Prednisolone
Prednisolone is the active glucocorticoid to which prednisone is converted in the liver, so it does not require hepatic activation and is preferred where liver conversion may be impaired. It shares prednisone's roughly fourfold anti-inflammatory potency over cortisol and the same double-edged profile: excellent inflammation control but catabolic, immunosuppressive and HPA-suppressive with sustained use.
01 Overview
Because prednisolone is already the active molecule, it is used interchangeably with prednisone in most settings and is favoured in liver disease or when a rapidly reliable systemic effect is wanted. It is available orally, intravenously and as eye drops. Its glucocorticoid receptor activity, indications and adverse-effect spectrum mirror prednisone almost exactly.
For athletes the same caveats apply. Systemic prednisolone opposes muscle anabolism, drives central adiposity, weakens bone and suppresses immunity and the HPA axis. It is prohibited in-competition by WADA via oral, intravenous, intramuscular and rectal administration.
02 Mechanism
Active glucocorticoid that binds the glucocorticoid receptor to suppress inflammatory transcription and drive gluconeogenesis and protein catabolism; no hepatic activation required.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Short burst | 20–60 mg/day | Oral | Anti-inflammatory burst; brief courses usually need no taper. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Anti-inflammatory actionDirectly active without needing hepatic conversion; reliable inflammation control. | rapid, broad | Clinical | |
| Muscle catabolismSustained use promotes muscle protein breakdown and steroid myopathy. | dose/duration dependent | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| HPA axis suppressionSuppresses endogenous cortisol; abrupt withdrawal after prolonged courses risks adrenal insufficiency. | Severe | Universal with prolonged use | Clinical | |
| ImmunosuppressionRaised infection risk and impaired healing. | Severe | Common with dose | Clinical | |
| Fluid retention and hypertensionSodium/water retention raising blood pressure. | Moderate | Common | Clinical |