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prednisone (Rx)Brand and Other Names:Deltasone, Rayos, more...Prednisone Intensol, Sterapred, Sterapred DS

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

concentrate

  • 5mg/mL

oral solution

  • 5mg/5mL

tablet

  • 1mg
  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 50mg

tablet, delayed release

  • 1mg
  • 2mg
  • 5mg
more...

Glucocorticoid-Responsive Conditions

5-60 mg/day PO in single daily dose or divided q6-12hr

Dosing considerations

  • When converting from immediate-release to delayed-release formulation, note that delayed-release formulation takes about 4 hours to release active substances
  • Note that exogenous steroids suppress adrenal cortex activity least during maximal natural adrenal cortex activity (between 4:00 and 8:00 AM)

Acute Asthma

40-60 mg/day PO in single daily dose or divided q12hr for 3-10 days

Giant Cell Arteritis

40-60 mg PO qDay (1-2 years usual duration of treatment)

Idiopathic Thrombocytopenic Purpura

1-2 mg/kg/day PO  

Dose Tapering

Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime

Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime

Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime

Day 4: 5 mg PO before breakfast, after lunch, and at bedtime

Day 5: 5 mg PO before breakfast and at bedtime

Day 6: 5 mg PO before breakfast

Rheumatoid Arthritis

Immediate-release: ≤10 mg/day PO added to disease-modifying antirheumatic drugs (DMARDs)

Delayed-release: 5 mg/day PO initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis

Advanced Pulmonary/Extrapulmonary Tuberculosis

40-60 mg/day PO, tapered over 4-8 weeks

Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)

40 mg PO q12hr for 5 days, then 40 mg PO q24hr for 5 days, then 20 mg q24hr for 11 days

Crohn's Disease (Off-label)

40-60 mg PO qDay until resolution and resumption of weight gain (7-28 days usual duration)

Autoimmune Hepatitis

60 mg PO qDay for 1 week; THEN 40 mg qDay for 1 week; THEN 30 mg qDay for 2 weeks; follow by 20 mg qDay; give half this dose if giving in combinaiton with azathioprine

Administration

Take with meal or snack

High-dose glucocorticoids may cause insomnia; immediate-release formulation is typically administered in morning to coincide with circadian rhythm

Delayed-release formulation takes about 4 hours to release active substances; thus, with this formulation, timing of dose should take into account delayed-release pharmacokinetics and disease or condition being treated (eg, may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis)

Dosage Forms & Strengths

oral solution

  • 5mg/5mL

tablet

  • 1mg
  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 50mg

tablet, delayed release

  • 1mg
  • 2mg
  • 5mg
more...

Inflammation

0.5-2 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 80 mg/day  

Acute Asthma

<12 years: 1-2 mg/kg/day PO in single daily dose or divided q12hr for 3-10 days; not to exceed 80 mg/day 

≥12 years: 40-60 mg/day PO in single daily dose or divided q12hr for 3-10 days

Nephrotic Syndrome

2 mg/kg/day PO; not to exceed 80 mg/day 

Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)

<12 years: 1 mg/kg PO q12hr for 5 days, then 0.5-1 mg/kg q12hr for 5 days, then 0.5 mg/kg q24hr for 11-21 days  

>12 years: 40 mg PO q12hr for 5 days, then 40 mg PO q24hr for 5 days, then 20 mg q24hr for 11 days

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Interactions

Interaction Checker

prednisone and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Allergic: Anaphylaxis, angioedema

            Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture after recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

            Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper- or hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria

            Endocrine: Abnormal fat deposits, decreased carbohydrate tolerance, development of cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon facies, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in children

            Fluid and electrolyte disturbances: Fluid retention, potassium loss, hypertension, hypokalemic alkalosis, sodium retention

            Gastrointestinal: Abdominal distention, elevation of serum liver enzymes levels (usually reversible upon discontinuance), hepatomegaly, hiccups, malaise, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis

            General: Increased appetite and weight gain

            Metabolic: Negative nitrogen balance due to protein catabolism

            Musculoskeletal: Osteonecrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures

            Neurologic: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri; usually following discontinuance of treatment), insomnia, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo

            Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, central serous chorioretinopathy

            Reproductive: Alteration in motility and number of spermatozoa

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            Warnings

            Contraindications

            Untreated serious infections

            Documented hypersensitivity

            Varicella

            Administration 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, such as, replacement therapy)

            Cautions

            Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia

            Prolonged use associated with increased risk of infection; monitor

            Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders

            Long-term treatment associated with increased risk of osteoporosis, myopathy, delayed wound healing

            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

            Methylprednisolone is preferred in hepatic impairment because prednisone must be converted to prednisolone in liver

            Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts

            May cause impairment of mineralocorticoid secretion; administer mineralocorticoid concomitantly

            May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions

            Monitor for Kaposi sarcoma

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            Pregnancy & Lactation

            Pregnancy category: C (immediate release); D (delayed release)

            Drug may cause fetal harm and decreased birth weight; maternal corticosteroid use during first trimester increases incidence of cleft lip with or without cleft palate

            Lactation: Of maternal serum metabolites, 5-25% are found in breast milk; not recommended, or, if benefit outweighs risk, use lowest dose

            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.

            more...
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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; in physiologic doses, corticosteroids are administered to replace deficient endogenous hormones; in larger (pharmacologic) doses, they decrease inflammation

            Absorption

            Bioavailability: 92%

            Duration: Plasma, 60 min; biologic, 8-36 hr

            Peak plasma time: PO (immediate release), 2 hr; PO (delayed release), 6.0-6.5 hr

            Distribution

            Protein bound: 65-91%

            Metabolism

            Extensively metabolized in liver; hydroxylated to active metabolite; conversion can be impaired in liver disease

            Metabolite: Prednisolone (active)

            Elimination

            Half-life: 2.6-3 hr

            Dialyzable: Hemodialysis, no

            Excretion: Urine (mainly)

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            Images

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            Formulary

            FormularyPatient Discounts

            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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