Prescribing Guides
Prednisolone Prescribing Guide for Indian Clinical Practice
Prednisolone prescribing guide for Indian clinicians covering corticosteroid dosing, tapering protocols, adrenal suppression and NEET PG pharmacology.
MedNext Editorial Team | 2026-08-01 | 8 min read
Prednisolone Prescribing Guide for Indian Clinical Practice
Prednisolone prescribing guide for Indian clinicians covering corticosteroid dosing, tapering protocols, adrenal suppression and NEET PG pharmacology.
Prednisolone is the most commonly prescribed oral corticosteroid in India, used across virtually every medical specialty for inflammatory, autoimmune, and allergic conditions. Understanding dose equivalencies, tapering, and adverse effect management is essential for safe prescribing.
Clinical Pharmacology Overview
Prednisolone is a synthetic glucocorticoid with approximately 4 times the anti-inflammatory potency of hydrocortisone and moderate mineralocorticoid activity. It acts by binding to intracellular glucocorticoid receptors, translocating to the nucleus, and modulating gene transcription to suppress inflammatory mediators.
Pharmacokinetics: Oral bioavailability is more than 80%. Protein binding is 70-90% (to transcortin and albumin). Metabolised in the liver. Biological half-life is 12-36 hours (intermediate-acting). Unlike prednisone, prednisolone is already the active form and does not require hepatic activation.
Indian Brand Names
- Wysolone (Pfizer/Organon)
- Omnacortil (Macleods)
- Predmet (Sun Pharma)
- Hostacortin H (Sanofi)
- Solone (Abbott)
Approved Indications in Indian Clinical Practice
- Rheumatoid arthritis and other inflammatory arthropathies
- Systemic lupus erythematosus
- Inflammatory bowel disease (moderate-severe flares)
- Asthma (acute exacerbations and chronic severe)
- Nephrotic syndrome (first-line in children and adults)
- Autoimmune hepatitis
- Allergic conditions (severe urticaria, drug reactions)
- Organ transplant rejection (with other immunosuppressants)
- Bell palsy
- ITP (immune thrombocytopenia)
- Temporal arteritis / polymyalgia rheumatica
Dosing in Adults
Mild conditions: 5-15 mg once daily in the morning.
Moderate conditions: 20-40 mg once daily.
Severe/acute conditions: 40-60 mg once daily (e.g., acute asthma, nephrotic syndrome, SLE flare).
Nephrotic syndrome (adult): 1 mg/kg/day (max 80 mg) for 4-6 weeks, then taper.
Asthma exacerbation: 40-50 mg daily for 5-7 days (may not require taper for courses under 2 weeks).
Bell palsy: 60 mg daily for 5 days, then taper over 5 days.
Alternate-day dosing: for chronic use, giving twice the daily dose on alternate mornings reduces adrenal suppression.
Important Drug Interactions
- NSAIDs: increased GI bleeding and ulcer risk
- CYP3A4 inducers (phenytoin, rifampicin, barbiturates): accelerate metabolism, reducing efficacy
- Oral anticoagulants: variable effect on INR -- monitor closely
- Oral hypoglycaemics and insulin: corticosteroids cause hyperglycaemia -- may need dose adjustment
- Live vaccines: contraindicated during immunosuppressive doses
- Diuretics: enhanced potassium loss
- Ciclosporin: mutual increase in levels
Side Effects and Monitoring
Dose and duration dependent. Short courses (under 2 weeks) are generally well tolerated.
Common: increased appetite, weight gain, insomnia, mood changes, facial rounding, fluid retention, hyperglycaemia.
Long-term: osteoporosis, avascular necrosis, cataracts, glaucoma, adrenal suppression, susceptibility to infections, skin thinning, striae, myopathy, growth suppression in children, peptic ulceration.
Monitoring: blood glucose, blood pressure, weight, potassium. Bone density (DEXA) for courses exceeding 3 months. Ophthalmology review for prolonged use. Growth monitoring in children. Consider calcium + vitamin D supplementation and bisphosphonate prophylaxis for long-term use.
Special Populations
Pregnancy: Category C (Category D in some references for first trimester). Prednisolone is largely inactivated by placental 11-beta-HSD2, limiting foetal exposure -- preferred over dexamethasone when maternal (not foetal) effect is needed. Used for SLE flares, asthma, and organ transplant in pregnancy.
Renal impairment: No dose adjustment. Monitor potassium.
Hepatic impairment: Prednisolone (not prednisone) preferred as it does not require hepatic activation.
Elderly: Higher risk of osteoporosis, hyperglycaemia, and infections. Use lowest effective dose.
NEET PG High-Yield Points
- Intermediate-acting glucocorticoid (t1/2 12-36 hours)
- 4x glucocorticoid potency of hydrocortisone, with moderate mineralocorticoid activity
- Dose equivalency: prednisolone 5 mg = hydrocortisone 20 mg = dexamethasone 0.75 mg
- Already active form (unlike prednisone) -- preferred in liver disease
- Inactivated by placental 11-beta-HSD2 -- preferred for maternal indications in pregnancy
- Alternate-day morning dosing minimises HPA suppression
- Adrenal crisis risk on abrupt withdrawal after more than 2-3 weeks of supraphysiological doses
- First-line for nephrotic syndrome in children (ISKDC protocol)
- Steroid myopathy: proximal weakness, elevated CK may be normal
Indian Regulatory Status
Prednisolone is a Schedule H drug under the Drugs and Cosmetics Act. It is included in the NLEM of India and is price-controlled under DPCO. Wysolone is the most recognised prednisolone brand in India. Available in tablets (5 mg, 10 mg, 20 mg, 40 mg), oral solution, and injectable forms. The CDSCO requires adequate patient counselling on long-term corticosteroid risks.
Frequently Asked Questions
What is the difference between prednisolone and prednisone?
Prednisone is a prodrug that must be converted to prednisolone in the liver to become active. In India, prednisolone is directly prescribed (already active), avoiding dependence on hepatic conversion. In liver disease, prednisolone is preferred over prednisone.
When should prednisolone be tapered?
Any course exceeding 2-3 weeks at supraphysiological doses (more than 7.5 mg/day prednisolone equivalent) should be tapered gradually to avoid adrenal crisis. Typical taper: reduce by 2.5-5 mg every 1-2 weeks. Faster tapers may be used for shorter courses at the clinician's discretion.
Why give prednisolone in the morning?
Endogenous cortisol peaks in the early morning (6-8 AM). Giving prednisolone in the morning mimics this physiological rhythm and minimises HPA axis suppression compared to evening dosing. Alternate-day morning dosing further reduces adrenal suppression for long-term therapy.
What are the steroid equivalencies that NEET PG tests?
The key equivalencies: prednisolone 5 mg = hydrocortisone 20 mg = dexamethasone 0.75 mg = methylprednisolone 4 mg = betamethasone 0.6 mg. Prednisolone is the reference intermediate-acting glucocorticoid with moderate mineralocorticoid activity.
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