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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 1^st 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