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Prednisone

    Brands

    DEA Class;  Rx

    Common Brand Names; Deltasone, Rayos, Prednisone Intensol, Sterapred, Sterapred DS

    • Corticosteroid

    Commonly-prescribed oral corticosteroid with little mineralocorticoid activity; metabolized to prednisolone; prednisone is roughly 4 times as potent as hydrocortisone as a glucocorticoid
    Used in many conditions in adult and pediatric patients, including asthma, COPD, SLE, rheumatoid and psoriatic arthritis, prevention of transplant rejection, and many allergic, dermatologic, and inflammatory states
    If long-term therapy required, the lowest possible effective dose should be used

    Indicated for maintenance therapy (i.e., replacement therapy) of primary (Addison’s disease) or secondary adrenocortical insufficiency.

    For the treatment of congenital adrenal hyperplasia.
    For kidney transplant rejection prophylaxis.
    For the treatment of chronic graft-versus-host disease (GVHD).
    For palliative management of acute lymphocytic leukemia (ALL).
    For the treatment of chronic lymphocytic leukemia (CLL).
    For the short-term treatment of hypercalcemia secondary to neoplastic disease.
    For the treatment of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.
    For the treatment of rheumatic conditions such as rheumatoid arthritis, juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA), ankylosing spondylitis, acute and subacute bursitis, acute non-specific tenosynovitis, acute gouty arthritis and gout, osteoarthritis, or epicondylitis.
    For the treatment of systemic autoimmune conditions such as acquired hemolytic anemia, congenital hypoplastic anemia, or symptomatic sarcoidosis.
    For asthma exacerbation.
    For asthma maintenance treatment in patients with severe, persistent asthma.
    For the treatment of thrombocytopenia or immune thrombocytopenic purpura (ITP).
    For the treatment of proteinuria in nephrotic syndrome, without uremia, of the idiopathic type or due to lupus nephritis.
    For the treatment of severe erythema multiforme or Stevens-Johnson syndrome.
    For the treatment of corticosteroid-responsive dermatoses and dermatologic disorders such as atopic dermatitis or eczema, bullous dermatitis herpetiformis, contact dermatitis, exfoliative dermatitis, mycosis fungoides, pemphigus, or severe seborrheic dermatitis.
    For the treatment of ACE-inhibitor induced angioedema once acute symptoms are controlled.
    For the treatment of allergic disorders including anaphylaxis or anaphylactoid reactions, angioedema, acute noninfectious laryngeal edema, hypersensitivity reactions (e.g., drug or food allergy), serum sickness, urticaria, or severe perennial allergies or seasonal allergies, including allergic rhinitis.

    Untreated serious infections

    Documented hypersensitivity

    Varicella

    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 (<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)

    Allergic: 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 after 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, urticaria

    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 of serum liver enzymes levels (usually reversible upon discontinuance), 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

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

    Prolonged use associated with increased risk of infection; monitor

    Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders

    Long-term treatment associated with increased risk of osteoporosis, myopathy, 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 intraocular pressure, glaucoma, or cataracts

    May cause impairment of mineralocorticoid secretion; administer mineralocorticoid concomitantly

    Based on findings from human and animal studies, therapy can cause fetal harm when administered to a pregnant woman

    Prednisolone has been found to be present in human milk following administration to lactating women; published reports suggest infant daily doses are estimated to be less than 1% of maternal daily dose; no adverse effects in breastfed infant have been reported following maternal exposure of prednisolone during breastfeeding

    Corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, and on patient response. There is no absolute maximum dosage.

    Prednisone

    concentrate

    • 5mg/mL

    oral solution

    • 5mg/5mL

    tablet

    • 1mg

    • 2.5mg

    • 5mg

    • 10mg

    • 20mg

    • 50mg

    tablet, delayed release

    • 1mg

    • 2mg

    • 5mg