Pharmacology · Corticosteroids (glucocorticoids)
Prednisolone !
The active form of prednisone. It does not need liver activation and comes as liquids for children and as eye drops.
Updated 2026-11-01
The figure shows cortisol (hydrocortisone) in the ligand-binding pocket of the human glucocorticoid receptor; prednisolone, which differs from cortisol by one double bond, binds the same pocket.
Mechanism of action
Prednisolone binds the glucocorticoid receptor directly. The complex enters the nucleus, switches on anti-inflammatory genes and represses NF-κB and AP-1, so cytokines, prostaglandins and immune cell activity fall. Because it is already active, it is a good choice in liver disease and in children, where it is often given as an oral solution.
- Prednisolone binds the glucocorticoid receptor without needing activation
- The drug-receptor complex moves into the nucleus
- It switches on anti-inflammatory genes and represses NF-κB and AP-1
- Fewer cytokines, prostaglandins and immune cells reach the tissue
Pharmacokinetics
- Absorption
- Well absorbed by mouth; tablets, dispersible tablets, solutions and eye drops exist
- Metabolism
- Already active; metabolised in the liver and excreted in the urine as conjugates
- Half-life
- Intermediate-acting glucocorticoid
Indications
- Asthma exacerbations, especially in children (oral solution) Asthma →
- Rheumatic and autoimmune diseases Rheumatoid arthritis →
- Multiple sclerosis exacerbations Multiple sclerosis →
- Eye inflammation such as uveitis (eye drops) Uveitis →
- Prevention of transplant rejection, with other drugs
Adverse effects
Common
- Mood changes and insomnia
- Increased appetite and fat redistribution
- Thin, fragile skin and slow healing
- Hyperglycaemia
- Acne
Contraindications
- Systemic fungal infections
- Hypersensitivity to the product
- Live or live attenuated vaccines during immunosuppressive doses
Key interactions
- CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, barbiturates)
- Faster clearance and a weaker corticosteroid effect
- Strong CYP3A4 inhibitors (ketoconazole)
- Higher corticosteroid levels and more side effects
- Aspirin and other NSAIDs
- Higher risk of gastrointestinal ulcer and bleeding
- Potassium-depleting drugs (loop or thiazide diuretics, amphotericin B)
- Hypokalaemia; with digoxin, more risk of arrhythmia
- Warfarin
- The anticoagulant response changes; INR is checked more often
What is monitored
- Blood glucose
- Blood pressure and weight
- Potassium
- Signs of infection
- Eye pressure and bone density with long use
Administration and safety
- Oral forms are given with food; liquids are measured with the device supplied, not a kitchen spoon
- Eye drops do not replace the oral drug; each form has its own order
- Long courses are tapered, not stopped suddenly
Nursing care
- Check glucose, especially in people with diabetes; corticosteroids raise it
- Watch for infection: fever and other signs may be blunted
- Watch mood and sleep; report agitation, depression or confusion
- Teach that a long course is not stopped suddenly; it is tapered under medical supervision
- In children on long courses, measure height and weight to watch growth
Pregnancy and breastfeeding
Used in pregnancy when the benefit justifies it; newborns of mothers on substantial doses are watched for adrenal insufficiency.
Test yourself
Think of the answer, then tap the question to see it.
Why might prednisolone be chosen over prednisone in severe liver disease?
Prednisolone is already active; prednisone needs hepatic conversion, which may be reduced when the liver fails.
Which eye complications are linked to long-term corticosteroids?
Posterior subcapsular cataract and raised eye pressure (glaucoma); herpes infections of the eye can also worsen.
What is checked regularly in a child on a long course of prednisolone?
Growth (height and weight), blood pressure, glucose and signs of infection.
Related drugs
Related conditions
← Back to the class: Corticosteroids (glucocorticoids)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Prednisolone: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2015); DailyMed - PREDNISOLONE SODIUM PHOSPHATE solution (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.