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Look Up > Drugs > Prednisone
Prednisone
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Pregnancy/Breast-Feeding Implications
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Test Interactions
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(PRED ni sone)

U.S. Brand Names
Deltasone®; Liquid Pred®; Meticorten®; Orasone®; Prednicen-M®

Generic Available

Yes


Canadian Brand Names
Apo®-Prednisone; Jaa-Prednisone®; Novo-Prednisone; Wimpred

Synonyms
Deltacortisone; Deltadehydrocortisone

Pharmacological Index

Corticosteroid, Oral


Use

Treatment of a variety of diseases including adrenocortical insufficiency, hypercalcemia, rheumatic, and collagen disorders; dermatologic, ocular, respiratory, gastrointestinal, and neoplastic diseases; organ transplantation and a variety of diseases including those of hematologic, allergic, inflammatory, and autoimmune in origin; not available in injectable form, prednisolone must be used


Pregnancy Risk Factor

B


Pregnancy/Breast-Feeding Implications

Clinical effects on the fetus: Crosses the placenta. Immunosuppression reported in 1 infant exposed to high-dose prednisone plus azathioprine throughout gestation. One report of congenital cataracts. Available evidence suggests safe use during pregnancy.

Breast-feeding/lactation: Crosses into breast milk. No data on clinical effects on the infant. American Academy of Pediatrics considers compatible with breast-feeding.


Contraindications

Serious infections, except septic shock or tuberculous meningitis; systemic fungal infections; hypersensitivity to prednisone or any component; varicella


Warnings/Precautions

Withdraw therapy with gradual tapering of dose, may retard bone growth; use with caution in patients with hypothyroidism, cirrhosis, hypertension, congestive heart failure, ulcerative colitis, thromboembolic disorders, and patients at increased risk for peptic ulcer disease. 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.


Adverse Reactions

>10%:

Central nervous system: Insomnia, nervousness

Gastrointestinal: Increased appetite, indigestion

1% to 10%:

Dermatologic: Hirsutism

Endocrine & metabolic: Diabetes mellitus

Ocular: Cataracts, glaucoma

Neuromuscular & skeletal: Arthralgia

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


Overdosage/Toxicology

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.


Drug Interactions

CYP3A3/4 enzyme substrate

Barbiturates, phenytoin, rifampin decrease corticosteroid effectiveness

Decreases salicylates

Decreases vaccines

Decreases toxoids effectiveness


Mechanism of Action

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; suppresses adrenal function at high doses. Antitumor effects may be related to inhibition of glucose transport, phosphorylation, or induction of cell death in immature lymphocytes. Antiemetic effects are thought to occur due to blockade of cerebral innervation of the emetic center via inhibition of prostaglandin synthesis.


Pharmacodynamics/Kinetics

Refer to Prednisolone monograph for complete pharmacokinetic information

Prednisone is inactive and must be metabolized to prednisolone which may be impaired in patients with impaired liver function

Half-life: Normal renal function: 2.5-3.5 hours


Usual Dosage

Oral: 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.

Anti-inflammatory or immunosuppressive dose: 0.05-2 mg/kg/day divided 1-4 times/day

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

Alternatively (for 3- to 5-day "burst"):

<1 year: 10 mg every 12 hours

1-4 years: 20 mg every 12 hours

5-13 years: 30 mg every 12 hours

>13 years: 40 mg every 12 hours

Asthma long-term therapy (alternative dosing by age):

<1 year: 10 mg every other day

1-4 years: 20 mg every other day

5-13 years: 30 mg every other day

>13 years: 40 mg every other day

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

Children and Adults: Physiologic replacement: 4-5 mg/m2/day

Adults: 5-60 mg/day in divided doses 1-4 times/day

Elderly: Use the lowest effective dose

Dosing adjustment in hepatic impairment: Prednisone is inactive and must be metabolized by the liver to prednisolone. This conversion may be impaired in patients with liver disease, however, prednisolone levels are observed to be higher in patients with severe liver failure than in normal patients. Therefore, compensation for the inadequate conversion of prednisone to prednisolone occurs.

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

Hemodialysis: Supplemental dose is not necessary

Peritoneal dialysis: Supplemental dose is not necessary


Dietary Considerations

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


Monitoring Parameters

Blood pressure, blood glucose, electrolytes


Test Interactions

Response to skin tests


Mental Health: Effects on Mental Status

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


Mental Health: Effects on Psychiatric Treatment

Barbiturates and carbamazepine may decrease corticosteroid effectiveness


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Take exactly as directed. Do not take more than prescribed dose and do not discontinue abruptly; consult prescriber. Take with or after meals. Take once-a-day dose with food in the morning. Limit intake of caffeine or stimulants. Maintain adequate nutrition; consult prescriber for possibility of special dietary recommendations. If diabetic, monitor serum glucose closely and notify prescriber of changes; this medication can alter hypoglycemic requirements. Notify prescriber if you are experiencing higher than normal levels of stress; medication may need adjustment. Periodic ophthalmic examinations will be necessary with long-term use. You will be susceptible to infection; avoid crowds or infected persons or persons with contagious diseases. You may experience insomnia or nervousness; use caution when driving or engaging in tasks requiring alertness until response to drug is known. Report weakness, change in menstrual pattern, vision changes, signs of hyperglycemia, signs of infection (eg, fever, chills, mouth sores, perianal itching, vaginal discharge), other persistent side effects, or worsening of condition.


Nursing Implications

Withdraw therapy with gradual tapering of dose


Dosage Forms

Solution, oral: Concentrate (30% alcohol): 5 mg/mL (30 mL); Nonconcentrate (5% alcohol): 5 mg/5 mL (5 mL, 500 mL)

Syrup: 5 mg/5 mL (120 mL, 240 mL)

Tablet: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg


References

Boot AM, Nauta J, Hokken-Koelega AC, et al, "Renal Transplantation and Osteoporosis," Arch Dis Child, 1995, 72(6):502-6.

Bowman H and Lennard TW, "Immunosuppressive Drugs," Br J Hosp Med, 1992, 48(9):570-3.

Frey BM and Frey FJ, "Clinical Pharmacokinetics of Prednisone and Prednisolone," Clin Pharmacokinet, 1990, 19(2):126-46.

Grotz WH, Mundinger FA, Gugel B, et al, "Bone Mineral Density After Kidney Transplantation: A Cross-Sectional Study in 190-Graft Recipients Up to 20 Years After Transplantation," Transplantation, 1995, 59(7):982-6.

Gutin PH, "Corticosteroid Therapy in Patients With Brain Tumors," Natl Cancer Inst Monogr, 1977, 46:151-6.

Kimberly RP, "Glucocorticoids," Curr Opin Rheumatol, 1994, 6(3):273-80.

Lowenthal RM and Jestrimski KW, "Corticosteroid Drugs: Their Role in Oncological Practice," Med J Aust, 1986, 144(2):81-5.

Murphy CM, Coonce SL, and Simon PA, "Treatment of Asthma in Children," Clin Pharm, 1991, 10(9):685-703.

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.

Verbeek PR and Geerts WH, "Nontapering Versus Tapering Prednisone in Acute Exacerbations of Asthma: A Pilot Trial," J Emerg Med, 1995, 13(5):715-9.

Wolkowitz OM, "Long-Lasting Behavioral Changes Following Prednisone Withdrawal," JAMA, 1989, 261(12):1731-2.


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