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Drug Detailed Description (Generic name) - Prednisone
Prednisone is a synthetic glucocorticoid with less sodium-retaining activity than hydrocortisone. Prednisone is inactive until converted into prednisolone. At the cellular level, glucocorticoids appear to act by controlling the rate of protein synthesis mediated through gene transcription. Clinically, these drugs are used primarily for their anti-inflammatory and immunosuppressant effects.22
Administration and Adult Dosage
Total daily dosage is variable and must be in-dividualized depending on the clinical disorder and patient response.2,5 Daily di-vided high-dose therapy for initial control of more severe disease states may be necessary until satisfactory control is obtained, usually 4–10 days for many aller-gic and collagen diseases. Administration of a short- or intermediate-acting prepa-ration given as a single dose in the morning (before 9 AM) is likely to produce fewer side effects and less pituitary–adrenal suppression than a divided dosage regimen with the same agent or an equivalent dosage of a long-acting agent. Alternate-day therapy (ie, total 48-hr dosage administered every other morning) with intermediate-acting agents (eg, prednisone) further reduces the prevalence and degree of side effects. However, it might not be uniformly effective in treating all disease states, unless large doses are used (eg, 40–60 mg every other day for adults requiring long-term corticosteroid therapy for asthma). Complete adrenal suppression might not occur with single daily doses given in the morning if the prednisone dose is =15 mg, but Cushing’s syndrome can still occur and patients should receive supplemental corticosteroids during periods of unusual stress.5,20 In times of stress (eg, surgery, severe trauma, serious illness), patients on long-term corticosteroid therapy (>5 mg/day prednisone or equivalent) should receive supplemental IV hydrocortisone 100–300 mg/day or PO prednisone 25– 75 mg/day in divided doses for 1–3 days.1,2,5,20 Guidelines for withdrawal from glucocorticoid therapy have been published.1,5 Common initial doses are: PO for acute asthma exacerbations in adults and adolescents 40–60 mg/day in 1 or 2 doses for 3–10 days; hospitalized pa-tients may require a parenteral preparation and a larger dosage (eg, methylpred-nisolone 120–180 mg/day in 3–4 divided doses for 48 hr, then 60–80 mg/day).23 Reduce dosage to minimum effective maintenance dosage as soon as possible; PO as an adjunct therapy for Pneumocystis carinii pneumonia (with an arterial PO2 =70 mm Hg or an arterial–alveolar gradient =35 mm Hg) 40 mg bid for 5 days begun with antimicrobial therapy, then 20 mg bid for 5 days, then 20 mg/day for the duration of antimicrobial therapy;22,24 PO for rheumatoid arthritis 5–7.5 mg/day;2 PO for collagen diseases 1 mg/kg/day in divided doses;2 PO for acute gout 30–50 mg/day, gradually decreasing over 10 days;25 PO for nephrotic syndrome 1–2 mg/kg/day;2 PO for skin disorders 40 mg/day, up to 120 mg/day in pemphigus;2 PO for ulcerative colitis 10–30 mg/day or, if severe, 60–120 mg/day;2 PO for thrombocytopenia 0.5 mg/kg/day;2 PO for organ transplantation (in combination with other immunosuppressants) 50– 100 mg once, then taper dosage and make further dosage adjustments based on the clinical situation;2 PO for acute exacerbations of multiple sclerosis 200 mg/day for 1 week, then 80 mg every other day for 1 month. Special Populations. Pediatric Dosage
Dosage depends on disease state and pa-tient response rather than strict adherence to age or body weight. Common initial doses are: PO for acute asthma 1–2 mg/kg/day, to a maximum of 60 mg/day in 1–2 divided doses for 3–10 days; hospitalized patients may require a parenteral preparation and a larger dosage (eg, methylprednisolone 1 mg/kg q 6 hr for 48 hr, then 1–2 mg/kg/day, to a maximum of 60 mg/day, in 2 divided doses).23 PO for inflammation or immunosuppression 0.5–2 mg/kg/day in 1–4 divided doses.26
Consider using lower dosages for decreased body size.
Soln 1, 5 mg/mL; Syrup 1 mg/mL; Tab 1, 2.5, 5, 10, 20, 50 mg.
Dose- and duration-related side effects include fluid and electrolyte disturbances (with possible edema and hypertension), hyperglycemia and glycosuria, spread of herpes conjunctivitis, activation of tuberculosis, osteo-porosis, bone fractures, myopathy, menstrual irregularities, behavioral distur-bances (increasing with dosages >40 mg/day), poor wound healing, ocular cataracts, glaucoma, arrest of growth (in children), hirsutism, pseudotumor cerebri (primarily in children), and Cushing’s syndrome (moon face, buffalo hump, cen-tral obesity, easy bruising, acne, hirsutism, and striae).2,11,30–32 Prolonged therapy can lead to suppression of pituitary–adrenal function. Too rapid withdrawal of long-term therapy can cause acute adrenal insufficiency (eg, fever, myalgia, arthralgia, and malaise); adrenally suppressed patients cannot respond to stress.
Systemic fungal infections (except as maintenance therapy in adrenal insufficiency); administration of live virus vaccines in patients receiving immunosuppressive doses of corticosteroids.
Pregnancy. Use with caution in diabetes mellitus; osteoporosis; peptic ulcer; esophagitis; tuberculosis; and other acute and chronic bacterial, viral, and fungal infections; hypertension or other cardiovascular diseases; hypothy-roidism; immunizations; hypoalbuminemia; psychosis; and liver disease. Suppres-sion of PPD and other skin test reactions can occur.
Corticosteroids can increase serum glucose levels, and an in-crease in the dosage of antidiabetic drugs might be required. Corticosteroids can decrease isoniazid and salicylate serum levels. Amphotericin B and loop and thi-azide diuretics can enhance corticosteroid-induced potassium depletion. Carba-mazepine, phenobarbital (and possibly other barbiturates), phenytoin (best docu-mented with dexamethasone), rifampin, and possibly aminoglutethimide increase the metabolism of corticosteroids. Parameters to Monitor. Observe for behavioral disturbances and signs or symp-toms of Cushing’s syndrome. With short-term, high-dose therapy, frequently monitor serum potassium and glucose and blood pressure. With long-term ther-apy, monitor these parameters occasionally and perform periodic eye examina-tions and possibly stool guaiac. Monitor growth in infants and children on pro-longed therapy.
Other, more expensive glucocorticoids offer minimal advantages over prednisone in most clinical situations.2 Dosage ranges for prednisolone are the same as those for prednisone. Patients who have received daily glucocorticoid therapy for less than 2 weeks do not require dosage tapering to prevent acute adrenal insufficiency; however, dosage tapering may be required to maintain an adequate clinical response.1,2,5 Efficacy in patients with stable COPD is controver 31,33,34