Adult Dosing
Corticosteroid responsive conditions
- 5-60 mg/day PO div qd-qid
- Notes:
- Dose frequency varies according to conditions
- Taper dose gradually after prolonged use
Acute exacerbation of multiple sclerosis
- Start: 200 mg PO qd x1 wk; then 80 mg PO qod x1 month
Bell's Palsy [Non-FDA Approved]
- 60-80 mg PO qd x 5 days, tapered over the next 5 days
Hyper-IgD Syndrome (HIDS) [Non-FDA Approved]
- 1mg/kg/day PO for 4-7 days
Pediatric Dosing
Asthma
- For those whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators: 1-2 mg/kg/day PO in single or divided doses
- Note: Continue short course until a child achieves a peak expiratory flow rate of 80% of his or her personal best or until resolution of symptoms
- Duration of therapy:
3-10 days
Bell's Palsy [Non-FDA Approved]
- 1 mg/kg/day PO x 5 days, tapered over the next 5 days
Hyper-IgD Syndrome (HIDS) [Non-FDA Approved]
- 1mg/kg/day PO for 4-7 days
Croup [Non-FDA Approved]
- 1 mg/kg PO once (some providers repeat the dose in 24 hours). No advantage to higher dose than 0.15 mg/kg, and no advantage to injectable over oral administration. In severe croup, many providers will proceed with higher dose of 0.6 mg/kg [Max=12 mg] IV
[Outline]
See Supplemental Patient Information
- Monitor patients for hypothalamic-pituitary adrenal (HPA) axis suppression, Cushing’s syndrome and hyperglycemia during chronic use of this drug
- Withdrawal of therapy is associated with reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency. Gradually reduce dosage to minimize drug-induced secondary adrenocortical insufficiency. Insufficiency persists for months after discontinuation of therapy; reinstitute hormone therapy in any situation of stress
- Concurrently administer salt and/or mineralocorticoid as mineralocorticoid secretion may be impaired during therapy
- Metabolic clearance of this drug may decrease in hypothyroid patients and increase in hyperthyroid patients; Modifications in dosage are necessary as a result of changes in thyroid status of the patient
- Corticosteroids are associated with increasing the risks related to infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic infections. The rate of occurrence of infectious complications increases with increasing doses of corticosteroids. Corticosteroids are associated with masking some signs of infection and may reduce resistance to new infections
- Restrict the use of this drug in active tuberculosis to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen
- Chicken pox and measles with serious or even fatal outcomes may occur in non-immune children and adults. Take utmost care to avoid exposure in pediatric and adult patients who have not had these diseases. On exposure to chicken pox, provide prophylaxis with varicella zoster immune globulin (VZIG). If exposed to measles, provide prophylaxis with immunoglobulin (IG). On occurrence of chicken pox, provide treatment with antiviral agents
- Use corticosteroids with great care in patients with known or suspected strongyloides (threadworm) infestation; corticosteroid-induced immunosuppression may lead to strongyloides hyperinfection and dissemination with widespread larval migration which is often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia
- Corticosteroids are associated with exacerbation of systemic fungal infections; avoid using in the presence of such infections unless they are needed to control drug reactions
- Closely observe patients as reactivation of the disease may occur if this drug is used in patients with latent tuberculosis or tuberculin reactivity. Provide chemoprophylaxis during prolonged corticosteroid therapy
- Corticosteroids may activate latent amebiasis. Rule out latent or active amebiasis before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea
- Avoid usage of this drug in cerebral malaria
- Corticosteroids are associated with elevation of blood pressure, salt and water retention, and increased excretion of potassium and calcium. Dietary salt restriction and potassium supplementation may be essential. Corticosteroids are associated with left ventricular free wall rupture after a recent myocardial infarctions
- Increased risk of GI perforation exists in patients with certain GI disorders. Signs of GI perforation, such as peritoneal irritation may be masked in some cases
- Use corticosteroids with caution if there is a probability of impending perforation, abscess or other pyogenic infections, diverticulitis, fresh intestinal anastomoses, and active or latent peptic ulcer
- This drug is associated with CNS effects ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Existing emotional instability or psychotic tendencies are aggravated by corticosteroids
- Bone mineral density (BMD) may decrease with prolonged use of corticosteroids. Give special consideration to patients at increased risk of osteoporosis (i.e. postmenopausal women) before initiating corticosteroid therapy, and monitor bone density in patients on long-term corticosteroid therapy
- Posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, enhancement of the establishment of secondary ocular infections due to fungi or viruses may occur with long term use of corticosteroids. The use of this drug is not recommended in the treatment of optic neuritis as it may lead to an increase in the risk of new episodes
- Intraocular pressure may be elevated in some individuals. If steroid therapy is continued for >6 wks, monitor intraocular pressure
- Administration of live or live attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of this drug. While on corticosteroid therapy, avoid vaccinating patients against smallpox. Avoid undertaking other immunization procedures in patients who are on corticosteroids, especially on high dose, as possible hazards of neurological complications and a lack of antibody response exist
- Prolonged use of corticosteroids is associated with negative effects on growth and development in children. Carefully monitor growth and development of pediatric patients on long-term corticosteroid therapy
- This drug is associated with fetal harm when administered to pregnant women. Use of corticosteroids during the first trimester of pregnancy is associated with an increased risk of orofacial clefts, intrauterine growth restriction and decreased birth weight. If this drug is used during pregnancy, or if the patient becomes pregnant while using this drug, apprise the patient of the potential hazard to the fetus
- An acute myopathy may occur with the use of high doses of corticosteroids, Patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs (e.g., pancuronium) are more susceptible. Acute myopathy is generalized, and may involve ocular and respiratory muscles, and may result in quadriparesis. Creatine kinase may increase
- Kaposi's sarcoma may occur in patients receiving this drug. Discontinuation of therapy may result in clinical improvement
- Monitor electrolytes, BP, weight; postprandial glucose, urinalysis, height (pediatrics), Perform chest x-ray if prolonged therapy; advise for ophthalmic. examination if therapy for >6wks; Monitor BMD if prolonged therapy or >65 yrs; consider upper GI x-ray if history of peptic ulcer disease or significant dyspepsia
Cautions: Use cautiously in
- Severe renal impairment
- Severe hepatic impairment
- Hypertension
- CHF
- Diabetes mellitus
- Seizure disorder
- Peptic ulcer disease
- Ulcerative colitis
- Diverticulitis
- Recent intestinal anastomosis
- Psychiatric disorder
- Hypothyroidism
- Osteoporosis
- Myasthenia gravis
- Thromboembolic disorder
- Coagulation disorder
- Patients with a known hypersensitivity reaction
- Active or quiescent tuberculosis infections
- Untreated local or systemic fungal or bacterial infections
- Systemic viral or parasitic infections
- Ocular herpes simplex infections
- Measles or varicella exposure
- Glaucoma
- Cataracts
- Increased intra ocular pressure
- Immunosuppression
- Adrenal insufficiency
- Adrenal suppression, hypercorticism
- Use of systemic steroid
- Vision changes
- Adolescent patients
- Pediatric patients
- Geriatrics
Supplemental Patient Information
- Warn patients to avoid discontinuing corticosteroids abruptly or without medical supervision
Pregnancy Category:C, D (Flo-Pred, Orapred ODT)
Breastfeeding: Limited literature indicates that maternal doses of prednisolone up to 50 mg/day produce low levels in milk and are unexpected to cause any adverse effects in breastfed infants. With high maternal doses, advise patients to avoid breastfeeding for 4 hrs after a dose to decrease the dose received by the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 28 April 2011. Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Orapred ODT 15 MG TBDP [Box] (SHIONOGI PHARMA)
48 mg = $257.22
144 mg = $730.26 - Veripred 20 20 MG/5ML SOLN [Bottle] (HAWTHORN PHARMACEUTICALS)
237 5ml = $160.58
711 5ml = $457.54 - Millipred 5 MG TABS [Bottle] (LASER PHARMACEUTICALS)
30 mg = $25.99
100 mg = $59.98 - PrednisoLONE 15 MG/5ML SOLN [Bottle] (HI-TECH)
240 5ml = $75.99
720 5ml = $219.99 - Pediapred 6.7 MG/5ML SOLN [Bottle] (UCB PHARMA)
120 5ml = $56.99
360 5ml = $154.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
Drug Name: Prednisolone 5 MG Oral Tablet
Ingredient(s): Prednisolone
Imprint: DAN;DAN;5059
Color(s): Orange
Shape: Round
Size (mm): 6.00
Score: 2
Inactive Ingredient(s): anhydrous lactose / collodial silicon dioxide / crospovidone / d & c yellow # 10 / docusate sodium / fd & c yellow #6 / magnesium stearate / sodium benzoate
Drug Label Author:
Watson Laboratories, Inc.
DEA Schedule:
Non-Scheduled
