Prednisolone: Difference between revisions
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==General== | ==General== | ||
*Type: [[Corticosteroid]] | *Type: [[Corticosteroid]] | ||
*Dosage Forms: 5; 5,15,25/5 mL | *Dosage Forms: PO (5; 5,15,25/5 mL), ophthalmic | ||
*Common Trade Names: Flo-Pred, Millipred, Oraped, Pedipred, Prelone, Veripred 20 | *Common Trade Names: Flo-Pred, Millipred, Oraped, Pedipred, Prelone, Veripred 20 | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Corticosteroid-responsive conditions=== | |||
*5-60mg/day PO divided QD-QID | |||
===[[Asthma]], acute=== | |||
*ED/hospital: 40-80mg/day PO divided QD-bid, cont. until peak flow = 70% predicted | |||
*Outpatient burst treatment: 40-60mg/day PO divided QD-bid x 3-10 days | |||
===[[Asthma]], severe persistent=== | |||
*7.5-60mg PO QD-qod | |||
===[[Adrenal insufficiency]]=== | |||
*4-5mg/m<sup>2</sup> PO QD | |||
===[[Multiple sclerosis]], acute exacerbation=== | |||
*200mg PO QD x 1 wk, then 80mg PO qod x 1 mo | |||
===[[Alcoholic hepatitis]], acute=== | |||
*40mg PO QD | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Corticosteroid-responsive conditions=== | |||
*0.14-2mg/kg/day PO divided QD-QID | |||
===[[Asthma]], acute=== | |||
*ED/hospital: 1-2mg/kg/day PO divided QD-bid | |||
*Max: 60mg/day, cont. until peak flow = 70% predicted | |||
*Outpatient burst treatment: 1-2mg/kg/day PO divided QD-bid x 3-10 days | |||
*Max: 60mg/day | |||
===[[Asthma]], severe persistent=== | |||
*0.25-2mg/kg PO QD-qod | |||
*Max 60mg/day | |||
===[[Adrenal insufficiency]]=== | |||
*4-5mg/m^2 PO QD | |||
===[[Nephrotic syndrome]]=== | |||
*60mg/m^2/day PO divided tid x 4 wk, then 40mg/m^2 PO qod x 4 wk | |||
==Special Populations== | ==Special Populations== | ||
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*avoid abrupt withdrawal (high dose or long-term use) | *avoid abrupt withdrawal (high dose or long-term use) | ||
*caution if active infection | *caution if active infection | ||
*caution if TB infection | *caution if [[TB]] infection | ||
*caution if ocular HSV | *caution if ocular HSV | ||
*caution if immunosuppressed | *caution if immunosuppressed | ||
*caution if | *caution if hypertension | ||
*caution if CHF | *caution if CHF | ||
*caution if diabetes mellitus | *caution if diabetes mellitus | ||
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*caution if thromboembolic disorder | *caution if thromboembolic disorder | ||
*caution if coagulation disorder | *caution if coagulation disorder | ||
*caution in elderly | *caution in elderly patients | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
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*immunosuppression | *immunosuppression | ||
*infection | *infection | ||
* | *[[hypertension]] | ||
*CHF | *[[CHF]] | ||
*diabetes mellitus | *[[diabetes mellitus]] | ||
*steroid psychosis | *steroid psychosis | ||
*GI perforation/ulcer | *GI perforation/ulcer | ||
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*tendon rupture | *tendon rupture | ||
*pseudotumor cerebri | *pseudotumor cerebri | ||
*ICP | *ICP increase | ||
*seizures | *[[seizures]] | ||
*glaucoma | *glaucoma | ||
*cataracts | *cataracts | ||
*pancreatitis | *[[pancreatitis]] | ||
*growth suppression (long-term use, | *growth suppression (long-term use, pediatric patients) | ||
*exophthalmos | *exophthalmos | ||
*anaphylaxis | *[[anaphylaxis]] | ||
*withdrawal | *withdrawal symptoms if abrupt discontinuation (high dose or long-term use) | ||
===Common=== | ===Common=== | ||
*sodium and fluid retention | *sodium and fluid retention | ||
*diaphoresis | *diaphoresis | ||
*headache | *[[headache]] | ||
*vertigo | *[[vertigo]] | ||
*insomnia | *insomnia | ||
*nervousness | *nervousness | ||
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*edema | *edema | ||
*muscle weakness | *muscle weakness | ||
*BP | *BP elevation | ||
*glucose intolerance | *glucose intolerance | ||
*petechiae/ecchymosis | *petechiae/ecchymosis | ||
*facial erythema | *facial erythema | ||
*menstrual irregularities | *menstrual irregularities | ||
*hypokalemia | *[[hypokalemia]] | ||
*IOP | *IOP increase | ||
*impaired wound healing (long-term use) | *impaired wound healing (long-term use) | ||
*Cushing syndrome | *Cushing syndrome | ||
*skin pigmentation abnormality | *skin pigmentation abnormality | ||
*hirsutism | *hirsutism | ||
*urticaria | *[[urticaria]] | ||
==Pharmacology== | ==Pharmacology== | ||
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==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] |
Latest revision as of 17:59, 20 September 2019
General
- Type: Corticosteroid
- Dosage Forms: PO (5; 5,15,25/5 mL), ophthalmic
- Common Trade Names: Flo-Pred, Millipred, Oraped, Pedipred, Prelone, Veripred 20
Adult Dosing
Corticosteroid-responsive conditions
- 5-60mg/day PO divided QD-QID
Asthma, acute
- ED/hospital: 40-80mg/day PO divided QD-bid, cont. until peak flow = 70% predicted
- Outpatient burst treatment: 40-60mg/day PO divided QD-bid x 3-10 days
Asthma, severe persistent
- 7.5-60mg PO QD-qod
Adrenal insufficiency
- 4-5mg/m2 PO QD
Multiple sclerosis, acute exacerbation
- 200mg PO QD x 1 wk, then 80mg PO qod x 1 mo
Alcoholic hepatitis, acute
- 40mg PO QD
Pediatric Dosing
Corticosteroid-responsive conditions
- 0.14-2mg/kg/day PO divided QD-QID
Asthma, acute
- ED/hospital: 1-2mg/kg/day PO divided QD-bid
- Max: 60mg/day, cont. until peak flow = 70% predicted
- Outpatient burst treatment: 1-2mg/kg/day PO divided QD-bid x 3-10 days
- Max: 60mg/day
Asthma, severe persistent
- 0.25-2mg/kg PO QD-qod
- Max 60mg/day
Adrenal insufficiency
- 4-5mg/m^2 PO QD
Nephrotic syndrome
- 60mg/m^2/day PO divided tid x 4 wk, then 40mg/m^2 PO qod x 4 wk
Special Populations
- Pregnancy Rating: C
- Lactation: Probably Safe
- Renal Dosing
- Adult: no adjustment
- Pediatric: no adjustment
- Hepatic Dosing
- Adult: not defined
- Pediatric: not defined
Contraindications
- Allergy to class/drug
- systemic fungal infection
- active or recent varicella infection
- active or recent measles infection
- avoid abrupt withdrawal (high dose or long-term use)
- caution if active infection
- caution if TB infection
- caution if ocular HSV
- caution if immunosuppressed
- caution if hypertension
- caution if CHF
- caution if diabetes mellitus
- caution if seizure disorder
- caution if PUD
- caution if ulcerative colitis
- caution if diverticulitis
- caution if recent intestinal anastomosis
- caution if psychiatric disorder
- caution if hypothyroidism
- caution if osteoporosis
- caution if myasthenia gravis
- caution if renal impairment, severe
- caution if hepatic impairment, severe
- caution if thromboembolic disorder
- caution if coagulation disorder
- caution in elderly patients
Adverse Reactions
Serious
- adrenal insufficiency
- Cushing syndrome
- immunosuppression
- infection
- hypertension
- CHF
- diabetes mellitus
- steroid psychosis
- GI perforation/ulcer
- osteopenia/osteoporosis
- hypokalemic alkalosis
- steroid myopathy
- tendon rupture
- pseudotumor cerebri
- ICP increase
- seizures
- glaucoma
- cataracts
- pancreatitis
- growth suppression (long-term use, pediatric patients)
- exophthalmos
- anaphylaxis
- withdrawal symptoms if abrupt discontinuation (high dose or long-term use)
Common
- sodium and fluid retention
- diaphoresis
- headache
- vertigo
- insomnia
- nervousness
- mood swings
- edema
- muscle weakness
- BP elevation
- glucose intolerance
- petechiae/ecchymosis
- facial erythema
- menstrual irregularities
- hypokalemia
- IOP increase
- impaired wound healing (long-term use)
- Cushing syndrome
- skin pigmentation abnormality
- hirsutism
- urticaria
Pharmacology
- Half-life: 18-36h
- Metabolism: liver, CYP450: 3A4 substrate
- Excretion: urine
- Mechanism of Action: exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects