Prednisolone (प्रेडनिसोलोन) — सम्पूर्ण क्लिनिकल गाइड
यह लेख Prednisolone के विज्ञान और क्लिनिकल उपयोग पर विस्तृत MBBS/MD-स्तर मार्गदर्शिका है — mg में डोज़, pediatric और विशेष परिस्थितियों के उदाहरण, टेपर निर्देश, मॉनिटरिंग, दवा-इंटरैक्शन, सपोर्टिव दवाएँ, पोषण और मरीज-काउंसलिंग।
Contents (Jump to)
- परिभाषा व सार
- Mechanism of action
- Indications (कब दें)
- Complete dosing (mg) — Adult & Pediatric
- Tapering templates
- Pathology & Diagnostic tests
- Drug interactions & precautions
- Supportive medicines & comanagement
- Side effects & long-term complications
- Diet — What to avoid & recommend
- Special situations (pregnancy, diabetes, TB/HBV/HCV, osteoporosis)
- Patient counselling & practical tips
- FAQ
- Selected references / guideline anchors
1) Prednisolone क्या है? (Definition & brief)
Prednisolone एक synthetic glucocorticoid है — cortisol का सक्रिय analogue — जिसमेंanti-inflammatory और immunosuppressive गुण होते हैं। यह acute inflammatory flares, autoimmune exacerbations और कुछ life-threatening inflammatory स्थितियों का शीघ्र नियंत्रण देता है। परन्तु systemic corticosteroids के साथ व्यापक दुष्प्रभाव और HPA-axis suppression का जोखिम जुड़ा होता है।
Clinical goal: सबसे कम effective dose और shortest duration से रोग नियंत्रित करना, और जहाँ संभव हो topical/inhaled steroid (जैसे Fluticasone) या steroid-sparing agents का उपयोग।
2) Mechanism of action (संक्षेप)
Prednisolone कोशिका-आधारित glucocorticoid receptor से जुड़ता है, नाभिक में जाकर gene transcription को बदलता है:
- Pro-inflammatory cytokines (IL-1, IL-6, TNF-α) और COX-2 expression ↓
- Leukocyte trafficking और adhesion molecules ↓ → साइटिक सूजन घटती है
- Phospholipase A₂ inhibit करके prostaglandin एवं leukotriene precursor कम होते हैं
- Short-term में non-genomic effects: vasoconstriction, membrane stabilization
Clinical implication: तेज symptomatic relief पर अक्सर लक्षित, पर long-term immune suppression से infection risk बढ़ता है।
3) Indications — किन स्थितियों में Prednisolone दिया जाता है
Prednisolone का उपयोग बहुआयामी है। प्रमुख उपयोगों का सार निम्न है:
- Respiratory: Acute asthma exacerbation, severe COPD exacerbation (short burst)
- Rheumatology: Rheumatoid arthritis flares, polymyalgia rheumatica, vasculitis
- Nephrology: Steroid-sensitive nephrotic syndrome (minimal change disease)
- Gastroenterology: Moderate–severe IBD flares (Ulcerative colitis, Crohn's)
- Neurology: Acute optic neuritis (often IV methylprednisolone then PO pred), acute transverse myelitis adjunct
- Dermatology/Allergy: Severe urticaria, angioedema, drug reactions (non-SJS/TEN)
- Hematology/Oncology: Certain lymphoid malignancies, chemotherapy adjuncts
- Transplant: Rejection therapy / immunosuppression protocols
- Endocrine: As replacement alternative in adrenal insufficiency scenarios (usually hydrocortisone preferred for replacement)
Note: हमेशा disease-specific guideline देखें — steroid अक्सर bridging therapy है; maintenance के लिए steroid-sparing agents पर विचार।
4) Complete dosing (mg) — Adult, Pediatric & condition-specific
नीचे वस्तुनिष्ठ, क्लिनिकल-प्रैक्टिकल doses दिए गए हैं — रोगी-विशिष्ट co-morbidity, वजन, और स्थानीय दिशानिर्देशों के अनुसार समायोजित करें।
4.1 General adult equivalence
Prednisolone 5 mg ≈ Hydrocortisone 20 mg ≈ Methylprednisolone 4 mg ≈ Dexamethasone 0.75 mg
4.2 Acute respiratory exacerbations
| Condition | Typical adult dose (mg) | Duration / comments |
|---|---|---|
| Asthma exacerbation | Prednisolone 40–50 mg PO once daily | Usually 5–7 days (short course). If ≤7–10 days, taper often not required. |
| COPD exacerbation | Prednisolone 40 mg PO once daily | Commonly 5 days (evidence supports short courses) |
4.3 Gastroenterology / IBD
| Condition | Dose | Comments |
|---|---|---|
| Ulcerative colitis (moderate–severe) | Prednisolone 40 mg PO daily (range 40–60 mg used) | Induce remission → then taper by ~5–10 mg/week (disease specific). Use steroid-sparing for maintenance. |
| Crohn’s disease (severe flare) | Prednisolone 40–60 mg PO daily | Limit duration; early steroid-sparing/biologic planning required. |
4.4 Nephrotic syndrome
Adults: Prednisolone 1 mg/kg/day PO (typical max 60–80 mg/day) until remission — often 4–16 weeks protocol dependent; after remission → alternate-day regimen and gradual taper.
Children (steroid sensitive): Prednisolone 2 mg/kg/day (max 60 mg/day) as per pediatric nephrology protocol; follow unit-specific regimen.
4.5 Rheumatology
- Rheumatoid arthritis flare: Prednisolone 5–20 mg PO daily (commonly 5–10 mg maintenance; flares 15–20 mg)
- Polymyalgia rheumatica: Prednisolone 10–20 mg/day often start; taper slowly over months
- Vasculitis (severe): High-dose IV methylpred 500–1000 mg/day ×3 days → PO prednisolone 1 mg/kg/day (specialist protocol)
4.6 Neurology / Bell’s palsy & optic neuritis
- Bell’s palsy (adult): Prednisolone 60 mg/day for 5 days then taper (e.g., 60 mg ×5 → 10 mg decrement over next 5 days) — regimens vary (60 mg ×5 then taper is common).
- Optic neuritis: IV methylpred 1 g/day ×3 days often followed by oral prednisolone; follow neuro-ophthalmology guidance.
4.7 Dermatology & allergic reactions
- Severe urticaria/angioedema: Prednisolone 20–40 mg/day for 3–5 days (adjunct to antihistamines).
- Severe eczema/psoriasis flare: Prednisolone occasionally used for short bursts; caution for rebound.
4.8 Oncology / Transplantation
Dose highly variable — protocols may use high-dose pulses, e.g., methylprednisolone IV then taper; transplant rejection protocols specialist-led.
4.9 Pediatric summary
- Asthma exacerbation: Prednisolone 1–2 mg/kg/day PO (max ≈40–60 mg) short course (3–5 days)
- Nephrotic syndrome (children): 2 mg/kg/day (max 60 mg) per pediatric nephrology protocol
- Pediatric dosing must follow weight-based charts and specialist guidance; growth suppression long term is a real risk.
यहाँ दिए गए mg doses सामान्य प्रवृत्तियाँ हैं — hospital protocols, comorbidities (diabetes, infections, pregnancy), और drug interactions के अनुसार संशोधन आवश्यक हैं।
5) Tapering — practical templates & when to taper
सिद्धांत: यदि systemic steroid ≥2–3 सप्ताह लगातार दिया गया हो या single high dose के बाद HPA-axis suppression का जोखिम हो, तो धीरे-धीरे रोकें। Short burst (≤7–10 दिन) में सामान्यतः abrupt stop acceptable माना जाता है।
Basic taper templates (examples)
A) Moderate course — 4 weeks total
- Week 1–2: Prednisolone 40 mg daily (induction)
- Week 3: 30 mg daily
- Week 4: 20 mg daily → then stop OR continue slower taper 10 mg/week depending on clinical response
B) Longer course — >8 weeks
- Reduce by 10 mg every 1–2 weeks until 20 mg/day
- Then reduce by 5 mg every 1–2 weeks to 10 mg
- Then reduce by 2.5 mg steps with clinical monitoring
C) Alternate-day transition (after remission)
यदि high daily dose से remission हुआ → consider alternate-day dosing (e.g., double dose every other morning) for a period then taper to cessation to reduce adrenal suppression.
अगर tapering के दौरान fatigue, nausea, vomiting, weakness, hypotension या fever आएँ → adrenal insufficiency संदिग्ध। तत्काल चिकित्सकीय मूल्यांकन आवश्यक।
6) Pathology, Diagnostic tests & interpretation
Prednisolone शुरू करने से पहले और दौरान नीचे की जांचें सहायक हैं:
- CBC: Leukocytosis (neutrophilia) हो सकता है; लेकिन infection markers clinical context अनुसार देखें
- Fasting glucose / HbA1c: steroid-induced hyperglycemia की निगरानी
- LFT / RFT: hepatic metabolism और renal clearance पर नजर
- Electrolytes: hypokalemia या sodium retention के कारण चेक करें
- Morning serum cortisol: यदि long-term steroid के बाद HPA axis evaluation जरूरी हो
- DEXA scan: prolonged steroid therapy (>3 months) में bone density evaluation
- Tuberculosis / Hepatitis screening: prior to long-term immunosuppression (IGRA/PPD, HBsAg, anti-HCV)
Clinical example: steroid-treated patient में high-grade fever के साथ rapid deterioration हो तो occult infection पर high suspicion; steroids mask fever and WBC changes — low threshold for infection workup.
7) Drug–drug interactions & clinical precautions
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): Prednisolone levels ↑ → Cushingoid features, immune suppression
- CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin): Steroid efficacy ↓ → dose adjustment/monitoring
- NSAIDs / anticoagulants: GI bleeding risk ↑ when combined — consider PPI prophylaxis
- Diabetes medications: steroid-induced hyperglycemia may require insulin or OHA adjustment
- Live vaccines: Contraindicated on high-dose systemic steroids; inactivated vaccines may be less effective
- Opioids / sedatives: co-use increases infection & sedation risk — if OUD present consider OST protocols and naloxone education: OST (Methadone/Buprenorphine) and Naloxone.
यदि patient anti-TB treatment (rifampicin) पर है, steroid doses may need adjustment and specialist coordination (HIV/TB co-infection scenarios require integrated care).
8) Supportive medicines & comanagement
Prednisolone के साथ commonly इस्तेमाल होने वाले supportive measures और दवाएँ:
- Calcium + Vitamin D: Bone protection — Ca 1000–1200 mg/day + Vitamin D 800–1000 IU/day when long-term steroids
- PPI / H2 blockers: GI prophylaxis for patients at high risk (NSAID or anticoagulant use)
- Antihypertensives: BP management as needed
- Antidiabetics / insulin: For steroid-induced hyperglycemia
- Bisphosphonates / bone-sparing agents: consider for prolonged steroid therapy with osteoporosis risk
- Antihistamines: Fexofenadine / Loratadine / Levocetirizine for allergic symptoms; topical steroids (Fluticasone) for airway/nasal disease when possible
Internal links: antihistamines and inhaled steroids — Fexofenadine, Loratadine, Fluticasone.
9) Side effects — short-term और long-term
Short-term (days–weeks)
- Fluid retention, weight gain
- Hyperglycemia, mood swings, insomnia
- Gastritis, peptic ulcer exacerbation
- Elevated blood pressure
Long-term (months–years)
- Cushingoid features (moon face, truncal obesity)
- Osteoporosis, increased fracture risk, avascular necrosis
- Muscle weakness (steroid myopathy)
- Impaired wound healing and increased susceptibility to infections (including TB, fungal)
- Glaucoma, cataract formation
- Adrenal suppression — potential adrenal crisis on abrupt withdrawal
Risk mitigation: lowest effective dose, morning dosing, calcium/vit D, DEXA monitoring for long-term use, vaccination planning and infection surveillance.
10) Diet — क्या खाएँ, क्या टाले
Recommended
- High protein foods — eggs, pulses, lean meat (muscle mass बचाने के लिए)
- Calcium-rich foods — milk, curd, paneer, small fish (bones)
- Vitamin D sources — sunlight exposure, fortified foods, supplements if deficient
- Complex carbs and fiber — whole grains, millets, vegetables (glycemic control में मदद)
Avoid / Limit
- Excess salt — fluid retention और hypertension घटाएँ
- Refined sugar और high-sugar foods — steroid-induced hyperglycemia को बढ़ाते हैं
- Alcohol — hepatic risk तथा immune suppression को बढ़ाता है
- Unhygienic/raw animal products in severely immunosuppressed patients — infection risk के कारण
Specific fruits like guava and banana are useful sources of vitamins and potassium; avoid grapefruit juice with some interacting drugs.
11) Special situations — pregnancy, diabetes, TB/HBV/HCV, osteoporosis
Pregnancy
Prednisolone can be used in pregnancy when benefit outweighs risk. For some indications (e.g., severe autoimmune flare), use lowest effective dose. For fetal risk/teratogenicity, prefer specialist consultation. For antenatal steroid exposure and neonatal outcomes coordinate with obstetrics and neonatology.
Diabetes
Steroids worsen glycemic control. For steroid-treated diabetic patients:
- Increase glucose monitoring frequency
- Adjust OHA/insulin dosing proactively
- Consider short-acting insulin for postprandial spikes when high-dose steroids used
TB / Hepatitis B / C
Before long-term immunosuppression, screen for latent TB (IGRA/PPD) and for hepatitis B (HBsAg, anti-HBc) and HCV. If latent TB/HBV active infection detected, treat/coordinate with specialist prior to prolonged steroid therapy.
Osteoporosis prevention
For patients on prolonged steroids (>3 months) — DEXA scan, calcium + vitamin D, lifestyle (weight-bearing exercise), and bisphosphonate therapy when indicated.
12) Patient counselling & practical tips
- Take Prednisolone in the morning with food — aligns with circadian cortisol and reduces insomnia
- Do not stop suddenly if you have taken more than 2–3 weeks — always taper under medical supervision
- Report signs of infection, severe abdominal pain, visual changes, marked mood changes or muscle weakness promptly
- Maintain daily weight/BP/glucose log if on prolonged treatment
- Carry a medical alert card if on chronic systemic steroid therapy
- Family members of opioid-using patients should know overdose reversal with Naloxone and have access if indicated
13) Frequently Asked Questions (FAQ)
Q1. Prednisolone लेने पर कितनी जल्दी असर दिखता है?
कई inflammatory सिंड्रोम में काफी जल्दी (घंटे—दिन) में लक्षणों में सुधार दिखाई देता है। पर underlying disease control और steroid-sparing therapy की ज़रूरत clinic-specific है।
Q2. क्या Prednisolone "नशा" देता है?
Therapeutic doses पर यह intoxicating नहीं होता; पर mood changes और behavioral effects हो सकते हैं। गलत उपयोग से कई दुष्प्रभाव होते हैं — केवल prescribed therapeutic use ही मान्य है।
Q3. क्या मैं Prednisolone के साथ वैक्सीन ले सकता/सकती हूँ?
High-dose systemic steroids (dose-dependent) पर live vaccines contraindicated होते हैं। Inactivated vaccines पर सलाह पर निर्भर। Vaccination plan clinician से discuss करें।
Q4. Prednisolone लेने के दौरान क्या घरेलू कदम उठाऊँ?
नमक घटाएँ, शुगर पर नियंत्रित रहें, calcium-rich diet, sunlight exposure, regular follow-up और infection precautions अपनाएँ।
Q5. क्या Prednisolone किसी को कभी भी तुरंत रोका जा सकता है?
यदि course बहुत छोटा (≤7–10 दिन) और कमी न हो तो कभी-कभी abrupt stop हो सकता है; पर लंबा course होने पर abrupt stop से adrenal crisis हो सकता है — इसलिए taper आवश्यक है।
14) Selected references & guideline anchors (suggested reading)
- Nephrotic syndrome steroid protocols (pediatric and adult nephrology guidelines)
- GINA — asthma exacerbation and systemic steroid short courses
- IBD clinical practice guidelines — induction steroid dosing and taper
- Rheumatology guidelines — steroid bridging and vasculitis protocols
- Disease-specific specialist protocols for transplant and oncology
(ये स्रोत-नाम सामान्य संकेत हैं — अपना clinical practice स्थानीय राष्ट्रीय दिशानिर्देशों/मार्गदर्शिकाओं के अनुसार संशोधित करें।)