prednisone

Contraindicated in:

Active untreated infections (may be used in patients being treated for tuberculous meningitis);
Some products contain alcohol and should be avoided in patients with known intolerance.

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 in children will result in ↓ growth; use lowest possible dose for shortest period of time.

Adv. Reactions/Side Effects ⬆ ⬇

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

Interactions ⬆ ⬇

Drug-drug:

Additive hypokalemia with thiazide and loop diuretics, amphotericin B, or piperacillin/tazobactam.
Hypokalemia may ↑ risk of digoxin toxicity.
May ↑ requirement for insulins 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 ↑ the risk of adverse reactions from live-virus vaccines.
May ↑ risk of tendon rupture from fluoroquinolones.

Availability ⬆ ⬇

(Generic available)

Tablets: 1 mg; 2.5 mg; 5 mg; 10 mg; 20 mg; 50 mg
Delayed-release tablets: 1 mg; 2 mg; 5 mg
Oral solution: 5 mg/5 mL; 5 mg/mL (concentrated)

Route/Dosage ⬆ ⬇

PO (Adults ): Most uses: 5–60 mg/day as a single dose or in divided doses (delayed-release tablets should be administered once daily). Multiple sclerosis: 200 mg/day for 1 wk; then 80 mg every other day for 1 mo. Adjunctive therapy of Pneumocystis jiroveci pneumonia in patients with AIDS: 40 mg twice daily for 5 days; then 40 mg once daily for 5 days; then 20 mg once daily for 10 days.
PO (Children ): Nephrotic syndrome: 2 mg/kg/day initially given in 1–3 divided doses (maximum 80 mg/day; delayed-release tablets should be administered once daily) until urine is protein-free for 4–6 wk. Maintenance dose of 2 mg/kg/day every other day in the morning; gradually taper off after 4–6 wk. Asthma exacerbation: 1 mg/kg every 6 hr for 48 hr; then 1–2 mg/kg/day (maximum 60 mg/day) in divided doses twice daily.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

In pharmacologic doses, suppresses inflammation and the normal immune response.
Suppresses adrenal function at chronic doses of 5 mg/day.
Replaces endogenous cortisol in deficiency states.
Has minimal mineralocorticoid activity.

Therapeutic effects:

Suppression of inflammation and modification of the normal immune response.

Classifications ⬆ ⬇

Therapeutic Classification: corticosteroids (intermediate acting), immune modifiers

Pharmacologic Classification: corticosteroids

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed.

Metabolism/Excretion: Converted by the liver to prednisolone, which is then metabolized by the liver.

Half-Life: 3.4–3.8 hr (plasma), 18–36 hr (tissue); adrenal suppression lasts 1.25–1.5 days.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(anti-inflammatory activity)

ROUTE	ONSET	PEAK	DURATION
PO	hrs	unknown	1.25–1.5 days

Patient/Family Teaching ⬆ ⬇

Educate patient on reason for prednisoneand 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 prednisone suspension should be refrigerated and shaken well prior to taking.
- 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.
- 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 Food Sources for Specific Nutrients). Alcohol should be avoided during therapy.

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Indications ⬇

Contraind./Precautions ⬆ ⬇