Prelone (Prednisolone): Comprehensive Patient Information for Australia
Basic Product Information
| International Non-proprietary Name (INN) | Prednisolone |
|---|---|
| Australia Brand Names | Prelone, Redipred, Panafcortelone, Solone, Predsolone |
| ATC Code | H02AB06 |
| Available Forms & Strengths | Tablets (1 mg, 5 mg, 25 mg), Oral liquid (5 mg/5mL, 1 mg/mL), Eye drops (various), Rectal preparations |
| Manufacturers (Australia) | Alphapharm, Aspen Pharmacare, Arrow Pharma, Sanofi-Aventis |
| Prescription Status | Prescription-only medicine (Schedule 4, S4) |
Mechanism of Action
- For Patients: Prednisolone is a type of corticosteroid (“steroid”) medicine that helps reduce inflammation and suppresses overactive immune responses. This can help relieve symptoms like swelling, redness, and pain in a wide range of conditions.
- For Healthcare Professionals: Prednisolone binds to intracellular corticosteroid receptors, modulating gene transcription to suppress pro-inflammatory cytokines and mediators, and inhibits leukocyte migration to inflammation sites.
Pharmacokinetics
- Absorption: Prednisolone is rapidly and well absorbed from the gastrointestinal tract after oral administration.
- Time to Peak Level: 1–2 hours after oral dosing.
- Bioavailability: Approximately 80–100% after oral intake.
- Metabolism: Predominantly hepatic, via CYP3A4 enzymes.
- Elimination: Mainly via the kidneys (urine).
- Duration of Action: Half-life approximately 2–4 hours; however, biological effects last up to 36 hours.
Use in Everyday Life and Best Practices
Prednisolone is used in Australia for a variety of conditions, including asthma, severe allergies, autoimmune disorders (such as rheumatoid arthritis, lupus), inflammatory bowel diseases (Crohn’s, ulcerative colitis), and skin conditions. Always follow your doctor’s instructions carefully.
- Do not alter your dose or stop using prednisolone suddenly without medical guidance.
- If taking for more than a few days, your doctor will advise on slowly reducing the dose (tapering).
- Always take at the same time each day to help maintain a routine and optimal effect.
Dosing in the Morning vs Evening
- Morning dosing: It is usually recommended to take prednisolone in the morning, with breakfast. This aligns with your body’s natural steroid rhythm, can help reduce side effects (like sleep disturbance), and mimics your own cortisol production.
- Evening dosing: Sometimes prescribed for specific medical cases only. Can increase risk of insomnia or indigestion.
- Tip: Stick to a regular schedule; if you miss a dose, follow your doctor’s advice or the pharmacy leaflet.
Taking with Food or on an Empty Stomach
- It’s best to take prednisolone with or after food to help prevent stomach irritation, heartburn, and nausea, which can occur, especially with higher or longer-term doses.
- In most English (AU) diets, prednisolone can be taken with a typical breakfast or lunch.
- Avoid alcohol and large amounts of caffeine, as these can further irritate your stomach.
Interaction Warnings
| Substance | Potential Effect | Advice |
|---|---|---|
| Alcohol | Increases risk of stomach ulcers and bleeding | Limit or avoid alcohol while on prednisolone |
| NSAIDs (eg. ibuprofen, aspirin) | Higher risk of stomach irritation, ulcers | Ask your doctor before combining |
| Diabetes medicines (oral or insulin) | Prednisolone may increase blood sugars | Monitor glucose closely; dose adjustment may be needed |
| Anticoagulants (warfarin) | Possible changes in blood clotting | INR checks may be required |
| Live vaccines | Reduced vaccine efficacy, increased infection risk | Avoid live vaccines while taking prednisolone |
| Grapefruit juice | May affect prednisolone metabolism | Best to avoid while on this medication |
Indications
| Condition | Indication Type |
|---|---|
| Asthma (acute exacerbations) | Official (TGA approved) |
| Severe allergic reactions (anaphylaxis adjunct, angioedema) | Official (TGA approved) |
| Rheumatoid arthritis, systemic lupus erythematosus | Official (TGA approved) |
| Ulcerative colitis, Crohn’s disease | Official (TGA approved) |
| Nephrotic syndrome | Official (TGA approved) |
| Multiple sclerosis relapse | Official (TGA approved) |
| Dermatitis, eczema, psoriasis (severe forms) | Official (TGA approved) |
| Off-label uses (eg. COVID-19, autoimmune hepatitis) | Off-label, under clinical supervision |
Dosing According to Clinical Indications
| Indication | Adults | Children | Elderly |
|---|---|---|---|
| Acute asthma attack | 40–50 mg once daily for 5–7 days | 1–2 mg/kg (max 40 mg), daily for 3–5 days | As per adult, start low, monitor for side effects |
| Rheumatoid arthritis / autoimmune disease | 5–60 mg daily, dose adjusted individually | Typically 0.5–2 mg/kg/day | As per adult, lowest effective dose |
| Allergic reactions / anaphylaxis adjunct | 10–50 mg daily, dose tapered as needed | 1–2 mg/kg/day in divided doses | Start at lower dose |
| Inflammatory bowel disease relapse | 40–60 mg daily, tapering over weeks | 1–2 mg/kg/day, then taper | Monitor closely for side effects |
| Multiple sclerosis (relapse) | Prednisolone: 200 mg/day for 1 week, or 60 mg/day for 2 weeks, then reduce | Specialist dosing only | Specialist advice; increased risk of side effects |
Note: The exact dose and schedule will be determined by your GP or specialist, based on your condition and health status.
Safety Profile / Side Effects
| Frequency | Side Effect | Notes |
|---|---|---|
| Common | Weight gain, fluid retention, mood changes (anxiety, mood swings), indigestion/upset stomach, raised blood sugar (especially in diabetes), increased appetite, insomnia | Monitor for persistent or bothersome symptoms |
| Less common | High blood pressure, muscle weakness, delayed wound healing, acne, easy bruising, increased risk of infection | Long-term use increases risk |
| Rare/serious | Stomach ulcers/bleeding, bone thinning (osteoporosis), eye changes (glaucoma, cataracts), psychosis, adrenal suppression | Report to GP urgently if suspected |
| Withdrawal effects | Muscle/joint pain, fatigue, depression | Always taper, do not stop suddenly |
- If you develop fever, unexplained pain, blurred vision, or mental health changes, seek prompt medical advice.
- Routine monitoring (blood pressure, blood sugar, bone density) may be indicated for long-term users.
Guidelines for Proper Use (Practical Tips in Australia)
- Pick up your medication from a licensed community pharmacy; ask for pharmacist counselling on first dispense.
- Always use the measuring device provided for liquid preparations.
- Carry a ‘Steroid Card’ or MedicAlert, as sudden withdrawal or stress (infection, surgery) may require dose adjustment.
- Attend recommended check-ups (blood pressure, blood sugar) as advised.
- Discuss vaccination (eg. annual flu, pneumococcal) with your GP, as steroid use may increase infection risks.
- If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip it—do not double up.
Alternative Treatment Options
- Methylprednisolone (Medrol, Solu-Medrol): Similar anti-inflammatory effects; some forms are given intravenously for severe cases. Slightly more costly but shorter half-life may offer dosing advantages.
- Prednisone: Almost identical to prednisolone, but must be converted in the liver. Less reliable in patients with liver dysfunction.
- Dexamethasone: Longer-acting, more potent steroid. Used for certain acute conditions (e.g., cerebral oedema) but higher risk of side effects with long-term use.
- Budesonide (for gut/lung inflammation): More targeted action; fewer systemic side effects, but not suitable for all conditions.
- All listed alternatives are reimbursed by the Pharmaceutical Benefits Scheme (PBS), subject to indication and individual eligibility.
Each alternative has its own pros and cons. Your GP or specialist will help select the most appropriate medicine for your condition and risk profile.
Legal, Registration, and Reimbursement Status in Australia
- Legal Status: Prescription-only medicine (Schedule 4, S4) – must be prescribed by a registered medical or nurse practitioner.
- Regulatory Authority: Registered with the Therapeutic Goods Administration (TGA)
- Reimbursement: Prednisolone is available under the PBS for approved indications with significant government subsidy (pbs.gov.au).
- Pharmacy Supply: Only supplied via Australian pharmacies upon production of a valid prescription; repeats usually at the doctor’s discretion.
Latest Research / Clinical Guidance (2022–2025)
- Asthma: The Australian Asthma Handbook (2022) continues to recommend short courses of oral prednisolone (3–5 days) for acute flare-ups, emphasising careful tapering for longer use (Asthma Handbook).
- COVID-19: Prednisolone is used off-label in hospitalised severe cases when dexamethasone is unavailable, but dexamethasone remains first choice per recent guidelines (Therapeutic Guidelines Ltd, 2023).
- Autoimmune diseases: New consensus statements (Rheumatology Australia, 2023) reinforce the importance of lowest effective dose, shortest possible duration, and bone/fracture risk assessment.
- Paediatric Use: Royal Australasian College of Physicians’ latest protocols (2023) stress weight-adjusted dosing and infection risk monitoring.
- Reference: "Therapeutic Guidelines: Corticosteroids", Therapeutic Guidelines Ltd (2024); Australian Prescriber 2023; Asthma Handbook 2022; consensus statements from RACGP and RACP (2022–2024).
Availability and Delivery
| Common Pack Sizes | Indicative Price Range (AUD, as of 2024) | Delivery Time: Sydney | Delivery Time: Melbourne | Delivery Time: Brisbane | Delivery Time: Perth |
|---|---|---|---|---|---|
| 30 x 5 mg tablets | $8 – $18 (with PBS subsidy) | 1 day (metro) | 1 day (metro) | 1 day (metro) | 2 days |
| 100 x 1 mg tablets | $11 – $22 (PBS pricing) | 1 day | 1 day | 1 day | 2–3 days |
| Oral liquid, 100 mL (5 mg/5 mL) | $12 – $24 | 1–2 days | 1–2 days | 1–2 days | 2–3 days |
Major chain and independent pharmacies can often provide same or next-day delivery service in metropolitan areas, with standard or express shipping options. Rural/regional delivery times may vary. Always ensure a valid prescription is provided for dispensing and delivery.
Frequently Asked Questions (FAQ)
- Will prednisolone affect my sleep?
It can cause insomnia, especially if taken late in the day. Always take your dose in the morning unless instructed otherwise by your doctor. - Can I drink alcohol while taking prednisolone?
Small amounts may be permitted, but both alcohol and steroids can irritate your stomach lining and increase bleeding risk—it's generally wise to limit or avoid alcohol while on this medication. - Do I need to finish the whole course?
Yes—complete the full course as prescribed, unless otherwise advised by your GP, to ensure the condition is treated fully and avoid withdrawal symptoms. - What should I do if I miss a dose?
Take it as soon as you remember, unless it's almost your next scheduled dose. Do NOT double the dose to catch up; seek advice from your pharmacist or doctor if unsure. - Are there any special diet or lifestyle changes I should follow?
Maintain a healthy balanced diet (including calcium- and protein-rich foods), regular exercise, and avoid excess salt and processed foods. This can help reduce risks of bone thinning, weight gain, and fluid retention associated with steroids.
For More Information
Always read the Consumer Medicine Information (CMI) leaflet provided with your medication and discuss any questions with your doctor, pharmacist or nurse. Additional resources can be found at the HealthDirect Australia website.
