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- Tablets 25 mg
- Injection 50 mg/mL
As short-acting glucocorticoid; depresses formation, release, and activity of endogenous mediators of inflammation; has some salt-retaining properties.
Crosses the placenta and is excreted in breast milk.
The t ½ is 30 min.
Indications and Usage
Treatment of primary or secondary adrenal cortex insufficiency; rheumatic disorders; collagen diseases; dermatologic diseases; allergic states; allergic and inflammatory ophthalmic processes; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states (caused by nephrotic syndrome); GI diseases; multiple sclerosis; tuberculous meningitis; trichinosis with neurologic or myocardial involvement.
Systemic fungal infections; administration of live virus vaccines in patients receiving immunosuppressive doses.
Dosage and AdministrationAdults
PO 25 to 300 mg/day. Use lowest possible effective dose.Alternate-day therapy
Provides at least twice usual daily dosage of short- to intermediate-acting medication.Adults
IM 20 to 300 mg/day. In less severe cases, less than 20 mg/day may be sufficient; in severe cases, more than 300 mg/day may be required.
Store at room temperature in tightly closed container. Protect from heat and freezing.
Drug may antagonize anticholinesterase effects in myasthenia gravis.Anticoagulants, oral
Drug may increase or decrease anticoagulant dose requirements.Barbiturates
May decrease pharmacologic effect of cortisone.Phenytoin
May decrease therapeutic efficacy of cortisone.Rifampin
May decrease therapeutic efficacy of cortisone.Salicylates
Drug may reduce serum levels and efficacy of salicylates.Troleandomycin
May increase effects of cortisone.
Laboratory Test Interactions
False-negative nitroblue tetrazolium test.
Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture after recent MI; CHF.
Convulsions; increased intracranial pressure with papilledema; vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia.
Impaired wound healing; petechiae and ecchymoses; erythema; lupus erythematosus–like lesions; suppression of skin test reactions; subcutaneous fat atrophy; purpura; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation.
Cataracts; increased IOP; glaucoma; exophthalmos.
Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; small bowel and large bowel perforation, especially in inflammatory bowel disease.
Increased or decreased motility and number of spermatozoa.
Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; increased serum cholesterol; hypocalcemia; hypothalamicpituitary-axis suppression; endocrine abnormalities (decreased T 3 , T 4 and 131 I uptake, menstrual irregularities, cushingoid state, growth suppression in children, increased sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements, manifestations of latent diabetes mellitus, negative nitrogen balance because of protein catabolism, hirsutism).
Musculoskeletal effects (eg, muscle weakness, myopathy, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures; anaphylactoid reactions; aggravation or masking of infections; malaise.
Report signs of adrenal insufficiency to health care provider: fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, and dizziness.Cushingoid symptoms
Report signs of cushingoid symptoms to health care provider.Need for dosage adjustment
Monitor patient closely for signs that might require dosage adjustments, including changes as a result of remissions or exacerbations of the disease, individual drug responsiveness, and the effect of stress.
Pregnancy category undetermined.
Excreted in breast milk.
Observe growth and development of infants and children undergoing prolonged therapy.
May require lower doses.
Anaphylactoid reactions have occurred rarely.
Prolonged therapy may lead to HPA suppression. Withdraw gradually after prolonged therapy.
Use with caution in patients with recent MI.
Fluid and electrolyte balance
Drug can cause elevated BP, salt and water retention, increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary.
Drug may be harmful in chronic active hepatitis that is positive for hepatitis B surface antigen.
Drug may mask signs of infection and decrease host-defense mechanisms that prevent dissemination of infection.
Use cautiously in ocular herpes simplex because of possible corneal perforation.
Drug may contribute to peptic ulceration, especially in large doses.
Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.
Acute adrenal insufficiency caused by too rapid withdrawal: fever, myalgia, arthralgia, malaise, anorexia, nausea, desquamation of skin, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia. Cushingoid changes from chronic use of too large dose: moonface, central obesity, striae, hirsutism, acne, ecchymoses, fluid and electrolyte imbalance, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer.
- Instruct patient to take with meals to avoid GI upset.
- Tell patient to take single daily dose before 9 AM.
- Instruct patient to monitor weight daily and to report steady gain to health care provider.
- Inform patients with diabetes to monitor blood glucose regularly.
- Instruct elderly patients undergoing long-term therapy to have BP, blood glucose, and electrolytes checked every 6 mo.
- Advise patient to avoid receiving live virus vaccine during therapy.
- Instruct patients undergoing long-term therapy to have an annual eye examination and to carry ID card.
- For discontinuation after long-term therapy, instruct patient to adhere to tapering schedule.
- Advise patient to notify health care provider before discontinuing medication.
- Instruct patient to report these symptoms to health care provider: cold, infection or prolonged sore throat; change in vision; swelling of extremities; weakness; black tarry stools; irregular heartbeat; menstrual irregularities; changes in mood or behavior; fatigue; anorexia; nausea; vomiting; diarrhea; weight loss.
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