Prednisolone

What it is

Prednisolone is a synthetic glucocorticoid, a man-made relative of the body's own cortisol. It is used for its strong anti-inflammatory and immune-suppressing effects in many conditions. It comes as tablets, oral liquids, and eye drops.

What the research says

The evidence depends on the condition. Steroids like it cut hospital admissions for acute asthma and treatment failure in COPD flare-ups. In Bell's palsy, prednisolone raised full recovery at 3 months from 64% to 83%. In older adults with rheumatoid arthritis, 5 mg a day slowed joint damage but caused more adverse events. It did not help preschool children with viral wheeze, and it did not significantly improve survival in severe alcoholic hepatitis. Even short courses are linked to more sepsis, blood clots and fractures. Stopping can leave the body's own adrenal glands under-active.

Evidence grade: Well established.

How it works

Drug class: Synthetic glucocorticoid (corticosteroid)

Prednisolone acts like a stronger version of the body's cortisol. It changes how many genes are expressed, which damps down inflammation and immune responses, and it has broad effects on metabolism. (Source 1)

What it is used for

• A Cochrane review found systemic steroids given within an hour in the emergency department cut admissions (OR 0.40, NNT 8). The label lists bronchial asthma under severe allergic states not managed by conventional treatment. Evidence: established. (Source 2)
• In the GLORIA trial in patients aged 65+, 5 mg/day for 2 years lowered disease activity and joint damage but raised adverse events of special interest (60% vs 49%). Evidence: established. (Source 3)
• Systemic steroids halved treatment failure (NNT 9, high-quality evidence) but did not reduce 30-day mortality, and they caused one extra adverse effect for every six people treated. COPD is not listed in the prednisolone oral solution label reviewed here. Evidence: established. (Source 4)
• In a randomised trial of 496 patients, 83.0% recovered facial function at 3 months on prednisolone versus 63.6% without it. Acyclovir added nothing. Evidence: established. (Source 5)
• In the 1103-patient STOPAH trial, prednisolone gave a non-significant fall in 28-day mortality, no benefit at 90 days or 1 year, and more serious infections. Evidence: disputed. (Source 6)
• In a 687-child placebo-controlled trial, oral prednisolone did not shorten hospital stay or improve any secondary outcome. Evidence: not-supported. (Source 7)

Interactions

• Liquorice (glycyrrhizin) (pharmacokinetic study): In six healthy men, oral glycyrrhizin raised prednisolone blood levels and slowed its clearance by inhibiting its metabolism. (Source 8)
• Calcium and vitamin D (clinical trial): In five small trials of corticosteroid-treated patients, calcium plus vitamin D reduced bone loss at the spine and forearm. Fracture rates did not differ significantly. (Source 9)
• Potassium and dietary salt (label): Corticosteroids can cause salt retention and potassium loss, and all of them increase calcium excretion. The label says salt restriction and potassium supplementation may be necessary. (Source 10)
• Aspirin (label): The label advises caution with aspirin in people with low prothrombin levels. Corticosteroids also independently raised GI bleeding risk in trials, and that risk persisted when NSAID-using studies were excluded. (Source 11)

Stopping it

• The label says to reduce or stop the dose gradually after more than a few days of use. (Source 12)
• The label says drug-induced adrenal insufficiency can last for months after stopping, so steroid cover is needed during stress in that period. (Source 13)
• A meta-analysis found no dose, route or duration at which adrenal insufficiency after stopping can be ruled out. Higher doses and longer use carry the most risk. (Source 14)

What goes wrong

In the STOPAH trial, serious infections were almost twice as common with prednisolone. (Source 6)

• Randomized trial, Certainty not rated.
• Size: 1053 analysed.
• Who: Adults with severe alcoholic hepatitis.
• How long: 28 days.
• Result: 13% vs 7% serious infections (P=0.002)
• Funding: independent (NIHR Health Technology Assessment programme)

Serious infections occurred in 13% of the patients treated with prednisolone versus 7% of those who did not receive prednisolone (P=0.002).

In COPD flare-ups, corticosteroids caused one extra adverse effect for every six people treated, with a higher risk of high blood sugar. (Source 4)

• Systematic review, Certainty not rated.
• Size: Trials in the Cochrane review.
• Who: People with acute COPD exacerbations.
• How long: Treatment course.
• Result: Adverse events OR 2.33 (1.59 to 3.43); NNH 6 (4 to 10); hyperglycaemia OR 2.79.
• Funding: not stated in abstract.

Overall, one extra adverse effect occurred for every six people treated (95% CI 4 to 10).

Short courses of oral corticosteroids (under 30 days) were linked to higher rates of sepsis, venous thromboembolism and fracture within 30 days. (Source 15)

• Cohort study, Certainty not rated.
• Size: 1,548,945 adults (327,452 users)
• Who: Commercially insured US adults aged 18-64.
• How long: 30 and 31-90 days after starting.
• Result: IRR sepsis 5.30 (3.80 to 7.41), VTE 3.33 (2.78 to 3.99), fracture 1.87 (1.69 to 2.07)
• Funding: not stated in abstract.

Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07)

Across placebo-controlled trials, corticosteroids raised gastrointestinal bleeding or perforation by about 40%. The rise was significant only in hospitalised patients. (Source 16)

• Meta-analysis, Certainty not rated.
• Size: 159 RCTs, 33,253 participants.
• Who: Participants in double-blind corticosteroid vs placebo trials.
• How long: Varied.
• Result: 2.9% vs 2.0%; OR 1.43 (1.22 to 1.66); ambulatory OR 1.63 (0.42 to 6.34), not significant.
• Funding: not stated in abstract.

In total, 804 (2.4%) patients had a gastrointestinal bleeding or perforation (2.9% and 2.0% for corticosteroids and placebo).

Adrenal insufficiency after stopping corticosteroids was common, and it rose with longer treatment. (Source 14)

• Meta-analysis, Certainty not rated.
• Size: 74 articles, 3753 participants.
• Who: Adult corticosteroid users tested for adrenal insufficiency.
• How long: Varied.
• Result: Asthma patients: 1.4% (<28 days) to 27.4% (>1 year)
• Funding: not stated in abstract.

according to treatment duration from 1.4% (95% CI, 0.3-7.4) (<28 d) to 27.4% (95% CI, 17.7-39.8) (>1 year) in asthma patients.

What the evidence supports

Early prednisolone in Bell's palsy raised the share of patients recovering facial function at 3 months from 63.6% to 83.0%. (Source 5)

• Randomized trial, Certainty not rated.
• Size: 496 of 551 randomised.
• Who: Adults with Bell's palsy within 72 hours of onset.
• How long: 10 days treatment; 9 months follow-up.
• Result: 83.0% vs 63.6% at 3 months (P<0.001); 94.4% vs 81.6% at 9 months.
• Funding: not stated in abstract.

At 3 months, the proportions of patients who had recovered facial function were 83.0% in the prednisolone group as compared with 63.6% among patients who did not receive prednisolone (P<0.001)

Systemic corticosteroids given within an hour in the emergency department reduced hospital admission for acute asthma (NNT 8). (Source 2)

• Systematic review, Certainty not rated.
• Size: 12 studies, 863 patients.
• Who: Patients with acute asthma in emergency departments; no adult trials used the oral route.
• How long: Single ED visit.
• Result: Admission OR 0.40 (95% CI 0.21 to 0.78); NNT 8 (5 to 21)
• Funding: not stated in abstract.

Early use of CS for acute asthma in the ED significantly reduced admission rates (N = 11; pooled OR: 0.40, 95% CI: 0.21 to 0.78). This would correspond with a number needed to treat of 8 (95% CI: 5 to 21).

In COPD flare-ups, systemic corticosteroids halved treatment failure (NNT 9, high-quality evidence). (Source 4)

• Systematic review, High certainty.
• Size: 9 studies, 917 participants for this outcome.
• Who: People with acute COPD exacerbations, mean age 68.
• How long: Median treatment 14 days.
• Result: Treatment failure OR 0.48 (0.35 to 0.67); NNT 9 (7 to 14)
• Funding: not stated in abstract.

The evidence was graded as high quality and it would have been necessary to treat nine people (95% CI 7 to 14) with systemic corticosteroids to avoid one treatment failure.

What the evidence does not support

In severe alcoholic hepatitis, prednisolone did not significantly reduce 28-day mortality and gave no benefit at 90 days or 1 year. (Source 6)

• Randomized trial, Certainty not rated.
• Size: 1103 randomised (1053 analysed)
• Who: Adults with severe alcoholic hepatitis.
• How long: 28 days treatment; 1 year follow-up.
• Result: 28-day mortality OR 0.72 (95% CI 0.52 to 1.01; P=0.06)
• Funding: independent (NIHR Health Technology Assessment programme)

Prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year.

Oral prednisolone was no better than placebo for preschool children admitted to hospital with mild-to-moderate viral wheeze. (Source 7)

• Randomized trial, Certainty not rated.
• Size: 687 children analysed.
• Who: Children aged 10 months to 5 years in three English hospitals.
• How long: 5-day course.
• Result: Hospital stay 13.9 h placebo vs 11.0 h prednisolone; ratio of geometric means 0.90 (0.77 to 1.05)
• Funding: not stated in abstract.

In preschool children presenting to a hospital with mild-to-moderate wheezing associated with a viral infection, oral prednisolone was not superior to placebo.

In COPD flare-ups, systemic corticosteroids did not reduce 30-day mortality. (Source 4)

• Systematic review, Certainty not rated.
• Size: 12 studies, 1319 participants.
• Who: People with acute COPD exacerbations.
• How long: Up to 30 days.
• Result: OR 1.00 (95% CI 0.60 to 1.66)
• Funding: not stated in abstract.

Mortality up to 30 days was not reduced by treatment with systemic corticosteroid compared with control in 12 studies (n = 1319; OR 1.00; 95% CI 0.60 to 1.66).

Where the evidence is mixed

In adults aged 65+ with rheumatoid arthritis, prednisolone 5 mg/day for 2 years lowered disease activity and joint damage but raised the share with adverse events of special interest from 49% to 60%. (Source 3)

• Randomized trial, Certainty not rated.
• Size: 451 patients.
• Who: Adults aged 65+ with active RA, mean age 72.
• How long: 2 years.
• Result: DAS28 0.37 lower; joint damage 1.7 points lower; harm outcome 60% vs 49%, adjusted RR 1.24.
• Funding: not stated in abstract.

Disease activity was 0.37 points lower on prednisolone (95% CL 0.23, p<0.0001); joint damage progression was 1.7 points lower (95% CL 0.7, p=0.003). 60% versus 49% of patients experienced the harm outcome, adjusted relative risk 1.24 (95% CL 1.04, p=0.02)

Where the research disagrees

Whether prednisolone helps severe alcoholic hepatitis

• STOPAH trial investigators (NEJM 2015), randomised controlled trial, 1103 patients: Prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year. (Source 6)
• Guidelines cited by the STOPAH authors, professional recommendations as described in the trial background: Prednisolone and pentoxifylline are both recommended for the treatment of severe alcoholic hepatitis, but uncertainty about their benefit persists. (Source 17)

How much

• Reference intake: Dosing is set by the prescriber for each condition. The oral solution label, as a position (DailyMed version effective 2026-09-02), gives an initial range of 5 to 60 mg per day. (Source 12)
• Upper limit: The label sets no fixed maximum. It says higher initial doses may be needed in selected patients, and that the lowest possible dose should be used. (Source 12)
• Studied: Prednisolone 5 mg/day for 2 years in older adults with RA (GLORIA). (Source 3)
• Studied: 10 mg or 20 mg once daily for 5 days in preschool children with viral wheeze. (Source 7)
• Studied: 10 days of prednisolone in Bell's palsy. (Source 5)

A common belief, and what the research shows

The belief: A short course of steroids is harmless.

What the research shows: In a US cohort of 1.5 million adults, courses under 30 days were followed by "an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07)". This is an association, not proof of cause.

Questions and answers

What is it?

Prednisolone is a synthetic glucocorticoid, a man-made analogue of the body's own cortisol, used mainly for its strong anti-inflammatory effect. (Source 1)

What does it do in the body?

It has wide effects on metabolism and suppresses immune and inflammatory responses throughout the body. (Source 1)

Is it good or bad for you?

It depends on the condition and the duration. It helps in asthma and COPD flare-ups, Bell's palsy and rheumatoid arthritis. It fails in preschool viral wheeze, and its benefit is unproven in alcoholic hepatitis. Short and long courses both carry harms, including infection, clots, fractures and high blood sugar. (Source 3)

How do you get more of it?

Does not apply as a nutrient. It is a prescription medicine, and the prescriber sets the dose for each condition. (Source 12)

If it is harmful, what reduces it?

Coming off prednisolone should be gradual after more than a few days of use, because the body's own cortisol production may be suppressed. (Source 12)

Why might someone be low in it or missing it?

The body makes its own cortisol, not prednisolone. When the adrenal glands fail (adrenal insufficiency), the label names hydrocortisone or cortisone as the first choice for replacement, with synthetic analogues as an alternative. (Source 18)

Which whole foods contain it or feed it?

Does not apply. No food contains prednisolone. Liquorice (glycyrrhizin) was shown to raise prednisolone blood levels in a small study. (Source 8)

What happens if you do not have it?

Not taking prednisolone causes no deficiency in itself. After it is stopped, the body's own adrenal output can stay low, and this is common after long or high-dose use. (Source 14)

How can you test for it?

Drug levels are not routinely measured. Reviewers advise a low threshold for testing adrenal function in people who have used corticosteroids, especially if nonspecific symptoms appear after stopping. (Source 14)

References

1. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source
2. The Cochrane database of systematic reviews. Early emergency department treatment of acute asthma with systemic corticosteroids.. 2001. PMID 11279756, DOI 10.1002/14651858.cd002178. Read the source
3. Annals of the rheumatic diseases. Low dose, add-on prednisolone in patients with rheumatoid arthritis aged 65+: the pragmatic randomised, double-blind placebo-controlled GLORIA trial.. 2022. PMID 35641125, DOI 10.1136/annrheumdis-2021-221957. Read the source
4. The Cochrane database of systematic reviews. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.. 2014. PMID 25178099, DOI 10.1002/14651858.cd001288.pub4. Read the source
5. The New England journal of medicine. Early treatment with prednisolone or acyclovir in Bell's palsy.. 2007. PMID 17942873, DOI 10.1056/nejmoa072006. Read the source
6. The New England journal of medicine. Prednisolone or pentoxifylline for alcoholic hepatitis.. 2015. PMID 25901427, DOI 10.1056/nejmoa1412278. Read the source
7. The New England journal of medicine. Oral prednisolone for preschool children with acute virus-induced wheezing.. 2009. PMID 19164186, DOI 10.1056/nejmoa0804897. Read the source
8. Endocrinologia japonica. Effect of oral administration of glycyrrhizin on the pharmacokinetics of prednisolone.. 1991. PMID 1752235, DOI 10.1507/endocrj1954.38.167. Read the source
9. The Cochrane database of systematic reviews. Calcium and vitamin D for corticosteroid-induced osteoporosis.. 2000. PMID 10796394, DOI 10.1002/14651858.cd000952. Read the source
10. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source
11. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source
12. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source
13. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source
14. The Journal of clinical endocrinology and metabolism. Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis.. 2015. PMID 25844620, DOI 10.1210/jc.2015-1218. Read the source
15. BMJ (Clinical research ed.). Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study.. 2017. PMID 28404617, DOI 10.1136/bmj.j1415. Read the source
16. BMJ open. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis.. 2014. PMID 24833682, DOI 10.1136/bmjopen-2013-004587. Read the source
17. The New England journal of medicine. Prednisolone or pentoxifylline for alcoholic hepatitis.. 2015. PMID 25901427, DOI 10.1056/nejmoa1412278. Read the source
18. US FDA-approved labeling via DailyMed (National Library of Medicine). Prednisolone Oral Solution USP 15 mg/5 mL prescribing information (TruPharma), DailyMed SPL effective 2026-09-02. 2026. Read the source