• The lowest cost formulation should be used when clinically appropriate.  Formulations approved include:
  
  • 1mg, 5mg tablets;
  • 5mg soluble tablets;
  • 1mg in 1ml oral solution (Prednisolone Dompé®);
  • 5mg suppositories.

• 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   
• 2.5mg buccal 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

NOTE: Triamcinolone acetonide 10mg/ml (Adcortyl® ampoules) and 40mg/ml (Kenalog® vials) suspension for injection are being discontinued with stock expected to be exhausted by early June 2025.

Clinicians in primary and secondary care should review patients and consider prescribing alternative steroid injections. See MSN/2025/021