EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens), propylene glycol
▶ Colifoam (Meda Pharmaceuticals Ltd)
Hydrocortisone acetate 100 mg per 1 gram Colifoam 10% aerosol
Methylprednisolone 03-Nov-2017
l DRUG ACTION Methylprednisolone exerts predominantly
glucocorticoid effects with minimal mineralcorticoid
Suppression of inflammatory and allergic disorders |
Cerebral oedema associated with malignancy
▶ Adult: Initially 2–40 mg daily
▶ BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
Treatment of graft rejection reactions
▶ Adult: Up to 1 g daily for up to 3 days
Treatment of relapse in multiple sclerosis
▶ Adult: 500 mg once daily for 5 days
Treatment of relapse in multiple sclerosis (when oral
steroids have failed or have not been tolerated, or in
those who require hospital admission)
▶ Adult: 1 g once daily for 3–5 days
Suppression of inflammatory and allergic disorders
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 40–120 mg, then 40–120 mg after 2–3 weeks if
required, to be injected into the gluteal muscle
▶ With intravenous use or oral use g Not licensed for use by
mouth for the treatment of multiple sclerosis relapse. Not
licensed for use by intravenous infusion for the treatment
of multiple sclerosis relapse for durations longer than
3 days. h. Methylprednisolone doses in the BNF may
differ from those in product literature.
MHRA/CHM ADVICE: METHYLPREDNISOLONE INJECTABLE
MEDICINE CONTAINING LACTOSE (SOLU-MEDRONE ® 40 MG): DO
NOT USE IN PATIENTS WITH COWS’ MILK ALLERGY (OCTOBER
▶ With intramuscular use or intravenous use
An EU-wide review has concluded that Solu-Medrone ®
40 mg may contain trace amounts of milk proteins and
should not be used in patients with a known or
suspected allergy to cows’ milk. Serious allergic
reactions, including bronchospasm and anaphylaxis,
have been reported in patients allergic to cows’ milk
proteins. If a patient’s symptoms worsen or new allergic
symptoms occur, administration should be stopped and
the patient treated accordingly.
▶ With intravenous use Rapid intravenous administration of
large doses associated with cardiovascular collapse
l INTERACTIONS → Appendix 1: corticosteroids
▶ With oral use Depressed mood
myocardial infarction). oedema . schizophrenia . suicidal
ideation . withdrawal syndrome
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion (as sodium
succinate) (Solu-Medrone ®), give continuously or
intermittently or via drip tubing in Glucose 5% or Sodium
chloride 0.9%. Reconstitute initially with water for
injections; doses up to 250 mg should be given over at least
5 minutes, high doses over at least 30 minutes.
l PATIENT AND CARER ADVICE Patient counselling is advised
for methylprednisolone tablets and injections (steroid
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
Powder and solvent for solution for injection
CAUTIONARY AND ADVISORY LABELS 10
Methylprednisolone (as Methylprednisolone sodium succinate)
40 mg Solu-Medrone 40mg powder and solvent for solution for
injection vials | 1 vial P £1.58
Methylprednisolone (as Methylprednisolone sodium succinate)
125 mg Solu-Medrone 125mg powder and solvent for solution for
injection vials | 1 vial P £4.75
Methylprednisolone (as Methylprednisolone sodium succinate)
500 mg Solu-Medrone 500mg powder and solvent for solution for
injection vials | 1 vial P £9.60
Methylprednisolone (as Methylprednisolone sodium succinate)
1 gram Solu-Medrone 1g powder and solvent for solution for injection
CAUTIONARY AND ADVISORY LABELS 10, 21
Methylprednisolone 2 mg Medrone 2mg tablets | 30 tablet P £3.88 DT = £3.88
Methylprednisolone 4 mg Medrone 4mg tablets | 30 tablet P £6.19 DT = £6.19
Methylprednisolone 16 mg Medrone 16mg tablets | 30 tablet P £17.17 DT = £17.17
Methylprednisolone 100 mg Medrone 100mg tablets | 20 tablet P £48.32 DT = £48.32
CAUTIONARY AND ADVISORY LABELS 10
Methylprednisolone acetate 40 mg per 1 ml Depo-Medrone
40mg/1ml suspension for injection vials | 1 vial P £3.44 DT =
Depo-Medrone 80mg/2ml suspension for injection vials | 1 vial P £6.18 DT = £6.18 | 10 vial P £61.39
Depo-Medrone 120mg/3ml suspension for injection vials | 1 vial P £8.96 DT = £8.96 | 10 vial P £88.81
l DRUG ACTION Prednisolone exerts predominantly
glucocorticoid effects with minimal mineralocorticoid
Acute exacerbation of chronic obstructive pulmonary
disease (if increased breathlessness interferes with
▶ Adult: 30 mg daily for 7–14 days
678 Corticosteroid responsive conditions BNF 78
Severe croup (before transfer to hospital)| Mild croup that
might cause complications (before transfer to hospital)
Mild to moderate acute asthma (when oral corticosteroid
taken for more than a few days)| Severe or lifethreatening acute asthma (when oral corticosteroid
taken for more than a few days)
▶ Child 1 month–11 years: 2 mg/kg once daily (max. per
dose 60 mg) for up to 3 days, longer if necessary
Mild to moderate acute asthma | Severe or life-threatening
▶ Child 1 month–11 years: 1–2 mg/kg once daily (max. per
dose 40 mg) for up to 3 days, longer if necessary
▶ Child 12–17 years: 40–50 mg daily for at least 5 days
▶ Adult: 40–50 mg daily for at least 5 days
Suppression of inflammatory and allergic disorders
▶ Adult: Initially 10–20 mg daily, dose preferably taken
in the morning after breakfast, can often be reduced
within a few days but may need to be continued for
several weeks or months; maintenance 2.5–15 mg
▶ Adult: 25–100 mg 1–2 times a week, as prednisolone
Suppression of inflammatory and allergic disorders
(initial dose in severe disease)
▶ Adult: Initially up to 60 mg daily, dose preferably taken
in the morning after breakfast, can often be reduced
within a few days but may need to be continued for
Idiopathic thrombocytopenic purpura
▶ Adult: 1 mg/kg daily, gradually reduce dose over several
Ulcerative colitis | Crohn’s disease
▶ Adult: Initially 20–40 mg daily until remission occurs,
followed by reducing doses, up to 60 mg daily, may be
used in some cases, doses preferably taken in the
Neuritic pain or weakness heralding rapid onset of
permanent nerve damage (during reversal reactions
▶ Adult: Initially 40–60 mg daily, dose to be instituted at
Generalised myasthenia gravis (when given on alternate
▶ Adult: Initially 10 mg once daily on alternate days, then
increased in steps of 10 mg once daily on alternate
days, increased to 1–1.5 mg/kg once daily on alternate
Generalised myasthenia gravis in ventilated patients
(when given on alternate days)
▶ Adult: Initially 1.5 mg/kg once daily on alternate days
Generalised myasthenia gravis (when giving daily)
▶ Adult: Initially 5 mg daily, increased in steps of 5 mg
daily. maintenance 60–80 mg daily, alternatively
maintenance 0.75–1 mg/kg daily, ventilated patients
may be started on 1.5 mg/kg (max. 100 mg) on alternate
▶ Adult: Usual dose 10–40 mg once daily on alternate
days, reduce to minimum effective dose
Reduction in rate of joint destruction in moderate to
severe rheumatoid arthritis of less than 2 years’
▶ Adult: 10–15 mg daily until remission of disease
activity; maintenance 7.5–10 mg daily, reduce
gradually to maintenance dose. Many patients require
treatment for at least 2 years and in some patients it
may be necessary to continue long term low-dose
Giant cell (temporal) arteritis
▶ Adult: 40–60 mg daily until remission of disease
activity, the higher dose being used if visual symptoms
occur; maintenance 7.5–10 mg daily, reduce gradually
to maintenance dose. Many patients require treatment
for at least 2 years and in some patients it may be
necessary to continue long term low-dose
Polyarteritis nodosa | Polymyositis | Systemic lupus
▶ Adult: Initially 60 mg daily, to be reduced gradually;
Symptom control of anorexia in palliative care
Pneumocystis pneumonia in moderate to severe
infections associated with HIV infection
▶ Adult: 50–80 mg daily for 5 days, the dose is then
reduced to complete 21 days of treatment,
corticosteroid treatment should ideally be started at
the same time as the anti-pneumocystis therapy and
certainly no later than 24–72 hours afterwards. The
corticosteroid should be withdrawn before antipneumocystis treatment is complete
Short-term prophylaxis of episodic cluster headache as
monotherapy or in combination with verapamil during
▶ Adult: 60–100 mg once daily for 2–5 days, then
reduced in steps of 10 mg every 2–3 days until
▶ Adult: 1 metered application 1–2 times a day for
2 weeks, continued for further 2 weeks if good
response, to be inserted into the rectum, 1 metered
application contains 20 mg prednisolone
▶ BY RECTUM USING SUPPOSITORIES
▶ Adult: 5 mg twice daily, to be inserted in to the rectum
morning and night, after a bowel movement
▶ Adult: 1 metered application 1–2 times a day for
2 weeks, continued for further 2 weeks if good
response, to be inserted into the rectum, 1 metered
application contains 20 mg prednisolone continued→
BNF 78 Corticosteroid responsive conditions 679
Rectal complications of Crohn’s disease
▶ BY RECTUM USING SUPPOSITORIES
▶ Adult: 5 mg twice daily, to be inserted in to the rectum
morning and night, after a bowel movement
Rectal and rectosigmoidal ulcerative colitis | Rectal and
rectosigmoidal Crohn’s disease
▶ Adult: 20 mg daily for 2–4 weeks, continued if response
Prednisolone has been confused with propranolol; care
must be taken to ensure the correct drug is prescribed
▶ With rectal use systemic absorption may occur with rectal
▶ With systemic use Duchenne’s muscular dystrophy (possible
transient rhabdomyolysis and myoglobinuria following
strenuous physical activity). systemic sclerosis (increased
incidence of scleroderma renal crisis with a daily dose of
l INTERACTIONS → Appendix 1: corticosteroids
myocardial infarction). scleroderma renal crisis . vomiting
l PREGNANCY As it crosses the placenta 88% of
Monitoring ▶ With systemic use Pregnant women with fluid
retention should be monitored closely.
l BREAST FEEDING Prednisolone appears in small amounts
in breast milk but maternal doses of up to 40 mg daily are
unlikely to cause systemic effects in the infant.
Monitoring ▶ With systemic use Infant should be monitored
for adrenal suppression if mother is taking a dose higher
▶ With systemic use Manufacturer advises monitor blood
pressure and renal function (s-creatinine) routinely in
patients with systemic sclerosis—increased incidence of
l PRESCRIBING AND DISPENSING INFORMATION
Palliative care ▶ With oral use in adults For further
information on the use of prednisolone in palliative care,
see www.medicinescomplete.com/#/content/palliative/
Medicines for Children leaflet: Prednisolone for asthma
▶ With oral use www.medicinesforchildren.org.uk/prednisoloneasthma
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
▶ Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium metasulfobenzoate)
20 mg per 1 application Prednisolone 20mg/application foam
enema | 14 dose P £187.00 DT = £187.00
CAUTIONARY AND ADVISORY LABELS 5, 10, 25
▶ Prednisolone (Non-proprietary)
Prednisolone 1 mg Prednisolone 1mg gastro-resistant tablets | 30 tablet P £1.60–£1.92 DT = £1.92
Prednisolone 5 mg Prednisolone 5mg gastro-resistant tablets |
28 tablet P £2.34 DT = £0.94 | 30 tablet P £0.96–£6.29
▶ Deltacortril Enteric (Alliance Pharmaceuticals Ltd)
Prednisolone 2.5 mg Deltacortril 2.5mg gastro-resistant tablets | 30 tablet P £1.16
Prednisolone 5 mg Deltacortril 5mg gastro-resistant tablets | 30 tablet P £1.19
▶ Dilacort (Crescent Pharma Ltd, Teva UK Ltd)
Prednisolone 2.5 mg Dilacort 2.5mg gastro-resistant tablets | 28 tablet P £1.14–£1.85 DT = £0.93
Prednisolone 5 mg Dilacort 5mg gastro-resistant tablets | 28 tablet P £1.45–£1.85 DT = £0.94
CAUTIONARY AND ADVISORY LABELS 10, 13, 21
▶ Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium phosphate)
5 mg Prednisolone 5mg soluble tablets | 30 tablet P £53.48 DT =
CAUTIONARY AND ADVISORY LABELS 10, 21
▶ Prednisolone (Non-proprietary)
Prednisolone 1 mg Prednisolone 1mg tablets | 28 tablet P £4.00 DT = £0.63
Prednisolone 2.5 mg Prednisolone 2.5mg tablets | 28 tablet P £1.35
Prednisolone 5 mg Prednisolone 5mg tablets | 28 tablet P £9.86 DT = £0.74
Prednisolone 10 mg Prednisolone 10mg tablets | 28 tablet P £1.77
Prednisolone 20 mg Prednisolone 20mg tablets | 28 tablet P £3.55
Prednisolone 25 mg Prednisolone 25mg tablets | 56 tablet P £78.38 DT = £77.23
Prednisolone 30 mg Prednisolone 30mg tablets | 28 tablet P £8.15 DT = £8.15
Prednisolone 2.5 mg Pevanti 2.5mg tablets | 30 tablet P £1.42
Prednisolone 5 mg Pevanti 5mg tablets | 30 tablet P £0.95
Prednisolone 10 mg Pevanti 10mg tablets | 30 tablet P £1.90
Prednisolone 20 mg Pevanti 20mg tablets | 30 tablet P £3.80
Prednisolone 25 mg Pevanti 25mg tablets | 56 tablet P £40.00
▶ Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium phosphate)
5 mg Prednisolone sodium phosphate 5mg suppositories | 10 suppository P £70.73 DT = £69.79
Prednisolone acetate 25 mg per 1 ml Deltastab 25mg/1ml
suspension for injection ampoules | 10 ampoule P £68.72
CAUTIONARY AND ADVISORY LABELS 10
▶ Prednisolone (Non-proprietary)
Prednisolone 1 mg per 1 ml Prednisolone 5mg/5ml oral solution unit
dose | 10 unit dose P £11.41 DT = £11.41
Prednisolone 10 mg per 1 ml Prednisolone 10mg/ml oral solution
sugar free sugar-free | 30 ml P £55.50 DT = £55.50
▶ Prednisolone (Non-proprietary)
Prednisolone sodium phosphate 200 microgram per
1 ml Prednisolone 20mg/100ml rectal solution | 7 enema P £14.95 DT = £7.50
680 Corticosteroid responsive conditions BNF 78
Triamcinolone acetonide 21-Dec-2017
l DRUG ACTION Triamcinolone exerts predominantly
glucocorticoid effects with minimal mineralcorticoid
Suppression of inflammatory and allergic disorders
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 40 mg (max. per dose 100 mg), repeated if
necessary, dose given for depot effect, to be
administered into gluteal muscle; repeated at intervals
according to patient’s response
l CAUTIONS High dosage (may cause proximal myopathy),
l INTERACTIONS → Appendix 1: corticosteroids
▶ Uncommon Dizziness . flushing . hyperglycaemia
l PATIENT AND CARER ADVICE Patient counselling is advised
for triamcinolone acetonide injection (steroid card).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10
EXCIPIENTS: May contain Benzyl alcohol
▶ Adcortyl Intra-articular / Intradermal (Bristol-Myers Squibb
Triamcinolone acetonide 10 mg per 1 ml Adcortyl Intra-articular /
Intradermal 50mg/5ml suspension for injection vials | 1 vial P £3.63
Adcortyl Intra-articular / Intradermal 10mg/1ml suspension for
injection ampoules | 5 ampoule P £4.47 DT = £4.47
▶ Kenalog (Bristol-Myers Squibb Pharmaceuticals Ltd)
Triamcinolone acetonide 40 mg per 1 ml Kenalog Intra-articular /
Intramuscular 40mg/1ml suspension for injection vials | 5 vial P £7.45 DT = £7.45
Most types of Cushing’s syndrome are treated surgically, that
which occasionally accompanies carcinoma of the bronchus
is not usually amenable to surgery. Metyrapone p. 682 has
been found helpful in controlling the symptoms of the
disease; it is also used in other forms of Cushing’s syndrome
to prepare the patient for surgery.
The dosages of metyrapone used are either low, and
tailored to cortisol production, or high, in which case
corticosteroid replacement therapy is also needed.
Ketoconazole below may have a direct effect on
corticotropic tumour cells in patients with Cushing’s disease.
It is used under specialist supervision for treatment of
endogenous Cushing’s syndrome.
Other drugs used for Cushing’s syndrome and disease
l DRUG ACTION An imidazole derivative which acts as a
potent inhibitor of cortisol and aldosterone synthesis by
inhibiting the activity of 17a-hydroxylase,
11-hydroxylation steps and at higher doses the cholesterol
side-chain cleavage enzyme. It also inhibits the activity of
adrenal C17-20 lyase enzymes resulting in androgen
synthesis inhibition, and may have a direct effect on
corticotropic tumour cells in patients with Cushing’s
Endogenous Cushing’s syndrome (specialist use only)
▶ Adult: Initially 400–600 mg daily in 2–3 divided doses,
increased to 800–1200 mg daily; maintenance
400–800 mg daily in 2–3 divided doses, for dose
titrations in patients with established dose,
adjustments in adrenal insufficiency, or concomitant
corticosteroid replacement therapy, consult product
literature; maximum 1200 mg per day
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶ Manufacturer advises max. dose 200 mg daily with
CHMP ADVICE: KETOCONAZOLE (JULY 2013)
The CHMP has recommended that the marketing
authorisation for oral ketoconazole to treat fungal
infections should be suspended. The CHMP concluded
that the risk of hepatotoxicity associated with oral
ketoconazole is greater than the benefit in treating
fungal infections. Doctors should review patients who
are being treated with oral ketoconazole for fungal
infections, with a view to stopping treatment or
choosing an alternative treatment. Patients with a
prescription of oral ketoconazole for fungal infections
should be referred back to their doctors.
Oral ketoconazole for Cushing’s syndrome and topical
products containing ketoconazole are not affected by
l CONTRA-INDICATIONS Acquired QTc prolongation . Acute
porphyrias p. 1058 . avoid concomitant use of hepatotoxic
drugs . congenital QTc prolongation
l CAUTIONS Pre-treatment liver enzymes should not exceed
2 times the normal upper limit.risk of adrenal
l INTERACTIONS → Appendix 1: antifungals, azoles
▶ Rare or very rare Fever. hepatic disorders .taste altered
▶ Frequency not known Alcohol intolerance . appetite
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