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Prednisone

Pronunciation

Pronunciation: PRED-nih-sone
Class: Glucocorticoid

Trade Names

Prednisone
- Tablets 1 mg
- Tablets 2.5 mg
- Tablets 5 mg
- Tablets 10 mg
- Tablets 20 mg
- Tablets 50 mg
- Solution, oral 1 mg/mL

Prednisone Intensol Concentrate
- Concentrate, oral 5 mg/mL

Apo-Prednisone (Canada)
Winpred (Canada)

Pharmacology

Intermediate-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body's immune response.

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Pharmacokinetics

Absorption

Rapid, almost complete.

Distribution

Crosses placenta.

Metabolism

Mainly hepatic, also renal and in the tissue. Prednisone is inactive and rapidly metabolized to active prednisolone.

Elimination

Renal. Plasma t ½ is 3.4 to 3.8 h.

Peak

1 to 2 h.

Duration

1.25 to 1.5 days.

Indications and Usage

Endocrine disorders; rheumatic disorders; collagen diseases; dermatologic diseases; allergic states; allergic and inflammatory ophthalmic processes; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states (because of nephrotic syndrome); GI diseases; multiple sclerosis; tuberculous meningitis; trichinosis with neurologic or myocardial involvement.

Unlabeled Uses

COPD; Duchenne muscular dystrophy; Graves ophthalmopathy.

Contraindications

Systemic fungal infections; administration of live virus vaccines.

Dosage and Administration

Adults

PO 5 to 60 mg/day.

COPD
Adults

PO 30 to 60 mg/day for 1 to 2 wk, then taper.

Duchenne Muscular Dystrophy
Adults

PO 0.75 to 1.5 mg/kg/day.

Graves Ophthalmopathy
Adults

PO 60 mg/day; taper to 20 mg/day.

Drug Interactions

Anticholinesterases

Antagonizes anticholinesterase effects in myasthenia gravis.

Anticoagulants, oral

Alters anticoagulant dose requirements.

Barbiturates, hydantoins (eg, phenytoin), rifampin

Decreased pharmacologic effect of prednisone.

Cyclosporine

Enhanced cyclosporine toxicity.

Estrogens, ketoconazole, oral contraceptives

Decreased Cl of prednisone.

Nondepolarizing muscle relaxants

May potentiate, counteract, or have no effect on neuromuscular blocking action.

Salicylates

Reduced serum levels and efficacy of salicylates.

Somatrem

Inhibition of growth-promoting effects of somatrem.

Theophylline

Alterations in pharmacologic activity of either agent.

Laboratory Test Interactions

May increase serum cholesterol; decrease serum levels of T 3 and T 4 ; decrease uptake of thyroid I 131 ; and cause false-negative result on nitroblue-tetrazolium test for systemic bacterial infection and suppression of skin test reactions.

Adverse Reactions

Cardiovascular

Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF.

CNS

Convulsions; pseudotumor cerebri (increased intracranial pressure with papilledema); vertigo; headache; neuritis/paresthesias; psychosis.

Dermatologic

Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; subcutaneous fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation.

EENT

Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos.

GI

Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation.

Genitourinary

Increased or decreased motility and number of spermatozoa.

Hematologic

Leukocytosis.

Metabolic

Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia.

Miscellaneous

Musculoskeletal effects (muscle weakness, steroid myopathy, muscle mass loss, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures, including vertebral compression fractures and pathologic fracture of long bones); endocrine abnormalities (menstrual irregularities, cushingoid state, growth suppression in children secondary to adrenocortical and pituitary unresponsiveness, increased sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics, negative nitrogen balance because of protein catabolism, hirsutism); anaphylactoid/hypersensitivity reactions; aggravation or masking of infections; malaise; fatigue; insomnia.

Precautions

Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Observe growth and development of infants and children on prolonged therapy.

Elderly

May require lower doses.

Hypersensitivity

May occur, including anaphylaxis.

Renal Function

Use with caution; monitor renal function.

Adrenal suppression

Prolonged therapy may lead to HPA suppression.

Cardiovascular effects

Use drug with great caution in patients who have suffered recent MI.

Hepatitis

Drug may be harmful in patients with chronic active hepatitis positive for hepatitis B surface antigen.

Immunosuppression

Do not administer live virus vaccines during treatment.

Infections

May mask signs of infection. May decrease host-defense mechanisms to prevent dissemination of infection.

Ocular effects

Use systemic drug cautiously in ocular herpes simplex because of possible corneal perforation.

Ophthalmic use

Prolonged use may result in glaucoma, cataracts, or other complications.

Peptic ulcer

May contribute to peptic ulceration, especially with large doses.

Stress

Increased dosage of rapidly acting corticosteroid may be needed before, during and after stressful situations.

Withdrawal

Abrupt discontinuation may result in adrenal insufficiency.

Overdosage

Symptoms

Cushingoid changes, moonfaced, striae, central obesity, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes mellitus, hyperlipidemia, peptic ulcer, GI bleeding, increased susceptibility to infection, electrolyte and fluid imbalance, psychosis.

Patient Information

  • Advise patient to take single daily doses or alternate day doses in morning (before 9 AM) and to take multiple doses at evenly spaced intervals throughout day.
  • Instruct patient to take medication with meals or snack to avoid GI irritation.
  • Caution patient not to discontinue drug suddenly, to avoid withdrawal syndrome. Explain that dosage will be tapered slowly (until 5 mg/day or less) before stopping.
  • Warn patient to avoid people with known viral infections, particularly chickenpox or measles, and to inform health care provider if exposure occurs.
  • Explain that patient should not receive live virus vaccinations.
  • Instruct diabetic patients to monitor blood glucose closely.
  • Advise patient to notify health care providers of drug regimen before any surgical procedure, emergency treatment, immunization, or skin test.
  • Tell patient to carry medical identification card at all times describing medication being taken.
  • Tell patient about symptoms of adrenal insufficiency (eg, fever, myalgia, malaise, anorexia, nausea, orthostatic hypotension, dizziness, fainting) and need to report these symptoms to health care provider immediately.
  • Instruct patient to report the following symptoms to health care provider: black tarry stools, vomiting of blood, menstrual irregularities, unusual weight gain, swelling of lower extremities, puffy face, muscle weakness, prolonged sore throat, fever, or cold.

Copyright © 2009 Wolters Kluwer Health.

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