pred-NISS-oh-lone

Therapeutic Classification: corticosteroids (intermediate-acting), immune modifiers

Pharmacologic Classification: corticosteroids

• Used systemically and locally in a wide variety of chronic diseases, including:
  • Inflammatory,
  • Allergic,
  • Hematologic,
  • Neoplastic,
  • Autoimmune disorders.
• Suitable for alternate-day dosing in the management of chronic illness.
• Replacement therapy in adrenal insufficiency.

• In pharmacologic doses, suppresses inflammation and the normal immune response.
• Suppresses adrenal function at chronic doses of 5 mg/day.
• Has minimal mineralocorticoid activity.

• Suppression of inflammation and modification of the normal immune response.
• Replacement therapy in adrenal insufficiency.

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed.

Metabolism/Excretion: Metabolized mostly by the liver.

Half-life: 2.1–3.5 hr (plasma), 18–36 hr (tissue); adrenal suppression lasts 1.25–1.5 days.

(anti-inflammatory activity)

Contraindicated in:

• Active untreated infections (may be used in patients being treated for tuberculous meningitis)
• Known alcohol or bisulfite hypersensitivity or intolerance (some products contain these; avoid in susceptible patients).

Use Cautiously in:

• Chronic treatment (leads to adrenal suppression; use lowest possible dose for shortest period of time)
• Stress (surgery, infections — supplemental doses may be needed)
• Potential infections may mask signs (fever, inflammation)
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Chronic use will result in ↓ growth; use lowest possible dose for shortest period of time
• Pedi: Neonates (oral solution and syrup contains benzoic acid, a metabolite of benzyl alcohol, which can cause potentially fatal gasping syndrome).

Adverse reactions/side effects are much more common with high-dose/long-term therapy

CV: hypertension.

Derm: acne, ↓wound healing, ecchymoses, hirsutism, petechiae.

EENT: cataracts, ↑ intraocular pressure.

Endo: adrenal suppression, cushingoid appearance (moon face, buffalo hump), hyperglycemia.

F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis.

GI: anorexia, nausea, PEPTIC ULCERATION, vomiting.

Hemat: THROMBOEMBOLISM, thrombophlebitis.

Metab: weight gain, weight loss.

MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain.

Neuro: depression, euphoria, headache, ↑ intracranial pressure (children only), personality changes, psychoses, restlessness.
Misc: INFECTION, KAPOSI'S SARCOMA.

Drug-Drug:

• Additive hypokalemia with thiazide and loop diuretics, amphotericin B, or piperacillin/tazobactam.
• Hypokalemia may ↑ risk of digoxin toxicity.
• May ↑ requirement for insulin or oral hypoglycemic agents.
• Phenytoin, phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness.
• Oral contraceptives may ↓ metabolism.
• ↑risk of adverse GI effects with NSAIDs (including aspirin).
• At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
• May ↑ risk of tendon rupture from fluoroquinolones.

• PO (Adults): Most uses: 5–60 mg/day as a single dose or in divided doses. Multiple sclerosis: 200 mg/day for 7 days; then 80 mg every other day for 1 mo. Asthma exacerbations: 120–180 mg/day in divided doses 3–4 times/day for 48 hr; then 60–80 mg/day in 2 divided doses.
• PO (Children): Anti-inflammatory/Immunosuppressive: 0.1–2 mg/kg/day in 1–4 divided doses.Nephrotic syndrome: 2 mg/kg/day (60 mg/m²/day) in 1–3 divided doses daily (maximum dose: 80 mg/day) until urine is protein-free for 4–6 wk, followed by 2 mg/kg/dose (40 mg/m²/dose) every other day in the morning; gradually taper off over 4–6 wk. Asthma exacerbations: 1 mg/kg every 6 hr for 48 hr; then 1–2 mg/kg/day (maximum: 60 mg/day) divided twice daily.

(Generic available)

• Tablets: 5 mg;
• Orally disintegrating tablets (grape flavor): 10 mg; 15 mg; 30 mg;
• Oral solution: 5 mg/5 mL; 10 mg/5 mL; 15 mg/5 mL; 20 mg/5 mL; 25 mg/5 mL;

• Indicated for many conditions. Assess involved systems prior to and periodically during therapy.
• Monitor for signs and symptoms of adrenal insufficiency (fatigue, weakness, nausea and vomiting, low BP); prednisolone should be tapered more slowly.
• Monitor for signs and symptoms of hypercorticism (moon face, buffalo hump, stretch marks, obesity, bruising, hyperglycemia, elevated BP) every 6 mo; pediatric patients under one yr of age may require more frequent monitoring (every 3–4 mo); temporary discontinuation, dose reduction, or slowed taper may be needed.
• Assess for signs of infection (fever, chills, sore throat, wound that will not heal).
• Assess for signs and symptoms of Kaposi's sarcoma (purple, red, or brown skin blotches on skin or inside the mouth) with long term use.
• Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional should these occur.
• Pedi: Evaluate growth of children periodically during therapy. Monitor linear growth and weight gain. Adjust doses accordingly.

• Monitor CBC, electrolytes, serum and urine glucose, and lipid panel routinely during therapy. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia, hypocalcemia, hypernatremia. May ↓ WBC counts. May ↑ lipid values.
  • Monitor ESR in patients with rheumatoid arthritis.
  • May suppress reactions to allergy skin tests.
  • Guaiac test stools. Promptly report presence of guaiac-positive stools.
  • May ↓ uptake of thyroid ¹²³I or ¹³¹I.
  • Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.

• Do not confuse prednisolone with prednisone.
• If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
• Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
• PO: Administer with meals or milk to minimize GI irritation; do not administer with grapefruit juice.
  • Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing.
  • Orally disintegrating tablets: Remove tablet from blister pack just prior to administration Tablets can be placed directly on tongue and may be swallowed whole or allowed to dissolve in mouth, with or without water. DNC: Do not cut, split, or break.
  • Use calibrated measuring device to ensure accurate dose of liquid forms.

• Educate patient on reason for prednisoloneand side effects. Instruct them to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Do not share medication with others, even if they have similar symptoms; may be harmful. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
  • Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
  • Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening. Medical ID should be worn in case of emergencies.
  • Inform patient that prednisolone syrup or suspension should not be refrigerated. Pediapred solution may be stored at room temperature or refrigerated.
  • Advise patient to avoid grapefruit juice during therapy.
  • Advise patient to notify health care professional of signs and symptoms of hypercorticism (acne; thicker or more hair on body and face; bruising easily; fatty pad or hump between shoulders [buffalo hump]; rounding of face [moon face]; pink or purple stretch marks on skin of abdomen, thighs, breasts, and arms; ankle swelling), adrenal suppression (tiredness, weakness, nausea and vomiting, low blood pressure), worsening of allergies (eczema, rhinitis), or infection (fever, chills, pain, feeling tired, aches, nausea and vomiting).
  • May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur.
  • Corticosteroids cause immunosuppression and may mask symptoms of infection. May worsen existing tuberculosis; fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex. Notify health care professional immediately if exposed to chicken pox or measles.
  • Caution patient to avoid vaccinations without first consulting health care professional.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications, especially St. John's wort.
  • Pedi: Advise parents that use may cause shortened stature.
  • Instruct patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Hypoadrenalism may occur in infants born to mothers receiving corticosteroids during pregnancy. Observe infant for signs of hypoadrenalism (poor feeding, irritability, weakness, vomiting).
• Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium and low in sodium and carbohydrates (see Appendix M). Alcohol should be avoided during therapy.

• Decrease in presenting symptoms with minimal systemic side effects.
• Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
• Management of symptoms in adrenal insufficiency.

Orapred ODT, Pediapred, Prelone