lUNLICENSED USEPrednisolone rectal foam not licensed
for use in children (age range not specified by
manufacturer).
IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
Prednisolone has been confused with propranolol; care
must be taken to ensure the correct drug is prescribed
and dispensed.lCONTRA-INDICATIONS
▶With rectal useBowel perforation.extensivefistulas.
intestinal obstruction.recent intestinal anastomoses
lCAUTIONS
▶With rectal usesystemic absorption may occur with rectal
preparations
▶With systemic useDuchenne’s muscular dystrophy (possible
transient rhabdomyolysis and myoglobinuria following
strenuous physical activity)
lINTERACTIONS→Appendix 1 : corticosteroids
lSIDE-EFFECTS
▶With oral useDiarrhoea.dizziness.dyslipidaemia.
exophthalmos.fatigue.lipomatosis.malaise.protein
catabolism
lPREGNANCYAs it crosses the placenta 88 %of
prednisolone is inactivated.
Monitoring▶With systemic usePregnant women withfluid
retention should be monitored closely.
lBREAST FEEDINGPrednisolone 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 useInfant should be monitored
for adrenal suppression if mother is taking a dose higher
than 40 mg.
lPATIENT AND CARER ADVICEPatient counselling is advised
for prednisolone tablets (steroid card).
Medicines for Children leaflet: Prednisolone (oral) for nephrotic
syndromewww.medicinesforchildren.org.uk/prednisolone-oral-
nephrotic-syndrome
Medicines for Children leaflet: Prednisolone for asthma
http://www.medicinesforchildren.org.uk/prednisolone-asthma
lMEDICINAL 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 solution, enema
Foam
▶Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium metasulfobenzoate)
20 mg per 1 applicationPrednisolone 20 mg/application foam
enema| 14 doseP£ 187. 00 DT = £ 187. 00
Gastro-resistant tablet
CAUTIONARY AND ADVISORY LABELS5, 10, 25
▶Prednisolone (Non-proprietary)
Prednisolone 1 mgPrednisolone 1 mg gastro-resistant tablets|
30 tabletP£ 1. 60 – £ 1. 92 DT = £ 1. 92
Prednisolone 2.5 mgPrednisolone 2. 5 mg gastro-resistant tablets|
28 tabletP£ 0. 83 DT = £ 0. 74 | 30 tabletP£ 0. 79 – £ 6. 15
Prednisolone 5 mgPrednisolone 5 mg gastro-resistant tablets|
28 tabletP£ 0. 76 DT = £ 0. 76 | 30 tabletP£ 0. 81 – £ 6. 29
▶Deltacortril Enteric(Alliance Pharmaceuticals Ltd)
Prednisolone 2.5 mgDeltacortril 2. 5 mg gastro-resistant tablets|
30 tabletP£ 1. 16
Prednisolone 5 mgDeltacortril 5 mg gastro-resistant tablets|
30 tabletP£ 1. 19
▶Dilacort(Crescent Pharma Ltd, Teva UK Ltd)
Prednisolone 2.5 mgDilacort 2. 5 mg gastro-resistant tablets|
28 tabletP£ 1. 14 – £ 1. 85 DT = £ 0. 74
Prednisolone 5 mgDilacort 5 mg gastro-resistant tablets|
28 tabletP£ 1. 45 – £ 1. 85 DT = £ 0. 76
Soluble tablet
CAUTIONARY AND ADVISORY LABELS10, 13, 21
▶Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium phosphate)
5mgPrednisolone 5 mg soluble tablets| 30 tabletP£ 53. 48 DT =
£ 21. 47
Tablet
CAUTIONARY AND ADVISORY LABELS10, 21
▶Prednisolone (Non-proprietary)
Prednisolone 1 mgPrednisolone 1 mg tablets| 28 tabletP
£ 4. 00 DT = £ 0. 37
Prednisolone 2.5 mgPrednisolone 2. 5 mg tablets| 28 tabletP
£ 1. 33
Prednisolone 5 mgPrednisolone 5 mg tablets| 28 tabletP
£ 9. 86 DT = £ 0. 47
Prednisolone 10 mgPrednisolone 10 mg tablets| 28 tabletP
£ 1. 77
Prednisolone 20 mgPrednisolone 20 mg tablets| 28 tabletP
£ 3. 55
Prednisolone 25 mgPrednisolone 25 mg tablets| 56 tabletP
£ 75. 00 DT = £ 75. 00
Prednisolone 30 mgPrednisolone 30 mg tablets| 28 tabletP
£ 8. 15
▶Pevanti(AMCo)
Prednisolone 2.5 mgPevanti 2. 5 mg tablets| 30 tabletP£ 1. 42
DT = £ 1. 42
Prednisolone 5 mgPevanti 5 mg tablets| 30 tabletP£ 0. 95
Prednisolone 10 mgPevanti 10 mg tablets| 30 tabletP£ 1. 90
DT = £ 1. 90
Prednisolone 20 mgPevanti 20 mg tablets| 30 tabletP£ 3. 80
DT = £ 3. 80
Prednisolone 25 mgPevanti 25 mg tablets| 56 tabletP£ 40. 00
DT = £ 75. 00
Suppository
▶Prednisolone (Non-proprietary)
Prednisolone (as Prednisolone sodium phosphate)
5mgPrednisolone sodium phosphate 5 mg suppositories|
10 suppositoryP£ 55. 61 DT = £ 50. 98
Suspension for injection
▶Deltastab(AMCo)
Prednisolone acetate 25 mg per 1 mlDeltastab 25 mg/ 1 ml
suspension for injection ampoules| 10 ampouleP£ 68. 72
Oral solution
CAUTIONARY AND ADVISORY LABELS 10
▶Prednisolone (Non-proprietary)
Prednisolone 1 mg per 1 mlPrednisolone 5 mg/ 5 ml oral solution unit
dose| 10 unit doseP£ 11. 41 DT = £ 11. 41
Prednisolone 10 mg per 1 mlPrednisolone 10 mg/ml oral solution
sugar free sugar-free| 30 mlP£ 55. 00 – £ 55. 50 DT = £ 55. 50
Enema
▶Predsol(RPH Pharmaceuticals AB)
Prednisolone sodium phosphate 200 microgram per 1 mlPredsol
20 mg/ 100 ml retention enema| 7 enemaP£ 7. 50 DT = £ 7. 502.1 Cushing’s syndrome and
disease
Cushing’s Syndrome
Management
Most types ofCushing’s syndromeare treated surgically.
Metyrapone p. 444 may be useful to control the symptoms of
the disease or to prepare the child 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 p. 444 may have a direct effect on
corticotropic tumour cells in patients with Cushing’s disease.
It is used under specialist supervision in children over
12 years for treatment of endogenous Cushing’s syndrome.BNFC 2018 – 2019 Cushing’s syndrome and disease 443
Endocrine system6