Prednisone
Classification
Glucocorticoid steroid
Indications
CCP: Asthma and others as directed
Contraindications
- Hypersensitivity
- Systemic fungal infections
- Varicella
- Cerebral malaria
- Avoid abrupt withdrawal.
Cautions
- Pediatric or adolescents
- Pregnancy 1st trimester
- Immunosuppressed
- Active infection
- Measles or varicella exposure
- HTN
- Pheochromocytoma
- CHF
- PUD
- Recent MI
- Diabetes
- Ulcerative colitis
- Diverticulitis
- Intestinal anastomosis
- GI perforation
- Seizure disorder
- Psychiatric disorder
- Thyroid disorder
- Osteoporosis
- Myasthenia gravis
- Optic nerve neuritis
- Ocular HSV
- Renal impairment
- Cirrhosis
Adult dosages
CCP: All indications
40-80 mg/day PO
Pediatric Considerations And Dosing
CCP: All indications
- < 12 years of age
- 1-2 mg/kg/day PO divided in 2 doses.
- ≥12 years of age
- 40-80 mg PO divided in 2 doses.
Mechanism Of Action
Exact mechanism is unknown. It is thought to inhibit multiple inflammatory cytokines. It exhibits glucocorticoid and mineralocorticoid effects. These effects controls or prevents inflammation by controlling the rate of protein synthesis and suppressing the migration of polymorphonuclear leukocytes. In physiologic doses corticoids are administered to replace deficient endogenous hormones. In larger doses they decrease inflammation.
Pharmacokinetics
Half-life: 2-4 hours
Peak plasma time: 2 hours
Duration: 8-36 hours
Adverse Effects
- Bradycardia
- Cardiac arrhythmias including cardiac arrest
- CHF
- HTN
- Pulmonary edema
- Cardiac enlargement
- Rash
- Dermatological derangements
- Cushingoid state
- Latent diabetes
- Menstrual irregularities
- Secondary adrenocortical and pituitary unresponsiveness
- Fluid and electrolyte disturbances
- Gastrointestinal disorders such as pancreatitis, hepatomegaly, peptic ulcer, ulcerative esophagitis.
- Pathological fractures of long bones
- Tendon ruptures
- Vertebral compression fractures
- Osteoporosis
- Convulsions
- Emotional instability
- Increased intracranial pressure
- Insomnia
- Neuropathy
- Vertigo
- Sensory disturbances
- Neuritis
- Glaucoma
- Increased intraocular pressure
- Posterior subcapsular cataracts
- Alterations in spermatozoa
Warning And Precautions
- Monitor for hypothalamic-pituitary-adrenal axis suppression
- Monitor for Cushing syndrome
- Monitor for hyperglycemia.
- Use with caution in
- Cirrhosis
- HTN
- Hypothyroidism
- Myasthenia gravis
- Ulcerative colitis
- Pregnancy
- Diabetes mellitus
- Osteoporosis
- Herpes simplex
- CHF
- Latent tuberculosis may be reactivated
- Methylprednisone is preferred in hepatic impairment.
- Avoid prolonged use.
- May cause behavioral and psychiatric disturbances.
Drug Interactions
- Live adenovirus
- BCG live intravesical
- Live cholera
- Desmopressin
- Live influenza vaccine
- Live measles, mumps, rubella vaccine
- Mifepristone
- Live rotavirus
- Live smallpox vaccine
- Talimogene laherparepvec
- Live typhoid vaccine
- Live varicella vaccine
- Live yellow fever vaccine