How does prednisolone work?
Prednisolone inhibits inflammation, counteracts allergic reactions, and suppresses the body’s defenses (immunosuppression).
Glucocorticoids such as prednisolone bind to so-called glucocorticoid receptors in the body. They are typically located inside the cell. After successful binding, the glucocorticoid-receptor complex enters the cell nucleus. There it influences the activity of various genes whose products play a role in inflammatory and defense reactions (genomic effect). This also explains why glucocorticoids do not take full effect immediately, but only after hours to days.
Prednisolone can also be used much more quickly when physicians administer it in high doses directly into the vein (especially in emergency situations). In doing so, it binds to glucocorticoid receptors in the cell membrane and stabilizes the membrane in this way (non-genomic effect). This acute effect has not yet been conclusively clarified.
In addition, it has numerous other effects in the body and, for example, also influences the connective tissue or the salt and water balance.
When is prednisolone used?
The anti-inflammatory, anti-allergic and immunosuppressive effect of prednisolone is used, among other things, in:
- Chronic polyarthritis (the “rheumatoid” inflammation of joints) and other rheumatic diseases
- Chronic inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
- Autoimmune diseases such as collagenosis or lupus erythematosus
- Inflammatory diseases of the eyes, lungs, skin or liver
- Allergic shock
- To prevent transplant rejection
- Cytostatic drug-induced vomiting
- Hearing loss
In addition, prednisolone dosing may be used to compensate for a chronic deficiency of cortisone in the body that may occur due to adrenal insufficiency (Addison’s disease).
How prednisolone is used
If prednisolone is to be applied only locally, prednisolone ointment, creams, drop solutions or tinctures are also used. Prednisolone eye ointment is used for allergic conjunctivitis and other inflammatory eye diseases.
What are the side effects of prednisolone?
Prednisolone is generally very well tolerated when used for short periods. This also applies to the high dosages of emergency treatment. Adverse effects of prednisolone therapy usually occur when patients take higher doses for longer periods of time.
Possible side effects include:
- Increased susceptibility to infections due to its immunosuppressive effect.
- Redistribution of the body’s fat with a possible increase in truncal fat (truncal obesity)
- Degradation of muscle tissue and muscle weakness
- Changes in appetite, stomach disorders (e.g. inflammation of the gastric mucosa and stomach ulcers)
Other less common prednisolone side effects include:
- Cataracts or glaucoma
- Hypertension
- Thinning of the skin (especially with topical use)
- Bone loss (osteoporosis)
Prednisolone eye ointment may reduce visual performance and responsiveness in traffic.
During internal prednisolone application, it is important to ensure that the so-called Cushing’s threshold of around 7.5 milligrams per day is not exceeded during prolonged therapy. Otherwise, the risk of undesirable side effects increases (Cushing’s syndrome). A high prednisolone dosage of about 1000 milligrams per day is only used for shock therapy lasting a few days.
Prednisolone and alcohol do not mix well, especially at higher doses of the drug. The effect of prednisolone may be reduced as a result. Many patients also report that they tolerate alcohol less well while taking prednisolone.
If the prednisolone dose is high, the combination can cause severe hypoglycemia or hyperglycemia. The general recommendation is therefore not to take prednisolone and alcohol at the same time.
Since the effect of prednisolone is, among other things, to suppress the immune system, treatment with this preparation should not be given in acute viral infections (e.g. chicken pox, herpes), before vaccinations or in the case of swelling of the lymph nodes.
If possible, treatment with prednisolone should be avoided in the case of existing diabetes mellitus and, in particular, in the case of high blood pressure (hypertension) that is difficult to control, or it should be administered under medical observation. Prednisolone also exerts an influence on the patient’s mood and ability to concentrate. Therefore, they should not participate in road traffic or operate machinery while taking high doses of prednisolone.
During treatment with prednisolone, the uptake of iodine by the thyroid gland may be reduced. Therefore, thyroid levels should be checked regularly. If possible, prednisolone should not be used during pregnancy and lactation, as prednisolone side effects can also be transferred to the child in this case. An exception is the local application on the skin.
Especially in children, the active ingredient is adapted to size, age and body weight.
How to obtain medication with the active ingredient prednisolone
Medicines with the active ingredient prednisolone are available on prescription in Germany, Austria and Switzerland.
Since when is prednisolone known?
Prednisolone was developed and launched on the market in 1957 by the German drug company Merck. It very quickly displaced other cortisone preparations in use at the time due to its versatile application and active profile, and has since become one of the best-selling drugs on the international market.
Other interesting facts about prednisolone
Prednisolone side effects can be exacerbated by stopping too abruptly after prolonged treatment. In addition, the patient’s natural hormonal balance can be disturbed because the body shuts down its own production of cortisone during treatment.
