Yes

Corticosteroid, Ophthalmic; Corticosteroid, Parenteral

Treatment of palpebral and bulbar conjunctivitis; corneal injury from chemical, radiation, thermal burns, or foreign body penetration; endocrine disorders, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, ophthalmic diseases, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states, and gastrointestinal diseases; useful in patients with inability to activate prednisone (liver disease)

C

Acute superficial herpes simplex keratitis; systemic fungal infections; varicella; hypersensitivity to prednisolone or any component

Use with caution in patients with hyperthyroidism, cirrhosis, nonspecific ulcerative colitis, hypertension, osteoporosis, thromboembolic tendencies, CHF, convulsive disorders, myasthenia gravis, thrombophlebitis, peptic ulcer, diabetes; acute adrenal insufficiency may occur with abrupt withdrawal after long-term therapy or with stress; young pediatric patients may be more susceptible to adrenal axis suppression from topical therapy. Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly, in the smallest possible dose, and for the shortest possible time.

>10%:

Central nervous system: Insomnia, nervousness

Gastrointestinal: Increased appetite, indigestion

1% to 10%:

Dermatologic: Hirsutism

Endocrine & metabolic: Diabetes mellitus

Neuromuscular & skeletal: Arthralgia

Ocular: Cataracts, glaucoma

Respiratory: Epistaxis

<1%: Edema, hypertension, vertigo, seizures, psychoses, pseudotumor cerebri, headache, mood swings, delirium, hallucinations, euphoria, acne, skin atrophy, bruising, hyperpigmentation, Cushing's syndrome, pituitary-adrenal axis suppression, growth suppression, glucose intolerance, hypokalemia, alkalosis, amenorrhea, sodium and water retention, hyperglycemia, peptic ulcer, nausea, vomiting, abdominal distention, ulcerative esophagitis, pancreatitis, muscle weakness, osteoporosis, fractures, muscle wasting, hypersensitivity reactions

When consumed in excessive quantities for prolonged periods, systemic hypercorticism and adrenal suppression may occur, in those cases discontinuation and withdrawal of the corticosteroid should be done judiciously.

CYP3A enzyme substrate; inducer of cytochrome P-450 enzymes

Barbiturates, phenytoin, rifampin decrease corticosteroid effectiveness

Decreases salicylates

Decreases vaccines

Decreases toxoids effectiveness

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and volume of the lymphatic system

Duration: 18-36 hours

Protein binding: 65% to 91% (concentration dependent)

Metabolism: Primarily in the liver, but also metabolized in most tissues, to inactive compounds

Half-life: 3.6 hours; Biological: 18-36 hours; End-stage renal disease: 3-5 hours

Elimination: In urine principally as glucuronides, sulfates, and unconjugated metabolites

Dose depends upon condition being treated and response of patient; dosage for infants and children should be based on severity of the disease and response of the patient rather than on strict adherence to dosage indicated by age, weight, or body surface area. Consider alternate day therapy for long-term therapy. Discontinuation of long-term therapy requires gradual withdrawal by tapering the dose.

Acute asthma:

Oral: 1-2 mg/kg/day in divided doses 1-2 times/day for 3-5 days

I.V. (sodium phosphate salt): 2-4 mg/kg/day divided 3-4 times/day

Anti-inflammatory or immunosuppressive dose: Oral, I.V., I.M. (sodium phosphate salt): 0.1-2 mg/kg/day in divided doses 1-4 times/day

Nephrotic syndrome: Oral:

Initial (first 3 episodes): 2 mg/kg/day or 60 mg/m²/day (maximum: 80 mg/day) in divided doses 3-4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1-1.5 mg/kg/dose or 40 mg/m²/dose given every other day for 4 weeks

Maintenance (long-term maintenance dose for frequent relapses): 0.5-1 mg/kg/dose given every other day for 3-6 months

Adults:

Oral, I.V., I.M. (sodium phosphate salt): 5-60 mg/day

Multiple sclerosis (sodium phosphate): Oral: 200 mg/day for 1 week followed by 80 mg every other day for 1 month

Rheumatoid arthritis: Oral: Initial: 5-7.5 mg/day; adjust dose as necessary

Elderly: Use lowest effective dose

Dosing adjustment in hyperthyroidism: Prednisolone dose may need to be increased to achieve adequate therapeutic effects

Hemodialysis: Slightly dialyzable (5% to 20%); administer dose posthemodialysis

Peritoneal dialysis: Supplemental dose is not necessary

Intra-articular, intralesional, soft-tissue administration:

Tebutate salt: 4-40 mg/dose

Sodium phosphate salt: 2-30 mg/dose

Ophthalmic suspension/solution: Children and Adults: Instill 1-2 drops into conjunctival sac every hour during day, every 2 hours at night until favorable response is obtained, then use 1 drop every 4 hours

Should be taken after meals or with food or milk to decrease GI effects; limit caffeine; increase dietary intake of pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus

Blood pressure, blood glucose, electrolytes

Response to skin tests

Nervousness and insomnia are common; may rarely cause delirium, mood swings, euphoria, and hallucinations

Barbiturates and carbamazepine may decrease corticosteroid effectiveness

No information available to require special precautions

No effects or complications reported

Take exactly as directed; do not increase dose or discontinue abruptly without consulting prescriber. Take oral medication with or after meals. Limit intake of caffeine or stimulants. Prescriber may recommend increased dietary vitamins, minerals, or iron. Diabetics should monitor glucose levels closely (antidiabetic medication may need to be adjusted). Inform prescriber if you are experiencing greater than normal levels of stress (medication may need adjustment). Some forms of this medication may cause GI upset (oral medication may be taken with meals to reduce GI upset; small frequent meals and frequent mouth care may reduce GI upset). You may be more susceptible to infection (avoid crowds and persons with contagious or infective conditions). Report promptly excessive nervousness or sleep disturbances; any signs of infection (sore throat, unhealed injuries); excessive growth of body hair or loss of skin color; changes in vision; excessive or sudden weight gain (>3 lb/week); swelling of face or extremities; difficulty breathing; muscle weakness; change in color of stools (black or tarry) or persistent abdominal pain; or worsening of condition or failure to improve. Pregnancy precautions: Inform prescriber if you are or intend to be pregnant.

Do not administer acetate or tebutate salt I.V.

Injection:

As acetate (for I.M., intralesional, intra-articular, or soft tissue administration only): 25 mg/mL (10 mL, 30 mL); 50 mg/mL (30 mL)

As sodium phosphate (for I.M., I.V., intra-articular, intralesional, or soft tissue administration): 20 mg/mL (2 mL, 5 mL, 10 mL)

As tebutate (for intra-articular, intralesional, soft tissue administration only): 20 mg/mL (1 mL, 5 mL, 10 mL)

Liquid, oral, as sodium phosphate: 5 mg/5 mL (120 mL)

Solution, ophthalmic, as sodium phosphate: 0.125% (5 mL, 10 mL, 15 mL); 1% (5 mL, 10 mL, 15 mL)

Suspension, ophthalmic, as acetate: 0.12% (5 mL, 10 mL); 0.125% (5 mL, 10 mL, 15 mL); 1% (1 mL, 5 mL, 10 mL, 15 mL)

Syrup: 15 mg/5 mL (240 mL)

Tablet: 5 mg

Report of a Workshop by the British Association for Paediatric Nephrology and Research Unit, Royal College of Physicians, "Consensus Statement on Management and Audit Potential for Steroid Responsive Nephrotic Syndrome," Arch Dis Child, 1994, 70(2):151-7.