Prednisone is used for many different autoimmune diseases and inflammatory conditions, including: asthma, COPD, CIDP, rheumatic disorders, allergic disorders, ulcerative colitis and Crohn's disease, adrenocortical insufficiency, hypercalcemia due to cancer, thyroiditis, laryngitis, severe tuberculosis, urticaria.
Prednisolone is a synthetic adrenocortical drug with predominantly glucocorticoid properties. Prednisolone directly inhibits the action of the Phospholipase A2 enzyme which is responsible for the production of different inflammatory mediators like Leukotrienes, SRS-A, Prostaglandins etc. Prednisolone is rapidly and well absorbed from the Gl tract following oral administration. Prednisolone is 70- 90% protein-bound in the plasma and it is eliminated from the plasma with a half-life of 2 to 4 hours. It is metabolized mainly in the liver and excreted in the urine.
ORAL Allergic & inflammatory disorders: Adult: 5-60 mg daily in 2-4 divided doses. Maintenance: 2.5-15 mg daily. Withdrawal should be gradual after long-term therapy. Child: 1 mth-18 yr: Autoimmune inflammatory disorders: Initially, 1-2 mg/ kg once daily; may reduce dose gradually after a few days if needed. Max: 60 mg daily. Autoimmune hepatitis: Initially, 2 mg/ kg once daily, then reduce to min effective dose. Max: 40 mg daily. Poorly controlled, moderate to severe asthma: Adult: Patients w/ at least 2 exacerbations/yr requiring oral corticosteroids: 40-60 mg daily in 1-2 divided doses; usually given as a short course treatment over 3-10 days until symptom resolution & patient achieves a peak expiratory flow (PEF) of at least 80% of his or her personal best. May be used w/ maintenance dosages of inhaled corticosteroid & a LA inhaled β2-agonist bronchodilator. Child: Patients w/ >3 exacerbations/yr in child 4yrorat least 2 exacerbations/yr in child 5-11 yr: 1-2 mg/ kg daily for 3-5 days may be used w/ existing asthma treatment; dose may be given in 1-2 divided doses. Max: 60 mg daily. Nephrotic syndrome: Child: 1 mth-18 yr: Initially, 60 mg/m2 (max: 80 mg) once daily for 4 wk until urine is protein-free followed by 40 mg/m2every other day for 4 wk, then w/draw dose gradually. Prevention of relapse: 0.5-1 mg/kg once daily every other day for 3-6 mth. Rheumatoid arthritis: Adult: Initially, 5-7.5 mg daily, adjusted as necessary. Elderly: 5mg daily. INTRA-ARTICULAR Joint inflammations: Adult: 5-25 mg (as acetate) or 2-30 mg (as phosphate) or 4-40 mg (as terbutate). The phosphate & tebutate may also be given intralesionally or injected into soft tissue. PARENTERAL Allergic & inflammatory disorders: Adult: Given as Na phosphate ester: 5-60 mg prednisolone base daily IV inj/infusion or lM. Dose to be individualised based on the severity of the condition & patient’s response. OPHTHALMIC Conjunctivitis: Adult: As 1% acetate susp or 0.12% acetate suspension: Instill 1-2 drops into the affected eye(s) 2-4 times daily. Higher frequency may be used during the initial 24-48 hr. if needed. Reevaluate if there is no improvement after 2 days of treatment. OTIC/AURAL Allergic & inflammatory conditions of the ear: Adult: As acetate or phosphate: 0.5 or 1% drops.
The efficacy of prednisolone is reduced by Aminoglutethimide, Antacids, Barbiturates, Carbamazepine, Griseofulvin, Mitotane, Phenylbutazone, Phenytoin, Primidone and Rifampin. Prednisolone reduces the amount of potassium in the blood. Digitalis can cause Cardiac arrhythmias if hypokalemia occurs. Immunization should be done very carefully.
Live vaccines; herpes simplex keratitis, systemic infections. Patients w/ hypothyroidism, cirrhosis, ulcerative colitis, CHF, convulsive disorders, thrombophlebitis, peptic ulcer, elderly. DM, hypertension, psychological disturbances, osteoporosis; pregnancy, lactation. Adrenal suppression & infection. May cause irreversible growth retardation, glaucoma, corneal perforation. Topical: Broken or infected skin. Not to be applied over large areas under occlusive dressings.
Cushing’s syndrome & growth retardation in childn; osteoporosis, fractures. Peptic ulceration; glaucoma, cataracts; hyperglycaemia, pancreatitis; increased appetite, obesity. Topical: Thinning & atrophy, systemic absorption w/ prolonged use over large surface, broken skin or under occlusive dressing. Rash, allergic reactions, pruritus. Intradermal/Intralesional: Local hypopigmentation of hyperpigmented lesions. Ophthalmic: Raised lOP & reduced visual function. Acute adrenal insufficiency precipitated by infection. trauma or surgery in patients on long-term therapy or following cessation of such therapy. CV collapse following rapid IV injection.
This drug should only be used during pregnancy if the benefit outweighs the potential risk to the fetus. Drug concentrations in human milk are expected to be 5% to 25% of the maternal serum levels. Total infant doses are expected to be about 0.14% of the maternal daily dose. High doses for long periods of time could produce infant growth and development problems, interfere with infant endogenous corticosteroid production, and occasionally cause temporary loss of milk supply. Use caution; this drug should be used only if clearly needed.
Adverse effects related to prednisone normally develop only after prolonged use of doses in excess of the normal physiological requirement. Treatment is symptomatic and where possible the prednisone dose should be reduced gradually.
Store in a cool and dry place, protected from light. Keep out of the reach of the children.
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