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===
===Corticosteroid-responsive conditions===
*5-60 mg/day PO divided qd-qid
*5-60mg/day PO divided QD-QID


===[[Asthma]], acute===
===[[Asthma]], acute===
*ED/hospital: 40-80 mg/day PO divided qd-bid, cont. until peak flow = 70% predicted
*ED/hospital: 40-80mg/day PO divided QD-bid, cont. until peak flow = 70% predicted
*Outpatient burst tx: 40-60 mg/day PO divided qd-bid x 3-10 days
*Outpatient burst treatment: 40-60mg/day PO divided QD-bid x 3-10 days


===[[Asthma]], severe persistent===
===[[Asthma]], severe persistent===
*7.5-60 mg PO qd-qod
*7.5-60mg PO QD-qod


===[[Adrenal insufficiency]]===
===[[Adrenal insufficiency]]===
*4-5 mg/m^2 PO qd
*4-5mg/m<sup>2</sup> PO QD


===[[Multiple sclerosis]], acute exacerbation===
===[[Multiple sclerosis]], acute exacerbation===
*200 mg PO qd x 1 wk, then 80 mg PO qod x 1 mo
*200mg PO QD x 1 wk, then 80mg PO qod x 1 mo


===[[Alcoholic hepatitis]], acute===
===[[Alcoholic hepatitis]], acute===
*40 mg PO qd
*40mg PO QD


==Pediatric Dosing==
==Pediatric Dosing==
===Corticosteroid-responsive conditions===
===Corticosteroid-responsive conditions===
*0.14-2 mg/kg/day PO divided qd-qid
*0.14-2mg/kg/day PO divided QD-QID


===[[Asthma]], acute===
===[[Asthma]], acute===
*ED/hospital: 1-2 mg/kg/day PO divided qd-bid
*ED/hospital: 1-2mg/kg/day PO divided QD-bid
*Max: 60 mg/day, cont. until peak flow = 70% predicted
*Max: 60mg/day, cont. until peak flow = 70% predicted
*Outpatient burst tx: 1-2 mg/kg/day PO divided qd-bid x 3-10 days
*Outpatient burst treatment: 1-2mg/kg/day PO divided QD-bid x 3-10 days
*Max: 60 mg/day
*Max: 60mg/day


===[[Asthma]], severe persistent===
===[[Asthma]], severe persistent===
*0.25-2 mg/kg PO qd-qod
*0.25-2mg/kg PO QD-qod
*Max 60 mg/day
*Max 60mg/day


===[[Adrenal insufficiency]]===
===[[Adrenal insufficiency]]===
*4-5 mg/m^2 PO qd
*4-5mg/m^2 PO QD


===[[Nephrotic syndrome]]===
===[[Nephrotic syndrome]]===
*60 mg/m^2/day PO divided tid x 4 wk, then 40 mg/m^2 PO qod x 4 wk
*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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*caution if ocular HSV
*caution if ocular HSV
*caution if immunosuppressed
*caution if immunosuppressed
*caution if HTN
*caution if hypertension
*caution if CHF
*caution if CHF
*caution if diabetes mellitus
*caution if diabetes mellitus
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*immunosuppression
*immunosuppression
*infection
*infection
*[[HTN]]
*[[hypertension]]
*[[CHF]]
*[[CHF]]
*[[diabetes mellitus]]
*[[diabetes mellitus]]
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*tendon rupture
*tendon rupture
*pseudotumor cerebri
*pseudotumor cerebri
*ICP incr.
*ICP increase
*[[seizures]]
*[[seizures]]
*glaucoma
*glaucoma
*cataracts
*cataracts
*[[pancreatitis]]
*[[pancreatitis]]
*growth suppression (long-term use, peds patients)
*growth suppression (long-term use, pediatric patients)
*exophthalmos
*exophthalmos
*[[anaphylaxis]]
*[[anaphylaxis]]
*withdrawal symptoms if abrupt D/C (high dose or long-term use)
*withdrawal symptoms if abrupt discontinuation (high dose or long-term use)


===Common===
===Common===
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*edema
*edema
*muscle weakness
*muscle weakness
*BP elevated
*BP elevation
*glucose intolerance
*glucose intolerance
*petechiae/ecchymosis
*petechiae/ecchymosis
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*menstrual irregularities
*menstrual irregularities
*[[hypokalemia]]
*[[hypokalemia]]
*IOP incr.
*IOP increase
*impaired wound healing (long-term use)
*impaired wound healing (long-term use)
*Cushing syndrome
*Cushing syndrome

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

See Also

References

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