The lowest cost formulation should be used when clinically appropriate.  Formulations approved include:

• 1mg, 5mg tablets;
• 1mg in 1ml oral solution (Prednisolone Dompé®);
• 5mg suppositories
• 5mg soluble tablets - to be restricted to patients who have a genuine need e.g. swallowing difficulties. 5mg plain tablets can be dispersed in water (an off-label administration method) which may be suitable for most patients.

• 100mg/ml solution for injection
• As an additional option to hydrocortisone sodium succinate for patients who are steroid dependent (pituitary or adrenal cause and occasionally non-endocrine reasons for long term steroid use) to manage sick day rules to avoid an Addisonian crisis.
• Paraesthesia and pain may follow intravenous injection.

• 500microgram & 2mg tablets
• 500microgram soluble tablets
• 2mg in 5ml oral solution and 5mg in 5ml oral solution  is also approved. unlicensed
• 20mg/5ml oral solution 
• Approved for use in patients requiring high dose to reduce pill burden

• Note: there are two different strength preparations of dexamethasone injection available in the UK (3.8mg/ml and 3.3mg/ml) where traditionaly a 4mg/ml preparation was available and prescribed as such. To avoid confusion the 3.3mg/ml strength is the preparation of choice in the acute Trusts. Where previously a 4mg dose would have prescribed it is appropriate to prescribe a 3.3mg dose (or multiples thereof). This is because the range of doses given in clinical practice varies widely and subsequent doses tend to be adjusted to reflect clinical response. If 4mg is required please ensure that the appropriate volume of 3.3mg/ml is (e.g. 1.2ml) prescribed (or mulitples thereof).

• 10mg and 20mg tablets
• 5mg, 10mg and 20mg dispersible tablets   
• 5mg/5ml and 10mg/5ml oral solution (Colonis®)
• In patients who are unable to swallow or have swallowing difficulties the most cost effective product should be used     
• 0.5mg, 1mg, 2mg & 5mg granules (in capsules for opening) 
  • Approved for treatment of adrenal insufficiency in infants, children and adolescents
  • Patients should be transitioned onto tablets once they are able to take them

Modified-release capsules: 5mg, 10mg

Approved for second-line use for congenital adrenal hyperplasia in patients aged 12-18 years who are in one of the specified groups. Patients should be reviewed at age 18 and switched to immediate-release options where possible.

• When acceptable biochemical control cannot be achieved with 3 times daily immediate release hydrocortisone or prednisolone
• Patients showing signs of excess glucocorticoid replacement with alternative preparations such as prednisolone and hydrocortisone
• Patients who have a specific difficulty with taking multiple daily doses of hydrocortisone or prednisolone
• Patients with evidence of suppression of the hypothalamic pituitary gonadal axis
• Patients developing Testicular Adrenal Rest Tumours (TART)
• Patients desiring and not achieving fertility
• Problems with pubertal growth and development (paediatric patients)

A GREEN+ information sheet has been requested to support primary care prescribers.