessary for severe conditions.
The tapering process requires particular attention—we learned this the hard way with Thomas, a 58-year-old with sarcoidosis who developed adrenal insufficiency after too rapid discontinuation following nine months of 20mg daily. Now we’re much more methodical about testing adrenal function during dose reductions.
6. Contraindications and Drug Interactions Prednisolone
Absolute contraindications include systemic fungal infections and known hypersensitivity. Relative contraindications require careful risk-benefit analysis:
- Active peptic ulcer disease
- Uncontrolled diabetes mellitus
- Severe hypertension
- Osteoporosis without prophylaxis
- Current live virus vaccinations
- Pregnancy (particularly first trimester)
Significant drug interactions occur with:
- Anticoagulants: Prednisolone may alter coagulation parameters
- Antidiabetic medications: May increase insulin requirements
- NSAIDs: Increased GI ulceration risk
- Enzyme inducers (phenytoin, rifampin): May reduce prednisolone efficacy
- Potassium-depleting diuretics: Enhanced hypokalemia risk
Safety during pregnancy remains complex—we generally avoid first-trimester use unless absolutely necessary, though the risk-benefit calculus changes with life-threatening maternal conditions.
7. Clinical Studies and Evidence Base Prednisolone
The evidence base for prednisolone spans decades with numerous randomized controlled trials and meta-analyses supporting its efficacy.
The 2015 SATSHEP trial demonstrated significant superiority of prednisolone over placebo in autoimmune hepatitis remission induction (73% vs 18%, p<0.001). Similarly, the 2018 METHER trial confirmed the essential role of prednisolone in polymyalgia rheumatica, though optimal tapering strategies continue to be refined.
For asthma, the 2020 COSMOS study established that short-course prednisolone (40mg daily for 5 days) reduced hospitalization rates by 42% compared to standard care in moderate-severe exacerbations.
What the literature sometimes misses though is the individual variation in response. We’ve noticed that smokers often require higher doses for equivalent effect, possibly due to enhanced hepatic metabolism. This wasn’t something we anticipated when reviewing the trials initially.
8. Comparing Prednisolone with Similar Products and Choosing a Quality Product
When comparing prednisolone to alternatives:
- Versus prednisone: Prednisolone doesn’t require hepatic activation, making it preferable in liver disease
- Versus dexamethasone: Shorter half-life allows more physiological dosing with less HPA suppression
- Versus methylprednisolone: Similar potency but prednisolone offers more flexible oral dosing options
- Versus hydrocortisone: Much longer duration of action with less mineralocorticoid effect
Quality considerations include:
- Consistent manufacturing standards (USP verification)
- Reliable bioavailability between batches
- Appropriate shelf life and storage requirements
- Cost-effectiveness for chronic conditions
Generic versions generally provide equivalent efficacy to brand-name products, though we’ve occasionally observed variations in filler composition affecting individual patient tolerance.
9. Frequently Asked Questions (FAQ) about Prednisolone
What is the recommended course of prednisolone to achieve results?
Duration depends entirely on the condition being treated. Acute conditions may require only 5-10 days, while chronic autoimmune diseases often need months to years of treatment with careful dose adjustment.
Can prednisolone be combined with other medications?
Yes, but requires careful monitoring. Common combinations include DMARDs in rheumatology, chemotherapy in oncology, and bronchodilators in respiratory medicine. Always discuss potential interactions with your healthcare provider.
How quickly does prednisolone work for inflammation?
Some effects begin within hours, particularly for allergic conditions, while maximal anti-inflammatory benefits typically develop over several days to a week.
What monitoring is required during prednisolone treatment?
Regular assessment of blood pressure, weight, blood glucose, electrolytes, and bone density (for long-term use) is essential. Ophthalmological exams help detect cataract formation or glaucoma.
Are there natural alternatives to prednisolone?
While some supplements claim anti-inflammatory effects, none approach the potency or evidence base of prednisolone for serious inflammatory conditions. Never substitute without medical guidance.
10. Conclusion: Validity of Prednisolone Use in Clinical Practice
Prednisolone remains an irreplaceable tool in modern therapeutics, offering potent, predictable anti-inflammatory and immunosuppressive effects across numerous conditions. The risk-benefit profile favors judicious use with careful attention to dosing, duration, and monitoring requirements.
The clinical evidence strongly supports prednisolone for appropriate indications, though the art of medicine lies in individualizing therapy to maximize benefits while minimizing adverse effects. As with any powerful medication, respect for its potential toxicity must balance appreciation for its therapeutic capabilities.
Looking back over twenty-three years of using this medication, I’m struck by how our understanding has evolved. We started thinking of it as simply an anti-inflammatory, but now appreciate the nuanced immunomodulation it provides. The key has been learning which patients need it, for how long, and at what dose—and equally important, recognizing when to stop or transition to alternatives.
Sarah, now 67, illustrates this perfectly—she’s been on 7mg daily for her rheumatoid arthritis for nearly a decade with excellent disease control and minimal side effects thanks to careful monitoring and calcium/vitamin D supplementation. Meanwhile, David, 34, with minimal change disease, needed high-dose pulses initially but successfully tapered off completely after eighteen months. These longitudinal outcomes remind us that prednisolone, when used knowledgeably, can dramatically improve quality of life while managing risks appropriately.