Prednisolone

Prednisolone is a synthetic glucocorticoid (cortisone preparation) with strong anti-inflammatory and immunosuppressive effects. It is used in pain treatment when there is a pronounced inflammatory component.

In pain therapy, prednisolone is mainly used short-term for acute inflammatory flare-ups, such as gout attacks, rheumatic flares, severe nerve root irritation (herniated disc), or osteoarthritis flares.

Prednisolone has an anti-inflammatory effect about 4 times stronger than hydrocortisone.

Prednisolone works via glucocorticoid receptors:

Mechanism of action:

• Binds to intracellular glucocorticoid receptors
• Inhibits the production of inflammatory mediators (prostaglandins, leukotrienes, cytokines)
• Suppresses the immune response
• Stabilizes cell membranes and reduces swelling

Effect profile:

• Strongly anti-inflammatory: Stronger than any NSAID
• Immunosuppressive: Suppresses excessive immune reactions
• Anti-allergic: Inhibits allergic reactions
• Anti-swelling: Reduces edema and tissue swelling

Pharmacokinetics:

• Onset of action: 1–2 hours
• Biological half-life: 12–36 hours
• Is metabolized in the liver

Prednisolone is used for pain in:

• Acute gout attack
• Rheumatic flares
• Nerve root irritation (herniated disc)
• Osteoarthritis flare with inflammation
• Severe inflammatory reactions of the musculoskeletal system
• Shoulder pain (frozen shoulder, tendinitis)

Short-term use preferred:

• Burst therapy over a few days
• Tapering off when used for a longer period

Not suitable as long-term medication for:

• Simple pain without inflammation
• Osteoarthritis without an active inflammatory component

Tablets:

• 5 mg, 10 mg, 20 mg, 50 mg

Short-term therapy for pain (examples):

• Acute gout attack: 30–35 mg/day for 5 days
• Disc-related nerve root irritation: 60–80 mg, tapered over 1–2 weeks
• Rheumatic flare: 20–40 mg/day, reduce gradually

Important:

• Take in the morning (matches the natural cortisol rhythm)
• If taken for > 5 days, taper off when stopping

How to take:

• In the morning after breakfast (follow the daily rhythm)
• Take the tablets with water
• Take with food (better stomach tolerability)

Burst therapy (short-term):

• High dose for a few days
• Stopping abruptly is usually possible if < 5 days

Tapering off (if > 1 week):

• Reduce the dose gradually
• Do not stop abruptly (adrenal insufficiency!)
• Have your doctor set the tapering schedule

Important notes:

• Do not stop the medication or change the dose on your own
• With long-term use: stomach protection, vitamin D, calcium

With short-term use, only a few absolute contraindications:

• Hypersensitivity to prednisolone
• Systemic fungal infections

With long-term use, caution in:

• Diabetes mellitus (blood sugar rises)
• Osteoporosis
• Stomach ulcers
• Severe infections
• Glaucoma
• Psychiatric disorders

Pregnancy: Possible if strictly indicated. Prednisolone is partially inactivated in the placenta and is considered the preferred corticosteroid during pregnancy.

Usually well tolerated with short-term use (< 2 weeks).

Possible side effects:

• Sleep disturbances
• Mood changes (euphoria or irritability)
• Increased appetite
• Rise in blood sugar
• Stomach discomfort

With long-term use (> 4 weeks):

• Cushing's syndrome (moon face, truncal obesity)
• Osteoporosis
• Diabetes
• Muscle weakness
• Skin changes (thin skin, bruising)
• Susceptibility to infections
• Adrenal insufficiency when stopping

Note: With short-term use in pain treatment, the risk of side effects is low.

Caution when used together with:

• NSAIDs (increased risk of gastrointestinal ulcers and bleeding)
• Coumarin derivatives (oral anticoagulants): The anticoagulant effect can be reduced or increased, and a dose adjustment of the anticoagulant may be necessary

Reduces the effect of:

• Oral antidiabetics and insulin (blood sugar rises)
• Antihypertensives (blood pressure may rise)

Increased prednisolone breakdown caused by:

• Rifampicin
• Phenytoin, carbamazepine
• Barbiturates

Increased prednisolone levels caused by:

• Ketoconazole
• Itraconazole
• Oral contraceptives