Prednisolone

Prednisolone is a synthetic glucocorticoid used as an anti-inflammatory and immunosuppressive medication. It is the active metabolite of prednisone and is available in oral, injectable, ophthalmic, and topical formulations.

Mechanism of action is through binding to the glucocorticoid receptor, which alters gene transcription and reduces production of inflammatory mediators such as cytokines and prostaglandins. It also modulates immune cell activity and distribution, contributing to its anti-inflammatory and immunosuppressive effects. The clinical response and duration depend on the dose, formulation, and individual factors.

Prednisolone is used for a wide range of conditions, including inflammatory and autoimmune diseases, asthma and other airway disorders, allergic reactions, dermatitis, inflammatory bowel disease, and certain systemic conditions. It can be given short-term for acute exacerbations or as part of long-term therapy under careful medical supervision to manage chronic disease activity.

Common adverse effects reflect systemic glucocorticoid exposure. Short-term use may cause mood changes, sleep disturbance, increased appetite, and fluid retention. Long-term therapy can lead to weight gain, osteoporosis, hyperglycemia, hypertension, cataracts, glaucoma, thinning of the skin, and an increased risk of infections. Hypothalamic-pituitary-adrenal axis suppression can occur, making gradual tapering essential when stopping treatment. Interactions include enhanced effects with other nephrotoxic or hypoglycemic agents and increased gastrointestinal risk with NSAIDs; live vaccines may have reduced effectiveness during systemic steroid therapy.

Pregnancy and lactation require careful consideration, with steroids used only when benefits outweigh risks and at the lowest effective doses.