prednisolone (Rx)

Brand and Other Names:Pediapred, FloPred, more...Orapred, Orapred ODT, Millipred, Millipred DP, Prelone Syrup, Veripred 20
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral solution

  • 5mg/5mL
  • 10mg/5mL
  • 15mg/5mL
  • 20mg/5mL
  • 25mg/5mL

tablet

  • 5mg

tablet, dose pack

  • 5mg (6 days [21 tabs])
  • 5mg (12 days [48 tabs])

tablet, orally disintegrating

  • 10mg
  • 15mg
  • 30mg
more...

Rheumatoid Arthritis

5-7.5 mg PO qDay

Multiple Sclerosis

200 mg/day PO for 1 week, then 80 mg PO every other day for 1 month

Acute Exacerbation of COPD (Off-label)

30-40 mg PO qDay for 10-14 days

Bells Palsy (Off-label)

60 mg PO qDay for 5 days; then taper down by 10 mg daily for 5 days for total duration time of 10 days

Dosage Forms & Strengths

oral solution

  • 5mg/5mL
  • 10mg/5mL
  • 15mg/5mL
  • 20mg/5mL
  • 25mg/5mL

tablet

  • 5mg

tablet, dose pack

  • 5mg (6 days [21 tabs])
  • 5mg (12 days [48 tabs])

tablet, orally disintegrating

  • 10mg
  • 15mg
  • 30mg
more...

Inflammation

0.1-2 mg/kg/day PO in single daily dose or divided q6-12hr; not to exceed 80 mg/day 

Acute Asthma

1-2 mg/kg/day in single daily dose or divided q12hr for 3-5 days 

Nephrotic Syndrome

First 4 weeks: 60 mg/m²/day or 2 mg/kg/day PO divided q8hr until urine is protein free for 3 consecutive days; not to exceed 28 days; dose not to exceed 80 mg/day 

Subsequent 4 weeks: 40 mg/m² or 1-1.5 mg/kg PO every other day; not to exceed 80 mg/day

Maintenance in frequent relapses: 0.5-1 mg/kg/dose PO every other day for 3-6 months

Treatment may have to be individualized

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Interactions

Interaction Checker

and prednisolone

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            Frequency Not Defined

            Acne

            Adrenal suppression

            Delayed wound healing

            Diabetes mellitus

            GI perforation

            Glucose intolerance

            Hepatomegaly

            Hypokalemic alkalosis

            Increased transaminases

            Insomnia

            Menstrual irregularity

            Myopathy

            Neuritis

            Osteoporosis

            Peptic ulcer

            Perianal pruritus

            Pituitary adrenal axis suppression

            Pseudotumor cerebri (on withdrawal)

            Psychosis

            Seizure

            Ulcerative esophagitis

            Urticaria

            Vertigo

            Weight gain

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            Warnings

            Contraindications

            Documented hypersensitivity

            Systemic fungal infection, varicella, superficial herpes simplex keratitis

            Receipt of live or attenuated live vaccine; Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (<2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages (replacement therapy)

            Cautions

            Use with caution in cirrhosis, diabetes, ocular herpes simplex, hypertension, diverticulitis, following myocardial infarction, thyroid disease, seizure disorders, hypothyroidism, myasthenia gravis, hepatic impairment, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy

            Thromboembolic disorders or myopathy may occur

            Delayed wound healing is possible

            Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated

            Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)

            Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy

            Parenteral forms (prednisolone sodium phosphate) have been discontinued

            Suppression of hypothalamic-pituitary-adrenal axis may occur particularly in patients receiving high doses for prolonged periods or in young children; discontinuation of therapy should be done through slow taper

            Posterior subcapular cataract formation associated with prolonged use of corticosteroids

            Prolonged use of corticosteroids may increase risk of secondary infections

            Increase in intraocular pressure associated with prolonged use of corticosteroids

            Long-term use associated with fluid retention and hypertension

            Development of Kaposi's sarcoma associated with prolonged corticosteroid use

            Acute myopathy associated with high dose of corticosteroids

            Corticosteroid use may cause psychiatric disturbances

            If product is used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients; steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently

            Steroids after cataract surgery may delay healing and increase incidence of bleb formation

            Use of ocular steroids may prolong course and may exacerbate severity of many viral infections of the eye (including herpes simplex)

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            Pregnancy & Lactation

            Pregnancy

            Prednisolone shown to be teratogenic in mice when given in doses 1-10 times human dose; dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both eyes of pregnant mice five times per day on days 10 through 13 of gestation; a significant increase in the incidence of cleft palate observed in fetuses of treated mice; there are no adequate well-controlled studies in pregnant women; prednisolone should be used during pregnancy only if potential benefit justifies potential risk to fetus

            Lactation

            Not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk; systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects

            Because of potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level

            Absorption

            Duration: 18-36 hr

            Peak plasma time: 5 min (IV); 1 hr (PO)

            Distribution

            Protein bound: 65-91% (lower in elderly)

            Vd: 0.22-0.7 L/kg

            Metabolism

            Extensively metabolized in liver

            Elimination

            Half-life: 3.6 hr (normal renal function); 3-5 hr (end-stage renal disease)

            Dialyzable: Hemodialysis, no

            Renal clearance: 9.5 mL/min

            Excretion: Urine (mainly)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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