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Prednisone

Medical and Pharmacy Editor:

Brand Name(s): Deltasone, Rayos, Prednisone Intensol, Sterapred, and Sterapred DS

Generic Name: prednisone

Drug Class: Corticosteroids

What Is Prednisone and How Does It Work?

Prednisone is a prescription medication used most commonly to treat diseases affecting endocrine, rheumatic, collagen, dermatologic, ophthalmic, respiratory, neoplastic, gastrointestinal diseases, allergic reactions, hematologic disorders, edematous conditions, and disorders of the nervous system.

Prednisone is available under the following different brand names: Deltasone, Rayos, Prednisone Intensol, Sterapred, and Sterapred DS.

Dosages of Prednisone

Adult and pediatric dosages:

Concentrate

Oral solution

  • 5 mg/5mL

Tablet

  • 1 mg
  • 2.5 mg
  • 5 mg
  • 10 mg
  • 20 mg
  • 50 mg

Dosage Considerations – Should be Given as Follows:

Administration

Prednisone should be taken with meal or snack. High-dose glucocorticoids may cause insomnia; and immediate-release formulation is typically administered in morning to coincide with circadian rhythm.

Delayed-release formulation takes about 4 hours to release active substances. With this formulation, timing of dose should take into account as to the delayed-release pharmacokinetics and the disease or condition being treated (for example, the medication may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis).

Adult

Glucocorticoid-Responsive Conditions

5-60 mg/day orally in single daily dose or divided every 6 to 12 hours.

Dosing considerations

When converting from immediate-release to delayed-release formulation, note that delayed-release formulation takes about 4 hours to release active substances.

Note that exogenous steroids suppress adrenal cortex activity least during maximal natural adrenal cortex activity (between 4:00 and 8:00 AM).

Acute Asthma

Adult: 40-60 mg/day orally in single daily dose or divided every 12 hours for 3-10 days

Children younger than 12 years: 1-2 mg/kg/day orally in single daily dose or divided every 12 hours for 3-10 days; not to exceed 80 mg/day.

Children 12 years or older: 40-60 mg/day orally in single daily dose or divided every 12 hours for 3-10 days

Giant Cell Arteritis

40-60 mg orally every day (1-2 years usual duration of treatment).

Idiopathic Thrombocytopenic Purpura

1-2 mg/kg/day orally.

Dose Tapering

Day 1: 10 mg orally before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime

Day 2: 5 mg orally before breakfast, after lunch, and after dinner and 10 mg at bedtime

Day 3: 5 mg orally before breakfast, after lunch, after dinner, and at bedtime

Day 4: 5 mg orally before breakfast, after lunch, and at bedtime

Day 5: 5 mg orally before breakfast and at bedtime

Day 6: 5 mg orally before breakfast

Rheumatoid Arthritis

Immediate-release: Greater than or equal to 10 mg/day orally added to disease-modifying anti-rheumatic drugs.

Delayed-release: 5 mg/day orally initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis.

Advanced Pulmonary/Extra pulmonary Tuberculosis

40-60 mg/day orally, tapered over 4-8 weeks

Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)

Adult: 40 mg orally every 12 hours for 5 days, then 40 mg orally every 24 hours for 5 days, then 20 mg every 24 hours for 11 days.

Children younger than 12 years: 1 mg/kg orally every 12 hours for 5 days, then 0.5-1 mg/kg orally every 12 hours for 5 days, then 0.5 mg/kg orally every 24 hours for 11-21 days.

Children 12 years or older: 40 mg orally every 12 hours for 5 days, then 40 mg orally every 24 hours for 5 days, then 20 mg orally every 24 hours for 11 days.

Crohn's Disease (Off-label)

40-60 mg orally every day until resolution and resumption of weight gain (7-28 days usual duration).

Autoimmune Hepatitis

60 mg orally once a day for 1 week; then 40 mg orally once a day for 1 week; then 30 mg once a day for 2 weeks; followed by 20 mg orally once a day; give half this dose if giving in combination with azathioprine.

Pediatric

Inflammation

0.5-2 mg/kg/day orally in single daily dose or divided every 12 hours; not to exceed 80 mg/day.

Nephrotic Syndrome

2 mg/kg/day orally; not to exceed 80 mg/day

Digestive Disease Myths:Common Misconceptions

What Are Side Effects Associated with Using Prednisone?

Common side effects of prednisone include:

Allergic reactions

Cardiovascular:

Dermatologic:

Endocrine

Fluid and electrolyte disturbances:

Gastrointestinal

General

  • increased appetite
  • weight gain

Metabolic

Musculoskeletal

Neurologic

  • pain disorder caused by inflammation of the membrane surrounding the nerves
  • convulsions
  • depression
  • emotional instability
  • intense excitement
  • headache
  • increased intracranial pressure with swelling effecting the optic nerve (pseudo tumor cerebri; usually following discontinuance of treatment)
  • insomnia
  • meningitis
  • mood swings
  • inflammation of a nerve or group of nerves
  • damage or disruption to nerves
  • partial paralysis
  • abnormal sensation
  • personality changes
  • sensory disturbances
  • spinning sensation (vertigo)

Ophthalmic:

  • abnormal protrusion of the eye
  • increased pressure within the eye
  • increased pressure of the fluid inside of the eye
  • posterior sub capsular cataracts
  • temporary visual impairment

Reproductive:

  • alteration in motility
  • number of spermatozoa

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Prednisone?

If your doctor has directed you to use this medication for diabetes, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of Prednisone include:

Prednisone has serious interactions with at least 76 different drugs.

Prednisone has serious interactions with at least 76 different drugs.

Prednisone has moderate interactions with at least 240 different drugs.

Prednisone has mild interactions with at least 129 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Digestive Disease Myths:Common Misconceptions

What Are Warnings and Precautions for Prednisone?

Warnings

This medication contains prednisone. Do not take Deltasone, Rayos, Prednisone Intensol, Sterapred, or Sterapred DS, if you are allergic to prednisone or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Avoid use if there are untreated serious infections, documented hypersensitivity, or chickenpox.

Administration of live or attenuated live vaccine (Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (less than 2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages, such as, replacement therapy.

Effects of Drug Abuse

No information provided.

Short-Term Effects

See "What Are Side Effects Associated with Using Prednisone?"

Long-Term Effects

Prolonged use associated with increased risk increased risk of osteoporosis, myopathy, delayed wound healing of infection; monitor. may result in elevated intraocular pressure, glaucoma, or cataracts.

See also "What Are Side Effects Associated with Using Prednisone?"

Cautions

Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia.

Prolonged use associated with increased risk of infection.

Use with caution in liver disease, herpes infection of the eye, high blood pressure, diverticulitis, hypothyroidism, abnormal muscle weakness, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, kidney insufficiency, pregnancy, diabetes mellitus, congestive heart failure, clotting disorders of the blood and GI disorders.

Long-term treatment associated with increased risk of osteoporosis, disease of muscle tissue, and delayed wound healing.

Patients receiving corticosteroids should avoid chickenpox or measles-infected persons, if unvaccinated.

Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored).

Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy.

Methylprednisolone is preferred in hepatic impairment because prednisone must be converted to prednisolone in liver.

Prolonged corticosteroid use may result in elevated pressure in the eye, glaucoma, or cataracts.

May cause impairment of mineralocorticoid secretion; administer mineralocorticoid simultaneously.

May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions.

Monitor for Kaposi sarcoma, a cancer that develops from cells that line lymph or blood vessels.

Pregnancy and Lactation

Use prednisone with caution in pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies are done. Use prednisone only in LIFE-THREATENING emergencies in pregnancy, when no safer drug is available. There is positive evidence of human fetal risk.

Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy.

Breastfeeding: 5-25% of maternal serum metabolities are found in breast milk; prednisone is not recommended when lactating or breastfeeding, or if the benefit outweighs the risk, use the lowest dose.

Reviewed on 3/27/2017


SOURCE:
Medscape. Prednisone.
https://reference.medscape.com/drug/prednisone-intensol-342747

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