Prednisolone
Prednisolone acetate, Prednisolone sodium phosphate
Also known as: Pred Forte · Pred Mild · Econopred Plus · Mydrapred · PLT · Prednicare · Prednidale · Prednisolone acetate · Prednisolone sodium phosphate · Prednisolonum
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Audited v13 dosing evidence
Structured calculator evidenceMedical management of insulinoma after stabilization of hypoglycemic crisis
- divided q12h
Governing clinical context (3)
- Once hypoglycemic crisis stabilized
- may need to increase dose over time
- Ideal to use H2 blocker concurrently
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Prednisolone is a potent, intermediate-acting synthetic corticosteroid widely used in veterinary medicine. In ophthalmology, it is considered the gold standard and most effective drug for the treatment of anterior uveitis.
Key clinical distinctions exist between its formulations:
- Prednisolone Acetate: Formulated as a suspension. It possesses superior anti-inflammatory activity and achieves excellent penetration into the anterior segment of the eye through the intact cornea, outperforming dexamethasone products.
- Prednisolone Sodium Phosphate: Formulated as a solution. It does not penetrate the intact cornea as effectively as the acetate form but is useful for surface ocular inflammation.
Clinical Pearl: While applied topically to the eye, prednisolone can be absorbed systemically via the nasolacrimal duct and conjunctival vessels. In small animals (under 20 kg), frequent application can lead to systemic side effects, including the destabilization of diabetes mellitus.
Mechanism of action
Prednisolone exerts its effects by diffusing across cell membranes and binding to specific cytosolic glucocorticoid receptors.
The receptor-ligand complex translocates to the nucleus → binds to glucocorticoid response elements (GREs) on DNA → alters gene transcription.
Mechanistically, it induces the synthesis of lipocortin-1 (annexin-1), which inhibits the enzyme phospholipase A2. This inhibition prevents the release of arachidonic acid from membrane phospholipids, thereby potently shutting down the downstream synthesis of inflammatory mediators, including prostaglandins and leukotrienes.
Safety & warnings
Contraindications
- Corneal ulcers (absolute contraindication for topical use)
- Ocular viral infections (e.g., Feline Herpesvirus-1)
- Ocular fungal infections
- Use with extreme caution in patients with uncontrolled diabetes mellitus or systemic infectious diseases
- Pregnant animals
- Renal disease (systemic use)
- Diabetes mellitus (systemic use)
- Ulcerative keratitis (topical ophthalmic use)
- Systemic fungal infections
- Concurrent NSAID administration
Adverse effects
- Systemic absorption leading to iatrogenic hyperadrenocorticism (PU/PD/PP, panting, alopecia)
- Insulin resistance and destabilization of diabetes mellitus
- Delayed corneal healing
- Potentiation or exacerbation of ocular infections (bacterial, viral, fungal)
- Corneal degeneration or calcification (with long-term topical use)
- Hypothalamic-pituitary axis (HPA) suppression
- Adrenal atrophy
- Proteinuria and glomerular changes (dogs)
- Weight loss and muscle atrophy (catabolic effects)
- Iatrogenic hyperadrenocorticism (Cushing's syndrome)
- Vomiting and diarrhoea
- Gastrointestinal ulceration
- Hyperglycaemia
- Decreased serum T4 values
- Impaired wound healing
- Delayed recovery from infections
- Polyuria/polydipsia (PU/PD)
- Polyphagia
- Immunosuppression
- Muscle wasting
Precautions
Important Warning: Subconjunctival and topical steroids can be absorbed systemically. Use with extreme caution in patients with endocrinopathies (e.g., diabetes mellitus) or infectious diseases.
Even frequent topical steroid application in small animal patients under 20 kg can cause difficulties with diabetes mellitus regulation. Once the peak inflammatory response has been suppressed, consider transitioning to nonsteroidal anti-inflammatory drugs (NSAIDs) for ongoing maintenance treatment to minimize systemic steroid exposure.
Drug interactions
Concurrent use may increase the risk of delayed corneal healing or corneal melting, though sometimes used together cautiously for severe inflammation.
Systemically absorbed prednisolone antagonizes insulin, increasing blood glucose and complicating diabetes regulation.
Increased risk of gastrointestinal ulceration if significant systemic absorption of prednisolone occurs.
Increased risk of gastrointestinal ulceration
Increased risk of hypokalaemia
Increased risk of hypokalaemia
Increased risk of hypokalaemia
Enhanced metabolism of corticosteroids
Enhanced metabolism of corticosteroids
Decreased metabolism of corticosteroids
Synergistic immunosuppression; may alter pharmacokinetics
Monitoring
- Resolution of clinical signs of uveitis (aqueous flare, miosis, pain, photophobia)
- Intraocular pressure (IOP) to monitor for secondary glaucoma
- Fluorescein staining (to ensure no corneal ulceration develops)
- Blood glucose and water intake/urine output in diabetic or small patients
- Clinical response to therapy
- Haematocrit (in cases of IMHA)
- Blood glucose (risk of hyperglycaemia)
- Serum T4 values (may be decreased)
- Renal parameters and urinalysis (proteinuria in dogs)
- Signs of GI ulceration (vomiting, melaena)
- Haematology at each visit (including 4 and 8 weeks after cessation of therapy)
- PCV (Packed Cell Volume)
- Liver parameters (especially if combined with azathioprine)
- Clinical signs of anaemia or GI bleeding
Pharmacokinetics
Half-life
Absorption
Prednisolone acetate is highly lipophilic and readily penetrates the intact corneal epithelium to reach therapeutic concentrations in the aqueous humor. Systemic absorption occurs via drainage through the nasolacrimal duct into the nasal mucosa and GI tract.
Distribution
Distributes widely into ocular tissues (anterior segment). Systemically absorbed drug distributes throughout total body water and binds to plasma proteins (transcortin and albumin).
Metabolism
Systemically absorbed prednisolone is metabolized primarily in the liver.
Elimination
Excreted primarily by the kidneys as conjugated metabolites.
Overdose
Acute overdose from topical ophthalmic application is highly unlikely to cause severe toxicity. However, chronic overdosage or overly frequent application (especially in small patients <20 kg) can lead to systemic absorption resulting in iatrogenic hyperadrenocorticism (Cushing's syndrome), adrenal suppression, and destabilization of blood glucose in diabetic patients. If a corneal ulcer is present, overuse can lead to rapid corneal melting and perforation.
Available products
Formulations
- Ophthalmic suspension (0.12%, 0.125%, 1%)
- Ophthalmic solution (0.125%, 1%)
- Ophthalmic drops combined with atropine
- Ophthalmic suspension: 0.5%, 1% (5 ml, 10 ml bottles)
- Topical preparations (dermatological, otic, ophthalmic)
- Injectable solution: prednisolone sodium succinate 10 mg/ml
- Injectable suspension: 7.5 mg/ml (plus 2.5 mg/ml dexamethasone)
- Oral tablets: 1 mg, 5 mg, 25 mg
- Oral compound: PLT (contains cinchophen)
- Oral suspension
Veterinary
- PLT (compound with cinchophen)
- Prednicare
- Prednidale
Human-labeled
- Prednisolone Acetate Drops: 0.12% Suspension (Pred Mild®)
- Prednisolone Acetate Drops: 0.125% Suspension (Econopred®)
- Prednisolone Acetate Drops: 1% Suspension (Econopred Plus®, Pred Forte®, generic)
- Prednisolone Sodium Phosphate Drops: 0.125% & 1% Solution (various)
- Prednisolone (0.25%) and Atropine (1%) Drops (Mydrapred®)
- Pred-forte (ophthalmic suspension 0.5%, 1%)
- Prednisolone tablets
Regulatory status
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store at room temperature (15°-25°C / 59°-77°F). Protect from freezing. Keep the bottle tightly closed when not in use. Suspensions must be stored upright.
Client information
Crucial Step: If you are using the acetate suspension (e.g., Pred Forte), you MUST shake the bottle vigorously before every single use. The medication settles at the bottom, and failing to shake it means you are only applying water to the eye.
- Administration: Wash your hands before use. Do not let the dropper tip touch your pet's eye, eyelids, or any other surface to prevent contamination.
- Spacing: If you are applying multiple types of eye drops, wait at least 5 to 10 minutes between each medication.
- Watch for Ulcers: Steroids delay healing. If your pet's eye becomes more red, cloudy, or if they start squinting or rubbing the eye, stop the medication and contact your veterinarian immediately. This could indicate a corneal scratch or ulcer.
- Systemic Signs: Even eye drops can be absorbed into the body. Monitor your pet for increased thirst, increased urination, or increased appetite, and report these to your vet.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.