Dosing & Uses
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
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
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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

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
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)
Pregnancy & Lactation
Pregnancy
Published epidemiological studies suggest a small but inconsistent increased risk of orofacial clefts with use of corticosteroids during first trimester
Infants born to pregnant women who have received corticosteroids should be carefully monitored for signs and symptoms of hypoadrenalism
Animal data
- 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 was 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, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from mother’s underlying condition
In order to minimize exposure, the lowest dose should be prescribed to a lactating women to achieve desired clinical effect
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.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
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