Prednisolone (Methylprednisolone)
Corticosteroid for inflammation, autoimmune conditions, and allergic disorders
Prednisolone (methylprednisolone) is a synthetic corticosteroid medication used to treat a wide range of inflammatory and autoimmune conditions. It works by mimicking the effects of cortisol, a hormone naturally produced by the adrenal glands, to suppress inflammation and modulate immune responses. This guide covers its uses, correct dosage, potential side effects, drug interactions, and important safety information based on current international medical guidelines.
📊 Quick facts about prednisolone
💡 Key takeaways about prednisolone
- Powerful anti-inflammatory: Methylprednisolone is a potent corticosteroid used to treat conditions ranging from rheumatoid arthritis and asthma to severe allergic reactions and certain cancers.
- Never stop suddenly: After prolonged use, this medication must be tapered gradually under medical supervision to avoid potentially life-threatening adrenal crisis.
- Multiple routes of administration: Available as oral tablets and injectable suspension, allowing treatment of both local joint conditions and systemic diseases.
- Significant drug interactions: Interacts with many medications including blood thinners, diabetes drugs, HIV medications, and live vaccines. Always inform your doctor of all medications you take.
- Side effects increase with duration: Short-term use is generally well tolerated, but long-term therapy carries risks including osteoporosis, diabetes, weight gain, and increased infection susceptibility.
What Is Prednisolone and What Is It Used For?
Prednisolone (methylprednisolone) is a synthetic corticosteroid that belongs to a group of medicines called glucocorticoids. It mimics cortisol, a hormone naturally produced by the adrenal glands, and is used to suppress inflammation and modulate immune responses in a wide range of medical conditions.
Corticosteroids are among the most widely prescribed medications in the world, and methylprednisolone is one of the most versatile members of this drug class. The body naturally produces cortisol in the adrenal glands, which plays essential roles in regulating inflammation, immune function, metabolism, and stress responses. When the body's natural cortisol is insufficient or when more potent anti-inflammatory action is needed, synthetic corticosteroids like methylprednisolone are prescribed.
Methylprednisolone has approximately five times the anti-inflammatory potency of hydrocortisone (the synthetic form of cortisol) while producing less sodium and water retention. This makes it particularly useful for treating conditions where strong anti-inflammatory effects are needed without excessive fluid retention. It is included on the WHO Model List of Essential Medicines, underscoring its importance in global healthcare.
Common Uses
Methylprednisolone can be administered in several ways depending on the condition being treated:
- Intra-articular injection (into or near a joint): For treating local symptoms caused by inflammatory or rheumatic conditions such as rheumatoid arthritis, osteoarthritis with inflammation, bursitis, and tendinitis.
- Intramuscular injection (into a muscle): For treating widespread systemic conditions such as severe asthma exacerbations, inflammatory and rheumatic disorders, severe allergic reactions, and certain autoimmune conditions.
- Intradermal injection (into the skin): For treating specific skin conditions including keloids, localized dermatitis, and alopecia areata.
- Oral tablets: For ongoing management of chronic inflammatory conditions, autoimmune diseases, and as part of cancer treatment protocols.
- Rectal administration: As an enema for treating ulcerative colitis (inflammation of the large intestine).
Additionally, methylprednisolone may be used in the treatment of certain types of leukaemia and other cancerous conditions as part of a chemotherapy regimen. It is also used for managing multiple sclerosis relapses, organ transplant rejection prevention, and various nephrological conditions.
Always use prednisolone exactly as prescribed by your doctor. If you are unsure about why you have been prescribed this medication, speak with your doctor or pharmacist for clarification. The dosage, duration, and route of administration will depend on the specific condition being treated and your individual medical history.
What Should You Know Before Taking Prednisolone?
Before starting prednisolone, inform your doctor about all medical conditions, medications, and supplements you use. There are several important contraindications and precautions that your healthcare provider must evaluate to ensure this medication is safe for you.
Contraindications
Do not use prednisolone (methylprednisolone) if:
- You are allergic to methylprednisolone or any of the other ingredients in the formulation.
- You have a systemic fungal infection (a fungal infection affecting the whole body), as corticosteroids can worsen these infections.
- The injection would be applied to a site with an active local viral or bacterial infection, including tuberculosis and gonorrhoea.
Methylprednisolone injection must never be administered directly into a vein (intravenously), into or around the spinal cord (intrathecally or epidurally). These routes of administration can cause serious, potentially fatal adverse events.
Warnings and Precautions
Inform your doctor before taking prednisolone if you have any of the following conditions, as your treatment may require closer monitoring, dose adjustment, or an alternative medication:
- Active or latent infection: Corticosteroids suppress the immune system and can mask symptoms of infection, making infections harder to detect. They can also reactivate latent infections such as tuberculosis.
- Psychiatric disorders: Corticosteroids can trigger or worsen psychiatric symptoms including mood swings, depression, euphoria, insomnia, and in rare cases psychosis.
- Diabetes mellitus: This medication can raise blood sugar levels and may worsen existing diabetes or unmask latent diabetes. Blood glucose monitoring may need to be intensified.
- Epilepsy: Corticosteroids may lower the seizure threshold in susceptible individuals.
- Glaucoma or cataracts: Long-term use increases the risk of developing posterior subcapsular cataracts and elevated intraocular pressure (glaucoma). Regular eye examinations are recommended.
- Heart failure: Mineralocorticoid effects can cause sodium and fluid retention, potentially worsening heart failure.
- Neuromuscular disorders: Including multiple sclerosis and myasthenia gravis. High-dose corticosteroids can cause acute myopathy.
- Hypertension: Blood pressure may increase with corticosteroid use and should be monitored regularly.
- Thyroid disorders: Both hypothyroidism and hyperthyroidism can alter corticosteroid metabolism and affect treatment response.
- Kidney impairment: Dose adjustments may be necessary in patients with reduced kidney function.
- Scleroderma (systemic sclerosis): Increased risk of scleroderma renal crisis with corticosteroid use.
- Osteoporosis: Long-term corticosteroid use is a major risk factor for osteoporosis and pathological fractures. Bone density monitoring and preventive treatment may be recommended.
- Peptic ulcer disease: Corticosteroids increase the risk of gastrointestinal perforation and bleeding, particularly when combined with NSAIDs.
- Inflammatory bowel disease: Including ulcerative colitis, as corticosteroids may increase the risk of bowel perforation.
- Phaeochromocytoma: Corticosteroids can trigger a hypertensive crisis in patients with this adrenal tumour.
- Thromboembolic disorders: There is an increased tendency for blood clot formation during corticosteroid therapy.
If you experience blurred vision or other visual disturbances during treatment, contact your doctor promptly. Inform any doctor who performs a skin test (such as an allergy prick test or tuberculin test) that you are taking or have recently taken methylprednisolone, as the medication can affect test results.
When corticosteroids are used in cancer treatment, tumour lysis syndrome may occur. Seek immediate medical attention if you experience symptoms such as muscle cramps, weakness, confusion, irregular heartbeat, vision changes, or shortness of breath.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor before using this medication.
Pregnancy: There is a risk that the fetus may be affected by methylprednisolone. Long-term use during pregnancy has been associated with low birth weight, withdrawal symptoms in newborns, and isolated cases of cataracts in infants. Therefore, methylprednisolone should not be used during pregnancy unless specifically prescribed by a doctor who has carefully weighed the benefits against the risks.
Breastfeeding: Small amounts of methylprednisolone pass into breast milk, which means there is a potential risk to the nursing infant. Use during breastfeeding should only occur under the direct supervision and explicit instruction of a doctor.
Driving and Operating Machinery
Methylprednisolone does not usually impair the ability to drive or operate machinery. However, some patients may experience side effects such as dizziness, visual disturbances, or fatigue that could affect these abilities. You should assess your own ability to perform tasks requiring alertness and concentration while taking this medication. If you experience any of these effects, avoid driving or operating machinery until the effects have resolved.
How Does Prednisolone Interact with Other Drugs?
Methylprednisolone interacts with a wide range of medications. Some drugs can increase corticosteroid effects leading to greater risk of side effects, while corticosteroids can alter the effectiveness of other medications. Always inform your doctor about all medicines you take, including over-the-counter products and herbal supplements.
Drug interactions with corticosteroids are common and clinically significant. Because methylprednisolone is metabolised primarily by the cytochrome P450 3A4 (CYP3A4) enzyme system in the liver, any drug that inhibits or induces this enzyme can alter methylprednisolone levels in the body. Additionally, corticosteroids themselves can affect the metabolism and efficacy of many other medications.
Major Interactions
| Drug / Class | Interaction Effect | Clinical Significance |
|---|---|---|
| Ritonavir, Cobicistat (HIV protease inhibitors) | Potent CYP3A4 inhibitors that significantly increase methylprednisolone levels in the blood | High – may cause severe Cushing's syndrome and adrenal suppression. Requires close monitoring. |
| Oral anticoagulants (e.g. warfarin) | Altered bleeding risk; corticosteroids may both increase bleeding tendency and reduce anticoagulant effectiveness | High – regular INR monitoring required. Dose adjustments may be needed. |
| NSAIDs (ibuprofen, naproxen, diclofenac) | Increased risk of gastrointestinal ulceration, bleeding, and perforation | High – use combination with caution. Consider gastroprotective agents. |
| Live vaccines (MMR, varicella, BCG) | Immunosuppression may lead to inadequate immune response or risk of vaccine-related infection | High – live vaccines are generally contraindicated during immunosuppressive corticosteroid therapy. |
| Antidiabetic agents (insulin, metformin, sulfonylureas) | Corticosteroids raise blood glucose, reducing the effectiveness of antidiabetic drugs | High – blood glucose monitoring and dose adjustment of antidiabetic medications may be needed. |
Other Notable Interactions
| Drug / Class | Interaction Effect | Advice |
|---|---|---|
| Antiepileptic drugs (phenytoin, carbamazepine, phenobarbital) | CYP3A4 inducers that can decrease methylprednisolone levels, reducing its effectiveness | Dose increase of corticosteroid may be required. |
| Ketoconazole, itraconazole (azole antifungals) | CYP3A4 inhibitors that increase corticosteroid levels | Monitor for increased corticosteroid side effects. |
| Ciclosporin | Mutual inhibition of metabolism; increased risk of seizures reported | Monitor drug levels and clinical response closely. |
| Diuretics (furosemide, thiazides) | Increased risk of hypokalaemia (low potassium) | Monitor potassium levels; consider potassium supplementation. |
| Grapefruit juice | CYP3A4 inhibitor; may increase methylprednisolone blood levels | Discuss grapefruit consumption with your doctor. |
This is not a complete list of drug interactions. Always tell your doctor, pharmacist, or healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal products. Never start, stop, or change the dosage of any medicine without consulting your doctor first.
What Is the Correct Dosage of Prednisolone?
The dosage of methylprednisolone varies widely depending on the condition being treated, its severity, the route of administration, and individual patient factors. Your doctor will prescribe the lowest effective dose for the shortest possible duration to minimise the risk of side effects.
Dosing of corticosteroids is highly individualised. The following information provides general guidance, but your doctor will determine the specific dose that is appropriate for your situation. The goal is always to achieve symptom control with the minimum necessary dose.
Oral Tablets (Methylprednisolone)
Adults
The typical starting dose ranges from 4 mg to 48 mg daily, depending on the condition being treated. For many inflammatory conditions, a common starting dose is 4–16 mg daily, which is then gradually reduced as symptoms improve. In severe conditions such as acute multiple sclerosis exacerbations, higher doses of up to 200 mg daily may be used for short periods.
Children
Dosage in children is based on body weight and the specific condition. Typical doses range from 0.5 mg to 1.7 mg per kilogram of body weight per day, divided into multiple doses. Growth should be monitored regularly in children receiving long-term corticosteroid therapy, as these medications can suppress growth.
Elderly Patients
Elderly patients are generally started on the lowest effective dose due to increased susceptibility to side effects including osteoporosis, diabetes, hypertension, and infections. More frequent monitoring is typically recommended.
Injectable Suspension (40 mg/ml)
| Route | Typical Dose | Indication |
|---|---|---|
| Intra-articular (large joints) | 20–80 mg | Rheumatoid arthritis, osteoarthritis with inflammation, bursitis |
| Intra-articular (small joints) | 4–10 mg | Finger or toe joint inflammation |
| Intramuscular | 40–120 mg | Systemic inflammatory conditions, severe asthma, severe allergic reactions |
| Intradermal | 20–60 mg | Keloids, localised skin conditions |
| Rectal (enema) | 40–120 mg | Ulcerative colitis |
Missed Dose
If you are taking oral methylprednisolone and miss a dose, take it as soon as you remember. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one. For injectable forms, your healthcare provider will determine the appropriate timing.
Overdose
Since the injectable form is administered by a healthcare professional, overdose is unlikely. However, chronic overuse or taking more tablets than prescribed can lead to Cushing's syndrome symptoms including weight gain (particularly around the face and trunk), skin thinning, easy bruising, high blood sugar, and muscle weakness. If you suspect an overdose, contact your doctor or poison control centre immediately. There is no specific antidote for corticosteroid overdose; treatment is supportive.
After prolonged treatment (typically more than 3 weeks), methylprednisolone must be tapered gradually under medical supervision. Abrupt discontinuation can cause adrenal crisis – a potentially life-threatening condition characterised by severe fatigue, weakness, dizziness, nausea, vomiting, and dangerously low blood pressure. If you develop signs of adrenal insufficiency after stopping treatment, seek medical attention immediately.
What Are the Side Effects of Prednisolone?
Like all medicines, methylprednisolone can cause side effects, although not everyone experiences them. The risk and severity of side effects are generally lower with short-term use than with long-term therapy. Report any concerning symptoms to your doctor promptly.
Corticosteroid side effects are largely dose-dependent and duration-dependent. Short courses of treatment (less than two weeks) typically cause few problems, while long-term use at moderate to high doses can lead to significant adverse effects affecting multiple organ systems. Your doctor will monitor you for these effects and adjust treatment as necessary.
- Swelling of the face, tongue, or throat; difficulty swallowing; hives or breathing difficulties (signs of angioedema or anaphylaxis)
- Severe abdominal pain (may indicate gastrointestinal bleeding or perforation)
- Signs of serious infection such as high fever, chills, and feeling very unwell, as this medication can reduce your resistance to infections
Common Side Effects
- Reduced resistance to infections
- Hormonal changes (lower levels of certain hormones)
- Cushing's syndrome features: weight gain with fat redistribution, round face, easy bruising, acne
- Growth suppression in children
- Osteoporosis (bone thinning)
- Muscle weakness and wasting
- Skin thinning with impaired wound healing
- Worsening or unmasking of diabetes
- Low potassium levels (causing fatigue)
- High sodium levels with fluid retention
- Increased appetite and weight gain
- Mood changes (irritability, anxiety, depression)
Uncommon Side Effects
- Exacerbation of psychiatric conditions
- Posterior subcapsular cataracts
- Glaucoma (increased eye pressure)
- Hypertension (high blood pressure)
- Stretch marks and skin fragility
Rare Side Effects
- Allergic reactions including anaphylaxis
- Raised intracranial pressure (headache, blurred vision)
- Peptic ulceration
- Eczema
- Avascular necrosis of bone (bone tissue death causing skeletal pain)
- Tendon rupture
Frequency Not Known
- Opportunistic infections; elevated white blood cell count
- Phaeochromocytoma crisis (palpitations, headache, sweating)
- Withdrawal symptoms on dose reduction
- Lipid metabolism disorders; fat redistribution
- Emotional symptoms: euphoria, mood swings, drug dependence, suicidal thoughts
- Psychiatric disturbances, personality changes, confusion, insomnia
- Seizures, memory impairment, dizziness, headache
- Blurred vision, visual disturbances, vertigo
- Low blood pressure; increased tendency to blood clots
- Flushing; hiccups
- Gastrointestinal perforation, oesophagitis, abdominal bloating, stomach pain, diarrhoea, heartburn, nausea
- Liver inflammation (hepatitis), elevated liver enzymes
- Increased body hair growth in women, rashes, redness, excessive sweating, stretch marks, itching, hives, acne
- Panniculitis (inflammation of subcutaneous fat) after dose reduction or discontinuation
- Muscle pain, muscle wasting, joint pain
- Transient pain flare after injection
- Oedema (swelling of ankles, feet, legs), fatigue, malaise
- Elevated urinary calcium, elevated blood urea nitrogen
Reporting suspected side effects after a medicine has been authorised is important for ongoing safety monitoring. Healthcare professionals and patients can report suspected adverse reactions to their national medicines agency (e.g. FDA MedWatch in the USA, Yellow Card Scheme in the UK, EMA EudraVigilance in the EU).
How Should You Store Prednisolone?
Store this medication out of the sight and reach of children. Specific storage requirements depend on the formulation, but no special storage conditions are generally required for either tablets or the injectable suspension.
Keep methylprednisolone tablets in their original packaging at room temperature (below 25°C / 77°F), protected from moisture and direct light. Do not use tablets that appear discoloured or damaged.
The injectable suspension (40 mg/ml) does not require special storage conditions. Once opened, the injection vial should be used within 7 days. Check the expiry date printed on the packaging before each use – the expiry date refers to the last day of the stated month.
Do not dispose of medications in wastewater or household waste. Ask your pharmacist about proper disposal methods for medicines you no longer use. These measures help protect the environment.
What Does Prednisolone Contain?
The active substance is methylprednisolone. The specific formulation varies between the oral tablet and injectable suspension forms.
Oral Tablets
Each tablet contains 4 mg methylprednisolone. Inactive ingredients typically include lactose, sucrose, starch, calcium stearate, and other excipients that vary by manufacturer (Medrol, Prednisolon Evolan, Prednisolon Pfizer, Prednisolon EQL Pharma). Consult the product leaflet for your specific brand for a complete list of excipients.
Injectable Suspension
Each 1 ml contains 40 mg methylprednisolone acetate. Other ingredients include macrogol 3350, sodium chloride, myristyl-gamma-picolinium chloride (preservative), and water for injections. The injection is available in glass vials (1 ml, 2 ml, 5 ml) and pre-filled syringes (2 ml).
The injectable formulation contains less than 1 mmol sodium (23 mg) per dose, meaning it is essentially sodium-free. This is relevant for patients on a sodium-restricted diet.
Frequently Asked Questions About Prednisolone
Medical References and Sources
This article is based on current medical research and international guidelines. All claims are supported by scientific evidence from peer-reviewed sources.
- World Health Organization (2023). "WHO Model List of Essential Medicines – 23rd List." WHO Essential Medicines List Methylprednisolone included as an essential medicine globally. Evidence level: 1A
- EULAR (2023). "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update." Annals of the Rheumatic Diseases. https://doi.org/10.1136/ard-2022-223356 International guideline on corticosteroid use in rheumatoid arthritis. Evidence level: 1A
- British National Formulary (2024). "Methylprednisolone: indications, dose, contraindications, side-effects, interactions." BNF Methylprednisolone Comprehensive prescribing reference. Continuously updated evidence-based resource.
- European Medicines Agency (2024). "Summary of Product Characteristics: Methylprednisolone acetate injectable suspension." Official EU regulatory source for methylprednisolone. Evidence level: Regulatory
- U.S. Food and Drug Administration (2023). "Medrol (methylprednisolone tablets) – Prescribing Information." FDA-approved prescribing information for methylprednisolone. Evidence level: Regulatory
- Liu D, Ahmet A, Ward L, et al. (2013). "A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy." Allergy, Asthma & Clinical Immunology, 9, 30. https://doi.org/10.1186/1710-1492-9-30 Comprehensive review of corticosteroid side effects and monitoring strategies. Evidence level: 1A
- Rhen T, Cidlowski JA (2005). "Antiinflammatory action of glucocorticoids – new mechanisms for old drugs." New England Journal of Medicine, 353(16), 1711-1723. https://doi.org/10.1056/NEJMra050541 Landmark review of glucocorticoid mechanisms. Evidence level: 1A
- Saag KG, et al. (2022). "American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis." Arthritis & Rheumatology. https://doi.org/10.1002/art.42364 Guideline on managing bone health during corticosteroid therapy. Evidence level: 1A
Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence assessment. Evidence level 1A represents the highest quality of evidence, based on systematic reviews of randomised controlled trials. All recommendations are consistent with current WHO, EMA, FDA, and BNF guidelines.
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