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- | *5-60mg/day PO divided QD-QID | ||
===[[Asthma]], acute=== | ===[[Asthma]], acute=== | ||
*ED/hospital: 40- | *ED/hospital: 40-80mg/day PO divided QD-bid, cont. until peak flow = 70% predicted | ||
*Outpatient burst treatment: 40- | *Outpatient burst treatment: 40-60mg/day PO divided QD-bid x 3-10 days | ||
===[[Asthma]], severe persistent=== | ===[[Asthma]], severe persistent=== | ||
*7.5- | *7.5-60mg PO QD-qod | ||
===[[Adrenal insufficiency]]=== | ===[[Adrenal insufficiency]]=== | ||
*4- | *4-5mg/m<sup>2</sup> PO QD | ||
===[[Multiple sclerosis]], acute exacerbation=== | ===[[Multiple sclerosis]], acute exacerbation=== | ||
* | *200mg PO QD x 1 wk, then 80mg PO qod x 1 mo | ||
===[[Alcoholic hepatitis]], acute=== | ===[[Alcoholic hepatitis]], acute=== | ||
* | *40mg PO QD | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Corticosteroid-responsive conditions=== | ===Corticosteroid-responsive conditions=== | ||
*0.14- | *0.14-2mg/kg/day PO divided QD-QID | ||
===[[Asthma]], acute=== | ===[[Asthma]], acute=== | ||
*ED/hospital: 1- | *ED/hospital: 1-2mg/kg/day PO divided QD-bid | ||
*Max: | *Max: 60mg/day, cont. until peak flow = 70% predicted | ||
*Outpatient burst treatment: 1- | *Outpatient burst treatment: 1-2mg/kg/day PO divided QD-bid x 3-10 days | ||
*Max: | *Max: 60mg/day | ||
===[[Asthma]], severe persistent=== | ===[[Asthma]], severe persistent=== | ||
*0.25- | *0.25-2mg/kg PO QD-qod | ||
*Max | *Max 60mg/day | ||
===[[Adrenal insufficiency]]=== | ===[[Adrenal insufficiency]]=== | ||
*4- | *4-5mg/m^2 PO QD | ||
===[[Nephrotic syndrome]]=== | ===[[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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*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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*immunosuppression | *immunosuppression | ||
*infection | *infection | ||
*[[ | *[[hypertension]] | ||
*[[CHF]] | *[[CHF]] | ||
*[[diabetes mellitus]] | *[[diabetes mellitus]] | ||
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*cataracts | *cataracts | ||
*[[pancreatitis]] | *[[pancreatitis]] | ||
*growth suppression (long-term use, | *growth suppression (long-term use, pediatric patients) | ||
*exophthalmos | *exophthalmos | ||
*[[anaphylaxis]] | *[[anaphylaxis]] |
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