Adult Dosing
Corticosteroid-responsive conditions
- 5-60 mg PO daily, administered usually in 2-4 divided doses
- Notes:
- Dose, frequency varies based on conditions being treated
- Taper dose gradually following prolonged use
Acute exacerbations of multiple sclerosis
- Start 200 mg PO qd x1 wk followed by 80 mg PO qod x1 month
Emergency department treatment of acute asthma exacerbations
- 40-80 mg/day PO divided qd-bid; continue until peak expiratory flow is 70% of predicted or until symptoms subside
Outpatient burst therapy for exacerbation of asthma
- 40-60 mg/day PO divided qd-bid ×3-10 days, until peak expiratory flow is 80% of predicted or until symptoms subside
Adjunctive therapy for Pneumocystis carinii pneumonia [Non-FDA Approved]
- 20 mg PO qd
- Start 40 mg PO bid x5 days followed by 40 mg qd x5 days, and then 20 mg qd x11 days or until completion of the anti-infective regimen
- Prednisone should be taken in the morning; multiple dose therapy should be distributed in evenly spaced intervals throughout the day
- Should be taken before, during, or immediately after meals or with food or milk to reduce gastric irritation; however, when large doses are given, administration of antacids between meals help prevent peptic ulcers
- Avoid abrupt withdrawal of therapy
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
Pharyngitis (Acute) [Non-FDA Approved]
TNF-Receptor associated periodic syndrome [Non-FDA Approved]
- 5–80 mg PO divided QD/BID. Total daily dose individualized to response
Goodpastures syndrome [Non-FDA Approved]
- 1 mg/kg/day (max 80 mg) PO divided bid/qd; reduce dose qweek to 20 mg by week 6 and then more slowly
Acute asthma exacerbation [Non-FDA Approved]
Pediatric Dosing
Anti-inflammatory/immunosuppressive
- 0.14-2 mg/kg/day PO divided qd-qid
- Notes:
- Dose, frequency varies based on conditions being treated
- Taper dose gradually following prolonged use
Emergency department treatment of acute asthma exacerbations
- Children
11 yrs: 1-2 mg/kg/day PO divided bid; Max: 60 mg/day; continue until PEF is 70% of predicted or until symptoms subside - Children
12 yrs: 40-80 mg/day PO divided qd-bid; continue until PEF is 70% of predicted or until symptoms subside
Moderate-to-severe asthma exacerbations with viral respiratory infection
- Children <4 yrs: 1 mg/kg/day PO x3-10 days
Outpatient burst therapy for exacerbation of asthma
- Children 11 yrs: 1-2 mg/kg/day PO divided qd-bid; Max: 60 mg/day
- Children >12 yrs: 40-60 mg/day PO divided qd-bid ×3-10 days, until peak expiratory flow is 80% of predicted or until symptoms subside
Nephrotic syndrome
- Initial dose: 2 mg/kg/day PO
- Max: 80 mg/day
Adjunctive therapy for Pneumocystis carinii pneumonia [Non-FDA Approved]
- Children >13 yrs: 20 mg PO qd
- Start 40 mg PO bid x5 days followed by 40 mg qd x5 days, and then 20 mg qd x11 days or until completion of the anti-infective regimen
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
Celiac Disease [Non-FDA Approved]
- 0.5-2 mg/kg/day PO (divided qd or bid)
Pharyngitis (Acute) [Non-FDA Approved]
- 1 mg/kg/day PO [Max 60 mg]
TNF-Receptor associated periodic syndrome [Non-FDA Approved]
- 0.14–2 mg/kg/day [Max 80 mg/day] PO divided qd/bid. Total daily dose individualized to response
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
Goodpastures syndrome [Non-FDA Approved]
- 1-2 mg/kg/day (max 80 mg) PO divided bid/qd
[Outline]
See Supplemental Patient Information
- Anaphylactoid reactions may occur rarely in patients receiving prednisone therapy
- Patients on corticosteroid therapy subjected to any unusual stress before, during and after the stressful situation may require increased dosage of rapidly acting corticosteroids
- Average and higher doses of prednisone may elevate blood pressure, salt and water retention, and increase excretion of potassium; dietary salt restriction and potassium supplementation may be necessary. Therapy may also increase calcium excretion
- Therapy with corticosteroids may be associated with left ventricular free wall rupture after a recent myocardial infarction; use cautiously in such patients
- Withdrawal of treatment may produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression with the potential for corticosteroid insufficiency. Taper dose gradually in order to minimize adrenocortical insufficiency. This type of insufficiency may persist for up to 12 months following therapy discontinuation. Reinstitution of hormone therapy is recommended in any situation of stress occurring during this period. Consider increasing dose if the patient is already receiving steroids. Dose adjustment may be indicated during changes in thyroid status as metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients
- Patients receiving corticosteroids are more prone to infections with any pathogen including bacterial, viral, fungal, protozoan, or helminthic. There may be decreased resistance and inability to localize infections during therapy. Rate of infectious complications increase proportionally with increasing corticosteroid doses. Therapy may mask certain signs of current infection
- Therapy may exacerbate systemic fungal infections. Avoid using this drug in the presence of systemic fungal infections unless they are needed to control life-threatening drug reactions
- Corticosteroids may cause activation of latent disease or exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, and Toxoplasma. Rule out latent amebiasis or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or those with unexplained diarrhea. Therapy-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia in patients with known or suspected Strongyloides (threadworm) infestation
- Therapy not recommended for use in cerebral malaria
- Restrict prednisone use in active tuberculosis to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for management of the disease in conjunction with an appropriate anti-tuberculous regimen
- Closely monitor patients with latent tuberculosis or tuberculin reactivity as reactivation of the disease may occur. Provide chemoprophylaxis to these patients during prolonged corticosteroid therapy
- Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of prednisone. May administer killed or inactivated vaccines; however, response to such vaccines may be diminished and cannot be predicted
- Chickenpox and measles, with serious or even fatal outcome, may occur in children and adults receiving corticosteroids. Take utmost care to avoid exposure in pediatric and adult patients who have not had these diseases. If exposed to chickenpox, provide prophylaxis with varicella zoster immune globulin (VZIG); if exposed to measles, provide prophylaxis with pooled IM immunoglobulin (IG). Consider treatment with antiviral agents if chickenpox develops
- Therapy may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi or viruses. Oral corticosteroid use is not recommended in the treatment of optic neuritis as it may lead to an increase in the risk of new episodes. Avoid using in active ocular herpes simplex because of possible corneal perforation
- Use the lowest possible dose of corticosteroids to control the condition under treatment
- A risk/benefit decision should be made in each individual case as to dose and course of therapy and as to whether daily or intermittent therapy should be used
- Therapy may cause Kaposi’s sarcoma, particularly in patients receiving corticosteroids for chronic conditions
- Sodium retention with resultant edema and potassium loss may occur during therapy
- There may be an enhanced effect of corticosteroids in patients with cirrhosis
- Therapy may decrease bone formation and increase bone resorption through their effect on calcium regulation and inhibition of osteoblast function. This, along with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age. Prolonged use of therapy may be associated with negative effects on growth and development in children; carefully monitor growth and development in such patients
- Consider inclusion of therapy for osteoporosis prevention or treatment. Use the smallest possible effective dosage and duration to minimize the risk of glucocortoicoid-induced bone loss. Encourage lifestyle modification to reduce the risk of osteoporosis
- Acute myopathy may occur with the use of high doses of corticosteroids, particularly in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs (e.g., pancuronium). Acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Creatinine kinase elevation may occur
- Therapy may cause psychiatric derangements, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids
- Intraocular pressure may be elevated in certain individuals. If steroid therapy is continued for >6 wks, monitor intraocular pressure
Cautions: Use cautiously in
- Severe renal impairment
- Severe hepatic impairment
- Hypertension
- CHF
- Diabetes mellitus
- Seizure disorder
- Psychiatric disorder
- Peptic ulcer disease
- Ulcerative colitis
- Diverticulitis
- Recent intestinal anastomosis
- Known or suspected Strongyloides (threadworm) infestation
- Nonspecific ulcerative colitis
- Hypothyroidism
- Myasthenia gravis
- Thromboembolic disorder
- Coagulation disorder
- Untreated local or systemic fungal or bacterial infections
- Systemic viral or parasitic infections
- Immunosuppressed individuals
- Adrenal insufficiency
- Co-administration with systemic steroids
- Geriatric patients
Supplemental Patient Information
- Warn patients not to discontinue the use of corticosteroids abruptly or without medical supervision
- Caution patients receiving immunosuppressant doses of corticosteroids to avoid exposure to chickenpox or measles and to seek immediate medical advice if exposed
- Advise patients to promptly contact their physician if they develop an acute illness including fever or other signs of infection
Pregnancy Category:C
Breastfeeding: Limited literature indicates that maternal doses of prednisone up to 20 mg/day produce low levels in milk and are unlikely to cause any adverse effects in breastfed infants. With high maternal doses, use of prednisolone instead of prednisone and avoiding breastfeeding for 3-4 hrs after a dose is recommended to reduce 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 19 August 2011. Due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or to discontinue the drug, analyzing the importance of the drug to the mother.
US Trade Name(s)
- Sterapred (Discontinued)
- Sterapred DS (Discontinued)
- Rayos
US Availability
prednisone (generic)
- TABS: 1, 2.5, 5, 10, 20, 50 mg
- SOLN: 5 mg/5 mL
prednisone intensol (generic)
Sterapred
Sterapred DS
Rayos
- Delayed Release TABS: 1, 2, 5 mg
Canadian Trade Name(s)
Canadian Availability
prednisone (generic)
Winpred
UK Trade Name(s)
UK Availability
Lodotra
Australian Trade Name(s)
Australian Availability
Panafcort
Predsolone
Sone
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- PredniSONE 10 MG TABS [Bottle] (WEST-WARD)
30 mg = $11.99
60 mg = $13.98 - PredniSONE 20 MG TABS [Bottle] (QUALITEST)
30 mg = $11.99
60 mg = $15.89 - PredniSONE 1 MG TABS [Bottle] (ROXANE)
90 mg = $23.99
180 mg = $33.97 - PredniSONE 5 MG TABS [Bottle] (WEST-WARD)
100 mg = $12.99
200 mg = $14.98 - PredniSONE 50 MG TABS [Box] (ROXANE)
30 mg = $17.99
60 mg = $25.98 - PredniSONE 2.5 MG TABS [Bottle] (ROXANE)
30 mg = $12.99
60 mg = $16.98 - PredniSONE 5 MG/5ML SOLN [Bottle] (ROXANE)
30 5ml = $14.99
60 5ml = $20.98
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.
