Prednisolone

About Prednisolone

Prednisolone is a corticosteroid used by mouth to calm inflammation and the immune response in a long list of conditions, among them severe allergies and asthma, skin, rheumatic and bowel diseases, multiple sclerosis flares, nephrotic syndrome, blood disorders and some leukemias and lymphomas. Adult starting doses range from 5 to 60 mg a day depending on the condition, then are lowered in small steps to the lowest dose that keeps it controlled; children are dosed by weight, and for children whose asthma is not controlled by inhaled treatment the label cites 1 to 2 mg/kg a day, usually for 3 to 10 days. After long-term use it is stopped gradually rather than abruptly, because the adrenal glands can take months to recover.

Oral prednisolone has no boxed warning; allergy to it rules it out, and the tablet and oral solution labels also rule it out in systemic fungal infections. It raises the risk of infections of every kind, chickenpox and measles can be serious or fatal in people who are not immune, and live vaccines are not given at immunosuppressive doses. Longer use can suppress the adrenal glands, raise blood sugar and blood pressure, retain salt and water, lower potassium, thin bones, slow children’s growth and cause cataracts or glaucoma, with eye pressure checked if treatment lasts beyond six weeks. Mood can swing from euphoria to depression or psychosis, ulcers call for caution, and use in the first three months of pregnancy may slightly raise the chance of a cleft lip, with or without cleft palate.

The eye drops are separate products for steroid-responsive inflammation of the conjunctiva, cornea and front of the eye. Pred Forte and its generics are prednisolone acetate 1 percent suspensions, and Pred Mild is a 0.12 percent suspension for mild to moderate noninfectious allergic and inflammatory conditions of the lid, conjunctiva, cornea and sclera; both are shaken well and usually given as 1 or 2 drops two to four times a day, while the sodium phosphate 1 percent solution is a different product. Prolonged use can raise eye pressure and damage the optic nerve, cause cataracts and raise the risk of secondary eye infections, so pressure is checked when drops are used for 10 days or longer, and most viral, fungal and mycobacterial eye infections rule them out. The Pred Forte label calls for an eye examination with magnification before the first prescription and any renewal beyond 20 mL, and Pred Forte and Pred Mild both contain a sulfite.

Taking Prednisolone

How to take it

By mouth: take it with food, measuring liquids with the dosing syringe or a marked measuring cup or spoon. Take Orapred ODT out of its blister just before use and let it dissolve on the tongue or swallow it whole; do not cut, split or break it. Eye drops: shake suspensions well, take out soft contact lenses and wait 15 minutes before putting them back, and do not touch the dropper tip to the eye.

If you miss a dose

By mouth: call the prescriber for instructions. Eye drops: use the missed dose as soon as you can, but skip it if the next is almost due; never use two doses at once.

Storage

Tablets and Orapred ODT at room temperature, away from moisture; oral liquids as the bottle’s label directs. Pred Forte and Pred Mild upright, at no more than 77°F (25°C), never frozen.

Interactions to know about

Rifampin, phenytoin and barbiturates can lower its levels, and ketoconazole and macrolide antibiotics can raise them. It can change the effect of warfarin (clotting tests are checked), raise blood sugar, add to potassium loss with diuretics (a concern with digoxin) and add to stomach effects with aspirin or other NSAIDs.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Prednisolone differs from pharmacy to pharmacy

Generic tablets and oral liquids cost pharmacies little, so for a short course most of a quote is the dispensing fee and markup. Orapred ODT has no rated generic, and a prescription for it cannot be switched to a tablet or liquid without the prescriber.

Pred Forte is priced as a brand, only a few products are rated equivalent to it, and a prescription that names it without allowing substitution is filled with the brand. Pred Mild has no generic, the sodium phosphate solution cannot be substituted for the suspension, and the bottle size written changes the quote.

Ways to pay less for Prednisolone without insurance

• For an oral course, ask for a generic tablet or oral liquid; if switching between liquid and tablets would help, ask the prescriber to write the change, keeping the same dose.
• If Orapred ODT is prescribed, ask the prescriber whether a generic liquid or tablet would suit instead.
• For Pred Forte, ask for generic prednisolone acetate 1 percent eye drops, check that the prescription allows substitution, and ask the prescriber for the bottle size your course needs.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Prednisolone

1. 1.Is this the tablet, the liquid, the dissolving tablet or the eye drop, and what strength?
2. 2.Do I need to taper the dose, or can I stop when the course ends?
3. 3.How do I shake and use my eye drops, and when can I put my contact lenses back in?
4. 4.When should my eye pressure be checked if I use the drops for ten days or longer?

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