Prednison (Cortikosteroid)

Adult Dosing & Uses

Dosing Forms & Strengths

oral solution

• 5mg/5mL

tablet

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

delayed-release tablet

• 1mg
• 2mg
• 5mg

Glucocorticoid Responsive Conditions

5-60 mg/day PO qDay or divided BID-QID
When converting from immediate- release to delayed- release formulation, note that delayed- release formulation takes about 4 hours to release active substances
Exogenous steroids suppress adrenal cortex activity least during maximal natural adrenal cortex activity (between 4am and 8am)

Acute Asthma

40-60 mg PO qDay or divided BID for 3-10 days

Idiopathic Thrombocytopenia Purpura

1-2 mg PO qDay

Allergic Conditions

Day 1: 10 mg PO BID (before breakfast and at bedtime) and 5 mg PO BID (after lunch and dinner)
Day 2: 5 mg PO TID and 10 mg PO at bedtime
Day 3: 5 mg PO QID
Day 4: 5 mg PO TID
Day 5: 5 mg PO BID
Day 6: 5 mg PO before breakfast

Pneumocystis (carinii) jiroveci Pneumonia (Off-label)

Pneumocystis jiroveci pneumonia infection in patients with HIV
40 mg PO BID x5 days, THEN
40 mg PO qDay x5 days, THEN
20 mg PO qDay x11 days

Rheumatoid Arthritis

Immediate-release: <10 added="added" day="day" dmards="dmards" mg="mg" p="p" po="po" to="to"> Delayed-release (Rayos): 5 mg PO qDay initially; maintenance dose should be lowest dose that maintains clinical response; may take qHS to decrease morning stiffness with rheumatoid arthritis)

Advanced Pulmonary/Extrapulmonary Tuberculosis

40-60 mg PO qDay, tapered over 4-8 weeks

Administration

Take with meal or snack
High dose glucocorticoids may cause insomnia; immediate-release product typically administered in morning to coincide with circadian rhythm
When converting from immediate- release to delayed- release formulation, note that delayed- release formulation takes about 4 hr to release active substances
For delayed-release, timing of dose should take into account the delayed-release pharmacokinetics and the disease or condition being treated (eg, may take at bedtime to decrease morning stiffness with rheumatoid arthritis)

Other Indications & Uses

Adrenocortical insufficiency, conditions treated by immunosuppression, inflammatory conditions, nephrotic syndrome, lupus nephritis, rheumatoid arthritis

Pediatric Dosing & Uses

Dosing Forms & Strengths

oral solution

• 5mg/5mL

tablet

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

delayed- release tablet

• 1mg
• 2mg
• 5mg

Anti-inflammatory/Immunosuppressive

0.5-2 mg/kg/day PO qDay or divided BID; not to exceed 80 mg/day

Acute Asthma

12 years or older: 40-60 mg PO qDay or divided BID for 3-10 days

Nephrotic Syndrome

2 mg/kg PO qDay; not to exceed 80 mg/day

Adverse Effects

Frequency Not Specified

Allergic reactions: anaphylaxis, angioedema
Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper or hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticarial

Endocrine: Abnormal fat deposits, decreased carbohydrate tolerance, development of Cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon facies, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery or illness), suppression of growth in children

Fluid and Electrolyte Disturbances: Fluid retention, potassium loss, hypertension, hypokalemic alkalosis, sodium retention

Gastrointestinal: Abdominal distention, elevation in serum liver enzymes levels (usually reversible upon discontinuation), hepatomegaly, hiccups, malaise, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis

General: Increased appetite and weight gain

Metabolic: Negative nitrogen balance due to protein catabolism

Musculoskeletal: Osteonecrosis of femoral and humeral heads, charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures

Neurological: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudo-tumor cerebri) usually following discontinuation of treatment, insomnia, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo

Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, and central serous chorioretinopathy

Reproductive: Alteration in motility and number of spermatozoa

Contraindications & Cautions

Contraindications

Untreated serious infections
Hypersensitivity
Concomitant mifepristone
Varicella

Patients receiving live or attenuated live vaccine

• However, ACIP & AAFP state administration of live virus vaccines usually is not contraindicated in pts receiving corticosteroid therapy as short-term (<2 alternate-day="alternate-day" as="as" dosages="dosages" in="in" li="li" long-term="long-term" low="low" maintenance="maintenance" moderate="moderate" physiologic="physiologic" preparations="preparations" replacement="replacement" short-acting="short-acting" therapy="therapy" to="to" tx="tx" w="w" wk="wk">

Cautions

Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, and hyperglycemia
Monitor for increased risk of infection

Cirrhosis, ocular herpes simplex, HTN, diverticulitis, hypothyroidism, myasthenia gravis, PUD, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, DM, CHF, thromboembolic disorders, GI disorders

Long-term treatment: risk of osteoporosis, myopathy, delayed wound healing

Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
Latent TB may be reactivated:; monitor patients with positive tuberculin test
Some suggestion of slightly increased cleft palate risk if corticosteroids used in pregnancy, but not fully substantiated

Methylprednisolone is preferred in hepatic impairment since prednisone needs to be converted to prednisolone in liver

Prolonged corticosteroid use may result in elevated IOP, glaucoma, and/or cataracts
May cause mineralcorticoid secretion impairment; administer concomitant mineralocorticoid
Monitor for behavioral and mood disturbances
Monitor for Kaposi’s sarcoma

Pregnancy & Lactation

Pregnancy Category: D
May cause fetal harm and decreased birth weight
Maternal corticosteroid use during the first trimester increases the rate of cleft lip with or without cleft palate
Lactation: 5-25% of serum maternal metabolites found in breast milk; avoid or use lowest dose if benefit outweighs risk

http://reference.medscape.com/drug/prednisone-intensol-342747#6
30-08-2012