Systemic Corticosteroids

Specialist initiation (S1)

PREDNISOLONE (oral)

  • Restriction: soluble tablets for use only in patients with swallowing difficulties.
  • The prescribing of enteric coated prednisolone is not recommended.

METHYLPREDNISOLONE (Depo-Medrone®)

  • Intramuscular depot injection.

TRIAMCINOLONE ACETONIDE (Kenalog®)

  • Intramuscular depot injection.

Prescribing Notes:

  • Systemic corticosteroids should only be commenced on the advice of a specialist.
  • The benefits and risks should be discussed with the patient before starting long term systemic corticosteroids, and a steroid card given where appropriate.
  • The lowest dose required to produce an acceptable response should be used.
  • Prophylactic bone protection should be considered for patients anticipated to receive prednisolone at a dose of 7.5mg daily for longer than 3 months depending on other risk factors such as dose, age and medical history.
  • Long term steroids should be withdrawn gradually.

Local Corticosteroid Injections

Preferred list (P)

METHYLPREDNISOLONE (Depo-Medrone®)

  • Intra-articular injection.

TRIAMCINOLONE ACETONIDE (Kenalog®)

  • Intra-articular injection.

METHYLPREDNISOLONE WITH LIDOCAINE (Depo-Medrone with Lidocaine®)

  • Intra-articular injection.

Specialist use only (S2)

HYDROCORTISONE (Hydrocortistab®)

  • Soft tissue injection.

Prescribing Notes:

  • Intra-articular injections should only be administered by appropriately trained staff.
  • Intra-articular steroids should be used judiciously and ideally any one joint should not be injected more than 3 times in 1 year.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.