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This is particularly important for patients previously prescribed a budesonide product for which the number of capsules/tablets taken was different. Corticosteroids distributed into breast milk may suppress growth and interfere with endogenous glucocorticoid production in nursing infants. Since adequate reproductive studies have not been performed in humans with glucocorticoids, these drugs should be administered to nursing mothers only if the benefits of therapy are judged to outweigh the potential risks to the infant. The ability of corticosteroids to cross the placenta varies between individual drugs, however, 88% of prednisolone is inactivated as it crosses the placenta.
In patients who have received more than physiological dose for systemic corticosteroids (approximately 7.5mg prednisolone or equivalent) for greater than 3 weeks, withdrawal should not be abrupt. How dose reduction should be carried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced. If the disease is unlikely to relapse on withdrawal of systemic corticosteroids but there is uncertainty about hypothalamic-pituitary-adrenal suppression, the dose of corticosteroid may be reduced rapidly to physiological doses. Once a daily dose equivalent to 7.5mg of prednisolone is reached, dose reduction should be slower to allow the HPA-axis to recover.
These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety. Prednisolone foam enema is not recommended as a treatment option for new patients with active Ulcerative Colitis or Crohn's Disease. They are regarded as cost effective choices which have evidence to support their use. Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
• Glucocorticoids should be used cautiously in patients with myasthenia gravis receiving anticholinesterase therapy. Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA , annotated within the formulary entry. 2 The link with peptic ulceration and standard formulation of prednisolone is weak and therefore enteric coated and soluble tablets offer no additional benefit . For induction of remission of eosinophilic oesophagitis only, not for maintenance treatment. Specialist Only - These drugs are deemed to be not appropriate for prescribing by GPs. High-level prescribing trends for Corticosteroids (BNF section 10.1.2) across all GP practices in NHS England for the last five years.
The initial dosage may vary from 5mg to 60mg daily in divided doses, as a single dose in the morning after breakfast, or as a double dose on alternate days. The dose can often be reduced within a few days but may need to be continued for several weeks or months. In asthma a two week course of 40mg daily or less does not need stepping down (Ref BNF, Section 6.3.2 Withdrawal of corticosteroids).
In general, initial dosage shall be maintained or adjusted until the anticipated response is observed. The dose should be gradually reduced until the lowest dose which will maintain an adequate clinical response is reached. Use of the lowest effective dose may also minimise side-effects (see section 4.4). Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol .
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