Prednisolone

General

  • Type: Corticosteroid
  • Dosage Forms: 5; 5,15,25/5 mL
  • 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