Prednisolone: Difference between revisions
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==General== | ==General== | ||
*Type: [[Corticosteroid]] | *Type: [[Corticosteroid]] | ||
*Dosage Forms: | *Dosage Forms: PO (5; 5,15,25/5 mL), ophthalmic | ||
*Common Trade Names: | *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== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: Probably Safe | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult: no adjustment | ||
**Pediatric | **Pediatric: no adjustment | ||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult: not defined | ||
**Pediatric | **Pediatric: not defined | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *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== | ==Adverse Reactions== | ||
===Serious=== | ===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=== | ===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== | ==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