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Prednisolone & Oral Steroids: What You Must Know

Prednisolone is a powerful anti-inflammatory steroid used for dozens of conditions. Long-term use requires careful monitoring for serious side effects including diabetes, osteoporosis, and adrenal suppression.1

Written and clinically reviewed by Suman Konda, PharmD, Clinical Pharmacist · Editorial policy · Not medical advice

Last reviewed and updated: · How we check our content

Drug class
Corticosteroid
Anti-inflammatory
Very potent
Long-term risks
Diabetes, bones, BP
Never stop
Abruptly after >3 weeks

What Prednisolone Is Used For

ConditionDuration
Asthma exacerbation5 days (short course: safe to stop abruptly)
COPD exacerbation5 days
Rheumatoid arthritisWeeks to months, at low dose
Polymyalgia rheumatica1–2 years, slow taper
Inflammatory bowel disease (Crohn's/UC)Weeks, then taper
Transplant rejection preventionLong-term, low dose
Temporal arteritis / GCA1–2 years
Adrenal SuppressionIf you've taken prednisolone for more than 3 weeks, your adrenal glands may have stopped making cortisol. Stopping suddenly can cause an 'adrenal crisis' (collapse, vomiting, shock). Always taper slowly and carry a Steroid Emergency Card.

Blood Tests to Monitor on Steroids

TestFrequencyWhy
Blood glucoseEvery 1–3 monthsSteroids cause steroid-induced diabetes
Blood pressureEvery visitSteroids raise BP
Bone density (DEXA scan)At start, then 1–2 yearlyPrevent osteoporosis
Full blood countEvery 3–6 monthsImmune suppression monitoring
Electrolytes (potassium)Every 3–6 monthsHypokalaemia risk
CholesterolAnnuallySteroids raise lipids
Bone ProtectionIf taking prednisolone >7.5 mg for >3 months, you should be prescribed calcium + vitamin D supplements and possibly a bisphosphonate (e.g. alendronate) to protect your bones. Ask your doctor if you haven't been prescribed these.

Common Long-Term Side Effects

  • Weight gain and increased appetite, especially abdominal fat
  • 'Moon face' and 'buffalo hump' (fat redistribution)
  • Raised blood sugar (steroid-induced diabetes)
  • High blood pressure
  • Osteoporosis (bone thinning)
  • Cataracts and glaucoma (eye pressure)
  • Skin thinning and easy bruising
  • Mood changes: euphoria or depression
  • Increased infection risk
Do I need to take extra steroids during illness?
Yes. This is the 'sick day rules'. If you have a fever or significant illness while on maintenance steroids, you may need to double your dose. Carry a steroid card. Seek emergency help if vomiting prevents taking your dose.
Can I get vaccinations on steroids?
Live vaccines (e.g. MMR, yellow fever, varicella) are generally avoided if on high-dose steroids. Flu and pneumococcal vaccines are strongly recommended. Discuss with your doctor.
Will my face go back to normal after stopping?
Yes. Moon face and weight gain from steroids usually reverse gradually after stopping or reducing the dose.
OsteoporosisSteroid-induced bone loss

The steroid emergency card – why it matters

Anyone taking prednisolone 5 mg or more daily for more than 3 months should carry a steroid emergency card (or wear a medical alert bracelet). This card is critical in emergencies because:

Long-term steroid use suppresses the body's own adrenal glands. Normally, under severe stress (major surgery, serious infection, trauma), the adrenal glands produce 5–10 times their usual cortisol output. In a person with adrenal suppression, this extra surge cannot happen. Without additional steroid cover, an Addisonian crisis can develop: profound hypotension, dehydration, and life-threatening shock.

Medical and paramedical staff are trained to act on the card immediately – giving emergency hydrocortisone injection. In the UK, NHS England issued revised guidance in 2020 making steroid emergency cards mandatory for all patients on long-term systemic steroids.

Sick day rules on prednisolone

If you are on prednisolone and develop a feverish illness (temperature above 37.5°C), vomiting, or significant physical stress, you must double your prednisolone dose for 48–72 hours. This is called "sick day doubling" or "stress dosing" and prevents an Addisonian crisis. If you cannot keep tablets down due to vomiting, seek emergency treatment immediately – you will need intramuscular or intravenous hydrocortisone instead.

Bone protection on long-term steroids

Prednisolone accelerates bone loss by reducing calcium absorption from the gut and increasing calcium excretion by the kidney, while also directly suppressing bone formation. The fracture risk begins to increase within 3 months of starting and is greatest in the spine.

UK NICE guidelines (CG146) recommend that anyone expected to be on oral corticosteroids for 3 months or more should be:

  • Assessed for fracture risk (using FRAX or QFracture).
  • Started on supplemental calcium (1000–1200 mg/day) and vitamin D (800–1000 IU/day).
  • Considered for a bisphosphonate (e.g., alendronate) if fracture risk is elevated – typically if aged over 40, postmenopausal, or with other risk factors.

A baseline DXA bone density scan is recommended in patients at higher risk. Annual monitoring blood tests should include calcium, vitamin D, and fasting blood glucose (to detect steroid-induced diabetes).

References

Sources cited on this page. PubMed links open the original abstract.

  1. Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study. Medicine (Baltimore). 2015;94(15):e647. PMID 25881841 · doi:10.1097/MD.0000000000000647

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Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.
Content written and reviewed by Suman Konda, PharmD, Clinical Pharmacist · Telangana State Pharmacy Council · Sources linked to PubMed · Not medical advice – see our disclaimer