Indications: suppression of inflammatory and allergic disorders; inflammatory bowel disease; asthma; immunosuppression; rheumatic disease.

Cautions: adrenal suppression and infection, children and adolescents (growth retardation possibly irreversible), elderly (close supervision required particularly on long- term treatment); frequent monitoring required if history of tuberculosis (or X-ray changes), hypertension, recent myocardial infarction (rupture reported), congestive heart failure, liver failure, renal impairment, diabetes mellitus including family history, osteoporosis (post-menopausal women at special risk), glaucoma (including family history), corneal perforation, severe affective disorders (particularly if history of steroid-induced psychosis), epilepsy, peptic ulcer, hypothyroidism, history of steroid myopathy; pregnancy.

Contra-indications: systemic infection (unless specific antimicrobial therapy given); avoid live virus vaccines in those receiving immunosuppressive doses (serum antibody response diminished).

Side Effects: minimised by using lowest effective dose for minimum period possible; gastro-intestinal effects include dyspepsia, peptic ulceration (with perforation), abdominal distension, acute pancreatitis, oesophageal ulceration and candidiasis; musculoskeletal effects include proximal myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture; endocrine effects include adrenal suppression, menstrual irregularities and amenorrhoea, Cushing's syndrome (with high doses, usually reversible on withdrawal), hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite; increased susceptibility to and severity of infection; neuropsychiatric effects include euphoria, psychological dependence, depression, insomnia, increased intracranial pressure with papilloedema in children (usually after withdrawal), psychosis and aggravation of schizophrenia, aggravation of epilepsy; ophthalmic effects include glaucoma, papilloedema, posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease; other side effects: include impaired healing, skin atrophy, bruising, striae, telangiectasia, acne, myocardial rupture following recent myocardial infarction, fluid and electrolyte disturbance, leucocytosis, hypersensitivity reactions (including anaphylaxis), thromboembolism, nausea, malaise, hiccups.

Dose: by mouth, initially up to 10-20 mg daily in divided doses may increase up to 60mg daily in severe disease.

Maintenance, 2.5-15 mg daily but higher doses may be needed; to be taking after food. cushingoid side effects; is more likely with doses above 7.5 mg daily.

By intramuscular injection, prednisolone acetate, 25–100 mg once or twice weekly.